{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:44:30Z","timestamp":1792075470840,"version":"4.4.0"},"reference-count":62,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T00:00:00Z","timestamp":1684886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Clinical management of vagal schwannoma is a real diagnostic and therapeutic challenge because the medical history and clinical examination are often non-specific and vagal nerve injury following surgical resection still represents an unsolved problem. The aim of this paper is to provide a case series along with a diagnostic and therapeutic algorithm for vagal schwannoma of the head and neck, combining our experience with clinical evidence available in the literature. Materials and Methods: We retrospectively analyzed a series of patients affected by vagal schwannoma who were treated between 2000 and 2020. In addition, a review of the literature on vagal schwannoma management was conducted. Based on the cases described and the literature review, we made a diagnostic and therapeutic algorithm for the management of vagal schwannoma. Results: We were able to identify 10 patients affected by vagal schwannoma and treated between 2000 and 2020. All patients presented with a painless, mobile, slow-growing lateral neck mass with onset varying from a few months to years. The preoperative diagnostic workup included ultrasound (US) in nine cases, computed tomography (CT) with contrast in six patients and magnetic resonance imaging (MRI) of the neck in seven cases. All patients included in this study were surgically treated. Conclusions: Vagal schwannoma management represents a true challenge for clinicians and surgery is currently the most effective therapeutic strategy. A multidisciplinary approach through the collaboration of otolaryngologist with other specialists is desirable to develop a tailored treatment plan for the patient.<\/jats:p>","DOI":"10.3390\/medicina59061013","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T01:36:28Z","timestamp":1684978588000},"page":"1013","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Diagnostic and Therapeutic Strategy for Vagal Schwannoma: Case Series and Literature Review"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7174-8126","authenticated-orcid":false,"given":"Antonella","family":"Loperfido","sequence":"first","affiliation":[{"name":"Otolaryngology Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Celebrini","sequence":"additional","affiliation":[{"name":"Otolaryngology Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3368-1810","authenticated-orcid":false,"given":"Bruno","family":"Fionda","sequence":"additional","affiliation":[{"name":"U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5341-3309","authenticated-orcid":false,"given":"Gianluca","family":"Bellocchi","sequence":"additional","affiliation":[{"name":"Otolaryngology Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Cristalli","sequence":"additional","affiliation":[{"name":"Otolaryngology Unit, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1007\/s00405-011-1491-4","article-title":"Extracranial head and neck schwannomas: A study of the nerve of origin","volume":"268","author":"Liu","year":"2011","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_2","first-page":"5924","article-title":"Supraclavicular Cervical Schwannoma: A Case Report","volume":"11","author":"Mohammed","year":"2019","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1097\/00000478-199409000-00003","article-title":"Schwannoma (neurilemoma) with malignant transformation. A rare, distintive peripheral nerve tumor","volume":"18","author":"Woodruff","year":"1994","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3027","DOI":"10.1007\/s00405-013-2871-8","article-title":"Experience of head and neck extracranial schwannomas in a whole population-based single-center patient series","volume":"271","author":"Sinkkonen","year":"2014","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1002\/1097-0142(19860515)57:10<2006::AID-CNCR2820571022>3.0.CO;2-6","article-title":"Malignant peripheral nerves heath tumors: A clinicopathologic study of 120 cases","volume":"57","author":"Ducatman","year":"1986","journal-title":"Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1001\/archotol.1974.00780040395016","article-title":"Neurilemmoma of the sphenoid sinus","volume":"100","author":"Calcaterra","year":"1974","journal-title":"Arch. Otolaryngol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1258\/0022215001905058","article-title":"Head and neck schwannomas\u2014A 10 year review","volume":"114","author":"Colreavy","year":"2000","journal-title":"J. Laryngol. Otol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.3174\/ajnr.A2212","article-title":"Imaging characteristics of schwannoma of the cervical sympathetic chain: A review of 12 cases","volume":"31","author":"Anil","year":"2010","journal-title":"Am. J. Neuroradiol."