title: Cervico-mediastinal schwannoma of the vagus nerve: resection with intraoperative nerve monitoring.
abstract: 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.
authors.affiliation: Department of Surgical Sciences and Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy. andrea.imperatori@uninsubria.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Imperatori
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.forename: Lavinia
authors.initials: L
authors.lastname: De Monte
authors.forename: Valentina
authors.initials: V
authors.lastname: Conti
authors.forename: Nicola
authors.initials: N
authors.lastname: Rotolo
mesh_terms: D000368:Aged; D003390:Cranial Nerve Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009442:Neurilemmoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014630:Vagus Nerve