Published: 2021-07-23

A rare lesion of the wanderer’s nerve with an unusual postoperative complication: vagal nerve schwanomma

Jagnnatha B., Pandu Dasappa, Suhasini Hanumaiah, Arunima Sheeja


Vagal nerve schwannomas are rare parapharyngeal tumours which was first described by Figi in 1933. Hoarseness is the most common symptom. Occasionally, a paroxysmal cough may be produced on palpating the mass. This is a clinical sign, unique to vagal schwannoma. Presence of this sign, along with a mass located on the medial border of the sternocleidomastoid muscle, should make clinicians suspicious of vagal nerve sheath tumours. However, in our case, the patient presented to us with a swelling in the neck and no other symptoms. MRI in the pre-operative work-up is helpful in defining diagnosis and in evaluating the extent and the relationship. A careful intracapsular enucleation with nerve-sparing technique remains the treatment of choice in order to avoid nerve injury which can lead to vocal cord paralysis. Horner’s syndrome following cervical surgeries is a rare phenomenon. Its occurrence following excision of a vagal schwannoma can occur due to direct injury to cervical sympathetic chain during excision or indirect injury due to traction on the sympathetic chain. Here is a case report of a patient diagnosed with left vagal scwanomma who developed horner’s syndrome post operatively.


Vagal nerve schwanomma, Cervical sympathetic chain, Horner’s syndrome

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Biswas D, Marnane CN, Mal R, Baldwin D. Extracranial head and neck schwannomas - a 10-year review. Auris Nasus Larynx. 2007;34:353-9.

Chang SC, Schi YM. Neurilemmoma of the vagus nerve: A case report and brief literature review. Laryngoscope. 1984;94:946-9.

Sreevatsa MR, Srinivasarao RV. Three cases of vagal nerve schwannoma and review of literature. Indian J Otolaryngol Head Neck Surg. 2011;63(4):310-2.

Ramdass AA, Yao M, Natarajan S. A Rare Case of Vagus Nerve Schwannoma Presenting as a Neck Mass. Am J Case Rep. 2017;18:908-11.

Vijendra SS, Rao RA, Prasad V. Niprupama M. A giant vagal schwannoma with unusual extension from skull base to the mediastinum. J Can Res Ther. 2015;11:970-3

Langner E, Del Negro A, Akashi HK, Akashi HK, Costa Araùjo PP, Tincani AJ, et al. Schwannomas in the head and neck: retrospectives analysis of 21 patients and review of the literature. Sao Paulo Med J. 2007;125:220-2.

Lahoti BK, Kaushal M, Garge S, Aggarwal G. Extra vestibular schwannoma: a two year experience.Indian J Otolaryngol Head Neck Surg. 2011;63:305-9.

Gibber MJ, Zevallos JP, Urken ML. Enucleation of vagal nerve schwannoma using intraoperative nerve monitoring. Laryngoscope. 2012;122:790-2.

Noh SH, Zhang HY. Hoarseness after Section of a Cervical Vagus Nerve Schwannoma. The nerve. 2017; 3(1):18-20.

Figi FA. Solitary neurofibroma of the pharynx. Arch Otolaryngol. 1933;17:386-9.

Colreavy MP, Lacy PD, Hughes J, Bouchier-Hayes D, Brennan P, O’Dwyer AJ, et al. Head and neck schwannomas – a 10-year review. J Laryngol Otol. 2000;114:119-24.

Saito DM, Glastonbury CM, El-Sayed I, Eisele DW. Parapharyngeal space schwannomas. Preoperative imaging determination of the nerve of origin. Arch Otolaryngol Head Neck Surg. 2007;133:662-7.

Furukawa M, Furukawa MK, Katoh K, Tsukuda M. Differentiation between schwannoma of the vagus nerve and schwannoma of the cervical sympathetic chain by imaging diagnosis. Laryngoscope. 1996;106:1548-52.

Murley RS. A case of neurinoma of the vagus nerve in the neck. Br J Surg. 1948;36:101-3.

Gonzalez‑Aguado R, Morales‑Angulo C, Obeso‑ Aguera S, Longarela‑Herrero Y, Garcia‑Zornoza R, Acle Cervera L, et al. Horner’s syndrome after neck surgery. Acta Otorrinolaringol Esp. 2012;63:299‑302.