====== Vagus Nerve Schwannoma case reports ====== ===== 2019 ===== One patient with cervical schwannoma causing internal carotid artery (ICA) compression. The patient underwent en bloc excision via a transcervical approach under general anesthesia. Pathological examination demonstrated the diagnosis of schwannoma. This case shows that VNS can cause ICA compression and therefore brain ischemia ((Keshelava G, Robakidze Z. Cervical Vagal Schwannoma Causing Asymptomatic Internal Carotid Artery Compression. Ann Vasc Surg. 2019 Oct 17. pii: S0890-5096(19)30859-3. doi: 10.1016/j.avsg.2019.09.021. [Epub ahead of print] PubMed PMID: 31629844. )). ---- In a case report, vagal sensory fibers were mapped and continuously monitored intraoperatively during high vagus schwannoma resection using the laryngeal adductor reflex (LAR). Mapping of nerve fibers on the schwannoma surface enabled identification of sensory fibers. Continuous LAR monitoring during schwannoma subcapsular microsurgical dissection enabled sensory (and motor) vagal fibers to be monitored in real-time with excellent postoperative functional outcomes ((Sinclair CF, Téllez MJ, Sánchez Roldán MA, Urken M, Ulkatan S. Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection. Laryngoscope. 2019 Dec;129(12):E434-E436. doi: 10.1002/lary.28147. Epub 2019 Jun 18. PubMed PMID: 31211430. )). ---- Schwam et al. reported a purely intracranial vagal schwannoma ((Schwam ZG, Kaul VZ, Shrivastava R, Wanna GB. Purely intracranial vagal schwannoma: A case report of a rare lesion. Am J Otolaryngol. 2019 May - Jun;40(3):443-444. doi: 10.1016/j.amjoto.2019.02.011. Epub 2019 Feb 18. PubMed PMID: 30799212. )). ==== 2018 ==== A 60-year-old female patient was seen at our service for a slow-growing, 9 × 6 cm left-sided cystic neck mass. Preoperative clinical and computed tomography evaluation suggested a diagnosis of a lateral neck cyst. The surgical exploration through the lateral cervicotomy revealed a large cystic mass and clearly identified that the tumor was originating from the left vagal nerve. The histopathologic analysis confirmed the diagnosis of schwannoma. Although uncommon, vagal schwannoma with pronounced cystic component should be included in the differential diagnosis of the cystic neck swellings ((Cukic O, Jovanovic MB. Vagus Nerve Schwannoma Mimicking a Lateral Neck Cyst. J Craniofac Surg. 2018 Nov;29(8):e827-e828. doi: 10.1097/SCS.0000000000005006. PubMed PMID: 30320693. )). ---- A 55-year-old woman who presented to the clinic complaining of throat irritation and feeling of something stuck in her throat for the past three months. On examination, a bulging left parapharyngeal mass was noted, displacing the left tonsil and uvula medially. A contrast-enhanced computed tomography (CT) scan of the neck showed a large, hypervascular soft tissue mass with splaying of the left internal carotid artery. Intraoperatively, the tumor was found to be arising from the vagus nerve. Macroscopic surgical pathology examination showed a tan-red, ovoid, and firm mass. Histopathology showed a benign spindle cell tumor with Antoni A areas with palisading cell nuclei and some degenerative change, confirming the diagnosis of vagus nerve schwannoma. CONCLUSIONS Vagus nerve schwannomas should be distinguished from other tumors that arise in the neck before planning surgery, to minimize the risk of nerve injury. Physicians need to be aware of the differential diagnosis of a neck mass, investigations required, the surgical treatment and the potential postoperative complications ((Ramdass AA, Yao M, Natarajan S, Bakshi PK. A Rare Case of Vagus Nerve Schwannoma Presenting as a Neck Mass. Am J Case Rep. 2017 Aug 21;18:908-911. PubMed PMID: 28824161; PubMed Central PMCID: PMC5574523. )). ---- Sreevatsa et al. described three cases of schwannoma involving the vagus who presented differently to our unit during past 5 years ((Sreevatsa MR, Srinivasarao RV. Three cases of vagal nerve schwannoma and review of literature. Indian J Otolaryngol Head Neck Surg. 2011 Oct;63(4):310-2. Epub 2011 Apr 8. PubMed PMID: 23024932; PubMed Central PMCID: PMC3227827. )). ---- A large vagal neurilemmoma in a 33-year-old man is reported. He complained of slowly progressive palsy of the tongue on the left side. Weakness of soft palate movement was also noted. Magnetic resonance imaging (MRI) revealed a tumour in the left parapharyngeal space with partial extension to the posterior cranial fossa through the jugular foramen. Carotid angiography revealed avascularity of the tumour and anterior shift of the left internal carotid artery. The venous phase showed no blood flow in the internal jugular vein. The tumour was successfully extirpated via a transmandibular transpterygoid approach. Although vagus nerve dysfunction was not observed pre-operatively, the tumour was identified as a neurilemmoma arising from the vagus nerve. The surgical approach should be selected according to the lesion in individual patients. Since neurilemmoma is benign in nature, minimal post-operative sequelae should be expected ((Yumoto E, Nakamura K, Mori T, Yanagihara N. Parapharyngeal vagal neurilemmoma extending to the jugular foramen. J Laryngol Otol. 1996 May;110(5):485-9. PubMed PMID: 8762326. )).