Unusual Postoperative Outcomes of Vagal Nerve Lesions: A Case Series

Introduction: Vagus nerve tumors are rare entities that typically present as slowly developing lateral neck masses that are often clinically silent but may present with symptomatology. Here we discuss vagal nerve pathology with intriguing clinical presentations and postsurgical sequelae.

Methods: Retrospective case series and presentation of initial and postoperative symptoms of surgical management of vagal nerve pathology.

Results: We present a case series involving patients with vagal tumors. In particular, a 44-year-old woman presented with a lower vagal schwannoma with associated syncope and other reported various vague symptoms, such as intermittent heart racing. Enucleation of schwannoma, with preservation of the nerve, resulted in complete resolution of her symptomatology and conservation of vagal nerve function. Additionally, a 47-year-old female with chronic neurogenic cough, failing medical management with nortriptyline and Lyrica, presented for evaluation. A paraganglioma emanating off the lower vagus nerve was identified. There was no vocal cord weakness or elevated metanephrines. Intraoperative decision was made not to resect the tumor due to good vocal fold function, but rather ligation of arterial vessels to the lesion was undertaken. Postoperatively, her cough resolved and vocal fold function remained intact.

These cases are in contrast to a 74-year-old female with a large, high vagal schwannoma with significant growth. She underwent enucleation with preservation of vagal nerve and confirmed function with neuromonitoring at the completion of the resection. Surgery resulted in new onset neurogenic cough that remains recalcitrant to treatment. Use of multiple neuroleptic medication (nortriptyline and gabapentin) have not resolved her symptoms. Cough only started postoperatively.

Conclusion: These cases offer distinctive presentations of presenting and postoperative course due to vagal tumors, providing interesting insight into these rare tumors and the preoperative and postoperative considerations.