Vagal schwannoma mimicking carotid body tumour treated by intracapsular excision: a case report

Abstract

Vagal schwannomas are rare benign neurogenic tumours of the head and neck that may closely mimic carotid body tumours (CBTs) on clinical and radiological evaluation. Differentiating the two entities is essential to optimize surgical planning, preserve neural function, and prevent unnecessary morbidity. We present the case of a 23-year-old female with a slowly enlarging, non-pulsatile left neck swelling in the carotid triangle. Clinical examination and magnetic resonance imaging (MRI) suggested a carotid space lesion displacing the common carotid artery anteromedially and internal jugular vein posterolaterally. Preoperative biochemical screening for catecholamine excess was negative. The lesion was excised via a transcervical approach using intracapsular enucleation, with careful preservation of vagal nerve fibres. Intraoperative findings confirmed an encapsulated spindle-shaped tumour arising from the vagus nerve. Histopathology revealed Antoni A and Antoni B areas with Verocay bodies, strongly positive for S-100 protein, consistent with schwannoma. Postoperative recovery was uneventful, with preserved vocal cord mobility and no features of Horner’s syndrome. At 12-month follow-up, the patient remained asymptomatic with no evidence of recurrence. This case highlights the diagnostic challenge of differentiating vagal schwannomas from CBTs. MRI vascular displacement patterns-anteromedial displacement of the carotid artery and posterolateral displacement of the IJV-are key imaging clues. Intracapsular excision offers the advantage of neural preservation with low recurrence risk when combined with meticulous dissection and long-term follow-up.