TY - JOUR
T1 - Cervico-mediastinal schwannoma of the vagus nerve
T2 - Resection with intraoperative nerve monitoring
AU - Imperatori, Andrea
AU - Dionigi, Gianlorenzo
AU - De Monte, Lavinia
AU - Conti, Valentina
AU - Rotolo, Nicola
PY - 2011
Y1 - 2011
N2 - 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 9 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.
AB - 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 9 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.
KW - Cervical-mediastinal
KW - Intraoperative nerve monitoring
KW - Recurrent laryngeal nerve
KW - Schwannoma
KW - Vagus nerve
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U2 - 10.1007/s13304-010-0040-9
DO - 10.1007/s13304-010-0040-9
M3 - Article
C2 - 21210273
AN - SCOPUS:84855554489
VL - 63
SP - 59
EP - 61
JO - Updates in Surgery
JF - Updates in Surgery
SN - 2038-131X
IS - 1
ER -