},{"key":"ref_9","first-page":"33","article-title":"Cervical vagal schwannoma. A case report","volume":"29","author":"Chiofalo","year":"2009","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"908","DOI":"10.12659\/AJCR.904084","article-title":"A Rare Case of Vagus Nerve Schwannoma Presenting as a Neck Mass","volume":"18","author":"Ramdass","year":"2017","journal-title":"Am. J. Case Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4103\/2006-8808.184941","article-title":"Malignant Transformation of Vagal Nerve Schwannoma into Angiosarcoma: A Rare Event","volume":"7","author":"Agarwal","year":"2015","journal-title":"J. Surg. Tech. Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s12070-015-0925-5","article-title":"Extracranial Head and Neck Schwannomas: Our Experience","volume":"68","author":"Shrikrishna","year":"2016","journal-title":"Ind. J. Otolaryngol. Head Neck Surg."},{"key":"ref_13","first-page":"342","article-title":"An extensive cervical vagal nerve schwannoma: A case report","volume":"67","author":"Chiun","year":"2012","journal-title":"Med. J. Malays."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"141","DOI":"10.2147\/IMCRJ.S401858","article-title":"A Rare Case of Cervical Vagal Nerve Schwannoma in a 30-Year-Old Ethiopian Man","volume":"16","author":"Aregawi","year":"2023","journal-title":"Int. Med. Case Rep. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1308\/003588414X14055925058355","article-title":"Diagnosis and management of schwannomas originating from the cervical vagus nerve","volume":"97","author":"Behuria","year":"2015","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.anl.2007.01.006","article-title":"Extracranial head and neck schwannomas\u2014A 10-year review","volume":"34","author":"Biswas","year":"2007","journal-title":"Auris Nasus Larynx"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1097\/MLG.0b013e31817b0702","article-title":"Neck nerve trunks schwannomas: Clinical features and postoperative neurologic outcome","volume":"118","author":"Ramos","year":"2008","journal-title":"Laryngoscope"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/01.mlg.0000249929.60975.a7","article-title":"Extracranial head and neck schwannomas: A clinical analysis of 33 patients","volume":"117","author":"Zhang","year":"2007","journal-title":"Laryngoscope"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.bjorl.2021.05.013","article-title":"Extracranial non-vestibular head and neck schwannomas: A case series with the review of literature","volume":"88","author":"Dosemane","year":"2022","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1590\/S1516-31802007000400005","article-title":"Schwannomas in the head and neck: Retrospective analysis of 21 patients and review of the literature","volume":"125","author":"Langner","year":"2007","journal-title":"Sao Paulo Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s12070-011-0154-5","article-title":"Extra vestibular schwannoma: A two year experience","volume":"63","author":"Lahoti","year":"2011","journal-title":"Ind. J. Otolaryngol. Head Neck Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1097\/MAO.0000000000002613","article-title":"Genomics, Epigenetics, and Hearing Loss in Neurofibromatosis Type 2","volume":"41","author":"Dinh","year":"2020","journal-title":"Otol. Neurotol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Liu, B., Zhang, Y., Zhang, L., Zhang, F., Li, H., Li, S., Liu, Y., Du, J., and Zhao, L. (2017). A rare case of bilateral cervical vagal neurofibromas: Role of high-resolution ultrasound. BMC Neurol., 17.","DOI":"10.1186\/s12883-017-0806-5"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"938","DOI":"10.3349\/ymj.2010.51.6.938","article-title":"Schwannoma in head and neck: Preoperative imaging study and intracapsular enucleation for functional nerve preservation","volume":"51","author":"Kim","year":"2010","journal-title":"Yonsei Med. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1186\/s12957-015-0541-6","article-title":"A literature review on surgery for cervical vagal schwannomas","volume":"13","author":"Cavallaro","year":"2015","journal-title":"World J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1097\/01.wco.0000044763.39452.aa","article-title":"Neurofibroma and schwannoma","volume":"15","author":"Ferner","year":"2002","journal-title":"Curr. Opin. Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1259\/dmfr\/81000210","article-title":"Imaging findings of neurogenic tumours in the head and neck region","volume":"41","author":"Kami","year":"2012","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1080\/00016480260000157","article-title":"Extracranial head and neck schwannomas: A review of 8 years experience","volume":"122","author":"Leu","year":"2002","journal-title":"Acta Otolaryngol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"973045","DOI":"10.1155\/2013\/973045","article-title":"Diagnosis and management of extracranial head and neck schwannomas: A review of 27 cases","volume":"2013","author":"Yasumatsu","year":"2013","journal-title":"Int. J. Otolaryngol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s13304-010-0040-9","article-title":"Cervico-mediastinal schwannoma of the vagus nerve: Resection with intraoperative nerve monitoring","volume":"63","author":"Imperatori","year":"2011","journal-title":"Updates Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ijscr.2018.10.025","article-title":"Challenges in managing a vagal schwannomas: Lesson learnt","volume":"53","year":"2018","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/S1079-2104(03)00462-1","article-title":"Schwannoma of the mental nerve: Usefulness of preoperative imaging: A case report","volume":"97","author":"Yamazaki","year":"2004","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1148\/rg.245045001","article-title":"Schwannoma: Radiologic-pathologic correlation","volume":"24","author":"Beaman","year":"2004","journal-title":"Radiographics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"38","DOI":"10.4103\/jcis.JCIS_40_17","article-title":"Magnetic Resonance Imaging Appearance of Schwannomas from Head to Toe: A Pictorial Review","volume":"7","author":"Crist","year":"2017","journal-title":"J. Clin. Imaging Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"103475","DOI":"10.1016\/j.amsu.2022.103475","article-title":"A rare association of Vagus Nerve Schwannoma and Pheochromocytoma: A case report","volume":"76","author":"Harhar","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.cjtee.2019.07.005","article-title":"Schwannoma of the upper cervical spine\u2014A case report","volume":"22","author":"Airlangga","year":"2019","journal-title":"Chin. J. Traumatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"215","DOI":"10.4103\/2229-5178.101826","article-title":"Learning from eponyms: Jose Verocay and Verocay bodies, Antoni A and B areas, Nils Antoni and Schwannomas","volume":"3","author":"Joshi","year":"2012","journal-title":"Ind. Dermatol. Online J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2214\/AJR.10.5734","article-title":"CT and MRI evaluation of nerve sheath tumors of the cervical vagus nerve","volume":"197","author":"Anil","year":"2011","journal-title":"Am. J. Roentgenol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"rjac084","DOI":"10.1093\/jscr\/rjac084","article-title":"Challenging diagnosis of cervical vagal nerve schwannoma","volume":"2022","author":"Pankratjevaite","year":"2022","journal-title":"J. Surg. Case Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0196-0709(00)80127-1","article-title":"Ancient cervical vagal neurilemmoma: A case report","volume":"21","author":"Saydam","year":"2000","journal-title":"Am. J. Otolaryngol."},{"key":"ref_41","first-page":"915","article-title":"Parapharyngeal Space","volume":"Volume 2","author":"Som","year":"1996","journal-title":"Head and Neck Imaging"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1097\/00005537-199612000-00021","article-title":"Differentiation between schwannoma of the vagus nerve and schwannoma of the cervical sympathetic chain by imaging diagnosis","volume":"106","author":"Furukawa","year":"1996","journal-title":"Laryngoscope"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1002\/lary.22485","article-title":"Enucleation of vagal nerve schwannoma using intraoperative nerve monitoring","volume":"122","author":"Gibber","year":"2012","journal-title":"Laryngoscope"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"517","DOI":"10.4103\/CRST.CRST_149_20","article-title":"Schwannomas of the head and neck region: A report of two cases with a narrative review of the literature","volume":"3","author":"Akheel","year":"2020","journal-title":"Cancer Res. Stat. Treat."