Diagnostic challenges of cervical vagal schwannoma: A case report and brief review of the literature

Cervical vagal schwannoma (CVS) is a rare benign tumor that may mimic other neck masses, particularly paragangliomas. Due to overlapping imaging features and a deep anatomical location, they are often misdiagnosed preoperatively. The present case report describes an uncommon case of CVS successfully treated with vagus nerve‑preserving resection, demonstrating a full post‑operative recovery without complications. A 26‑year‑old woman presented with a painless left neck mass following a flu‑like illness. An examination revealed a firm, non‑tender, laterally mobile lesion without lymphadenopathy or neurological deficits. Ultrasonography and magnetic resonance imaging suggested a paraganglioma due to vascular displacement and carotid bifurcation splaying. She underwent surgical excision, during which the mass was identified as arising from the vagus nerve and was removed with the preservation of nerve integrity. Histopathological analysis confirmed schwannoma. Post‑operative recovery was uneventful, with no neurological complications or recurrence observed during follow‑up. In addition, a review of eight published cases of cervical vagal nerve schwannoma revealed that the age of the patients involved ranged from 13‑42 years and the tumors measured 4‑13 cm, predominantly arising from the right vagus nerve. Diagnosis was mainly established using an ultrasonography, computed tomography scan, fine needle aspiration cytology and magnetic resonance imaging. Surgical excision was the primary mode of treatment, with nerve preservation achieved in the majority of cases with overall favorable outcomes. Although transient complications, such as hoarseness and dysphonia were reported, recurrence was rare, supporting surgery as an effective management strategy. CVS is a rare diagnostic challenge that often mimics other carotid‑space lesions. Definitive diagnosis and nerve‑preserving excision can result in an uncomplicated recovery with full functional preservation.