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Cervico-mediastinal schwannoma of the vagus nerve: resection with intraoperative nerve monitoring

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Schwannomas are usually benign, single, encapsulated, slow-growing tumours originating from cranial or spinal nerve sheaths. The vagus nerve involvement at the mediastinal inlet is very uncommon. For anatomical reasons, the resection of cervical and mediastinal schwannoma of the vagus nerve has a high risk of vocal fold paralysis. We describe the case of a 67-year-old female with a cervico-mediastinal schwannoma of the vagus nerve that we removed using the intraoperative neuromonitoring technique. The patient presented with mild hoarseness and complained of discomfort behind the jugular notch. Neck and chest computerized tomography described a 35 × 30 mm solid lesion behind the left clavi-sternal junction; preoperative fine needle aspiration cytology revealed schwannoma. Resection of the mass was performed with a cervical approach and the vagus nerve tumour was completely removed under continuous neuromonitoring (NIM-3® System), preserving the vagus and the recurrent laryngeal nerve function. Pathology on the resected mass documented A-type schwannoma with “ancient schwannoma” areas. The intraoperative neurostimulation and neuromonitoring approach for the resection of vagus schwannoma are recommended because it may reduce the risk of injury to the vagus and to the recurrent laryngeal nerve.

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  1. Conley JJ (1955) Neurogenic tumors in the neck. AMA Arch Otolaryngol 61:167–180

    PubMed  CAS  Google Scholar 

  2. Mevio E, Gorini E, Sbrocca M, Artesi L, Mullace M, Castelli A, Migliorini L (2003) Unusual cases of cervical nerves schwannomas: phrenic and vagus nerve involvement. Auris Nasus Larynx 30:209–213. doi:10.1016/S0385-8146(03)00005-1

    Article  PubMed  Google Scholar 

  3. Weiss SW (1994) Hystological typing of soft tissue tumours. WHO official web site. Accessed 4 Nov 2010

  4. Maebeya S, Miyoshi S, Fujiwara K, Sekii H, Suzuma T, Yosimasu T, Naito Y, Nishino E (1993) Malignant schwannoma of the intrathoracic vagus nerve: report of a case. Surg Today 23:1078–1080

    Article  PubMed  CAS  Google Scholar 

  5. Fujino K, Shinohara K, Aoki M, Hashimoto K, Omori K (2000) Intracapsular enucleation of vagus nerve-originated tumors for preservation of neural function. Otolaryngol Head Neck Surg 123:334–336

    Article  PubMed  CAS  Google Scholar 

  6. Barczyński M, Konturek A, Cichoń S (2009) Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 96:240–246. doi:10.1002/bjs.6417

    Article  PubMed  Google Scholar 

  7. Dionigi G, Boni L, Rovera F, Bacuzzi A, Dionigi R (2009) Neuromonitoring and video-assisted thyroidectomy: a prospective, randomized case-control evaluation. Surg Endosc 23:996–1003. doi:10.1007/s00464-008-0098-3

    Article  PubMed  Google Scholar 

  8. Fukai I, Masaoka A, Yamakawa Y, Niwa H, Eimoto T (1995) Mediastinal malignant epithelioid schwannoma. Chest 108:574–575. doi:10.1378/chest.108.2.574

    Article  PubMed  CAS  Google Scholar 

  9. Shoji F, Maruyama R, Okamoto T, Wataya H, Nishiyama K, Ichinose Y (2005) Malignant schwannoma of the upper mediastinum originating from the vagus nerve. World J Surg Oncol 3:65–68. doi:10.1186/1477-7819-3-65

    Article  PubMed  Google Scholar 

  10. Nakano CG, Massarollo LC, Volpi EM, Barbosa Junior JG, Arias V, Ueda RY (2008) Ancient schwannoma of the vagus nerve, resection with continuous monitoring of the inferior laryngeal nerve. Br J Otorhinolaryngol 74:316. doi:10.1590/S0034-72992008000200027

    Google Scholar 

  11. Colreavy MP, Lacy PD, Hughes J, Bouchier-Hayes D, Brennan P, O’Dwyer AJ, Donnelly MJ, Gaffney R, Maguire A, O’Dwyer TP, Timon CV, Walsh MA (2000) Head and neck schwannomas–a 10-year review. J Laryngol Otol 114:119–124

    Article  PubMed  CAS  Google Scholar 

  12. Chiofalo MG, Longo F, Marone U, Franco R, Petrillo A, Pezzullo L (2009) Cervical vagal schwannoma. A case report. Acta Otorhinolaryngol Ital 29:33–35

    PubMed  CAS  Google Scholar 

  13. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A, German IONM Study Group (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32:1358–1366. doi:10.1007/s00268-008-9483-2

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Andrea Imperatori.

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Imperatori, A., Dionigi, G., De Monte, L. et al. Cervico-mediastinal schwannoma of the vagus nerve: resection with intraoperative nerve monitoring. Updates Surg 63, 59–61 (2011).

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