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.15537\/smj.2015.11.12314","article-title":"Extracranial non-vestibular head and neck schwannomas","volume":"36","author":"Wang","year":"2015","journal-title":"Saudi Med. J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1097\/00005537-199807000-00011","article-title":"Expected neurologic outcomes for surgical treatment of cervical neurilemmomas","volume":"108","author":"Valentino","year":"1998","journal-title":"Laryngoscope"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"75","DOI":"10.2214\/ajr.176.1.1760075","article-title":"Cross-sectional imaging of peripheral nerve sheath tumors: Characteristic signs on CT, MR imaging, and sonography","volume":"176","author":"Lin","year":"2001","journal-title":"Am. J. Roentgenol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"28760","DOI":"10.1097\/MD.0000000000028760","article-title":"Pre-operative embolization and excision of vagal schwannoma with rich vascular supply: A case report and literature review","volume":"101","author":"Xu","year":"2022","journal-title":"Medicine"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1001\/jamaoto.2016.0113","article-title":"Functional Nerve Preservation in Extracranial Head and Neck Schwannoma Surgery","volume":"142","author":"Ijichi","year":"2016","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1097\/00006123-200006000-00036","article-title":"Neurogenic tumors of the cervical vagus nerve: Report of four cases and review of the literature","volume":"46","author":"Kline","year":"2000","journal-title":"Neurosurgery"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.otohns.2004.09.062","article-title":"Surgical management of parapharyngeal space tumors: A 10-year review","volume":"132","author":"Khafif","year":"2005","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"190","DOI":"10.4103\/ijabmr.IJABMR_439_16","article-title":"\u201cCollateral Damage\u201d: Horner\u2019s Syndrome Following Excision of a Cervical Vagal schwannoma","volume":"8","author":"Kumar","year":"2018","journal-title":"Int. J. Appl. Basic Med. Res."},{"key":"ref_53","first-page":"299","article-title":"Horner\u2019s syndrome after neck surgery","volume":"63","year":"2012","journal-title":"Acta Otorrinolaringol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"867705","DOI":"10.3389\/fphys.2022.867705","article-title":"The Effects of Vagus Nerve Stimulation on Ventricular Electrophysiology and Nitric Oxide Release in the Rabbit Heart","volume":"13","author":"Allen","year":"2022","journal-title":"Front. Physiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.1007\/s00405-014-3156-6","article-title":"An algorithm for treating extracranial head and neck schwannomas","volume":"272","author":"Yafit","year":"2015","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Fionda, B., and Rembielak, A. (2022). Is There Still a Role for Radiation Therapy in the Management of Benign Conditions?. Clin. Oncol.","DOI":"10.1016\/j.clon.2022.09.051"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"149","DOI":"10.3171\/JNS\/2008\/109\/12\/S23","article-title":"Gamma Knife surgery for schwannomas originating from cranial nerves III, IV, and VI","volume":"109","author":"Kim","year":"2008","journal-title":"J. Neurosurg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"371","DOI":"10.3892\/mco.2016.922","article-title":"Hypofractionated stereotactic radiotherapy for dumbbell-shaped hypoglossal schwannomas: Two cases of long-term follow-up and a review of the literature","volume":"5","author":"Li","year":"2016","journal-title":"Mol. Clin. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"772831","DOI":"10.3389\/fonc.2021.772831","article-title":"Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery","volume":"11","author":"Eichkorn","year":"2021","journal-title":"Front. Oncol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13014-022-02057-8","article-title":"Early-onset adverse events after stereotactic radiosurgery for jugular foramen schwannoma: A mid-term follow-up single-center review of 46 cases","volume":"17","author":"Kim","year":"2022","journal-title":"Radiat. Oncol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"102412","DOI":"10.1016\/j.amsu.2021.102412","article-title":"Head and neck paragangliomas: Ten years of experience in a third health center. A cohort study","volume":"66","author":"Merzouqi","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"460.e9","DOI":"10.1016\/j.avsg.2019.09.021","article-title":"Cervical Vagal Schwannoma Causing Asymptomatic Internal Carotid Artery Compression","volume":"63","author":"Keshelava","year":"2020","journal-title":"Ann. Vasc. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/6\/1013\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:41:05Z","timestamp":1760125265000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/6\/1013"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,24]]},"references-count":62,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["medicina59061013"],"URL":"https:\/\/doi.org\/10.3390\/medicina59061013","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,24]]}}}