Overview and Facts about Vagal Schwannoma
Vagal schwannoma is an extremely rare, benign tumor that arises from the vagus nerve—the longest cranial nerve that originates in the brain stem and extends down through the neck and into the chest and abdomen.
This nerve controls involuntary processes such as the muscles of the throat and the voice box. Schwannomas are tumors originating from the Schwann cells of the nerve sheath—the insulating layer that forms around nerve fibers and allows electrical impulses to transmit quickly and efficiently along the nerve cells.
Approximately one-third of schwannomas occur in the head and neck region.
Symptoms and Signs of Vagal Schwannoma
The primary sign of a vagal schwannoma is neck swelling or a slow-growing neck mass that is typically painless and firm. Masses usually grow slow at a rate of approximately 2.5 millimeters to 3 millimeters per year. Occasionally they will grow more rapidly.
Hoarseness and cough, especially when the mass is pressed, are other common signs. As the mass increases, difficulty swallowing (dysphagia) and difficulty breathing may occur.
Tests and Diagnosis of Vagal Schwannoma
Computed tomography (CT) scans and magnetic resonance imaging (MRI) are the imaging studies used for diagnosing these tumors.
MRI, in particular, provides information on the size and location of the tumor as well as the surrounding structures. This information is useful in planning optimal surgical treatment.
Causes and Risk Factors of Vagal Schwannoma
Vagal schwannomas typically occur in patients between 30 and 60 years of age but can be found at any age.
The exact cause of these rare tumors is unknown. Researchers are investigating if underlying genetic disorders may play a role.
Treatment and Care for Vagal Schwannoma
Surgical removal, performed by a specialist in otolaryngology (ENT), is the primary treatment for vagal schwannoma. The surgical approach taken will depend on the tumor size and location.
Surgery should be carefully weighed between the risks and benefits due to the proximity of the tumor to the vagus nerve and vessels of the neck.
Resection of these tumors can cause postoperative complications such as hoarseness and paralysis of the vocal cord muscles. Vocal cord paralysis can affect one’s ability to speak and even breathe.
Other treatment options include observation with several imaging or potentially radiation therapy. Growing evidence shows that a procedure known as intracapsular enucleation effectively removes the tumor while preserving nerve function.
This nerve-sparing technique uses meticulous microsurgical dissection and intraoperative nerve monitoring. When successfully removed, recurrence of vagal schwannomas is rare.
