Enucleation of vagal nerve schwannoma using intraoperative nerve monitoring

Abstract

Vagal nerve schwannomas are rare, benign, neural sheath tumors. The treatment of enlarging or symptomatic vagal nerve schwannomas is surgical resection. Transecting the vagus nerve results in significant morbidity, and attempts at nerve preservation should be made whenever possible. We introduce a nerve-sparing technique using meticulous microsurgical dissection and intraoperative nerve monitoring for vagal schwannomas. A 61-year old patient presented with an enlarging 2-cm right vagal nerve schwannoma. She underwent resection via a transcervical approach. The patient was intubated with an electromyographic (EMG) endotracheal tube that allowed for monitoring of the recurrent laryngeal nerve intraoperatively. A microsurgical subcapsular dissection was performed after branches of the vagus nerve were identified using a nerve probe and preserved. At the conclusion of the resection the nerve was intact and stimulated along its entire course. Postoperatively, the patient had normal vagal nerve function. We introduced the role of intraoperative nerve monitoring using an EMG endotracheal tube for successful enucleation of vagal schwannomas. In conjunction with meticulous microsurgical dissection, nerve monitoring allows for successful preservation of the vagus nerve and decreased postoperative morbidity.