Nerve-sparing resection of cervical vagal schwannoma with complete functional recovery: a case report

Vagal schwannomas are rare benign neoplasms arising from the Schwann cells of the vagus nerve, representing 2%-5% of all peripheral nerve tumors and ~10% of head and neck schwannomas. They typically present as slow-growing, asymptomatic lateral neck masses and pose significant diagnostic and surgical challenges due to their proximity to critical neurovascular structures. We report a case of a 28-year-old Asian male who presented with a right-sided neck swelling. Imaging workup including ultrasound, magnetic resonance imaging, and computed tomography angiography identified a well-defined mass in the right carotid space at the level of C4-C5, displacing adjacent vascular structures. The tumor was surgically excised en bloc via a lateral transverse approach with full preservation of vagal nerve function, confirmed by intraoperative nerve monitoring. Histopathology confirmed the diagnosis of vagal schwannoma. This case highlights the importance of a multidisciplinary approach, thorough preoperative imaging, and meticulous intraoperative technique in achieving complete resection with minimal morbidity.