Introduction: Vagal nerve schwannomas are rare types of schwannomas. Majority of these tumors present
as masses in the neck. Intracranial vagal nerve schwannomas are even rare.
Materials and Methods: A retrospective analysis was performed, and a single case of intracranial vagal nerve
schwannoma was identified.
Results: Patient was a 33-year-old female, single mother of 5 years. She presented with dizziness
and gait imbalance. She was diagnosed with a large posterior fossa mass extending
into the jugular foramen displacing internal carotid artery and jugular vein, anteriorly
and posteriorly, respectively. There was significant mass effect from posterior fossa
mass. Surgical options including retrosigmoid craniotomy alone with posterior mass
resection versus more aggressive petrooccipital transsigmoid (POTS) approach to attempt
gross total resection. Her vocal cord analysis and swallow study was normal. After
lengthy discussion with the patient and her current social situation, it was decided
to proceed with retrosigmoid craniotomy with endoscopic assistance. Posterior fossa
tumor was resected which was extending up to tentorium. Using 30-degree endoscope
tumor was chased into the jugular foramen up to carotid artery. She tolerated the
procedure well with mild facial nerve weakness (HB II). She was evaluated by physical
therapy and discharged home on post-operative day 2. On follow-up appointment in 6
weeks, her facial weakness had improved to HB I. She is being closely monitored for
tumor progression.
Conclusion: Patients with intact cranial nerves present a challenge in decision making. Patient’s
young age puts her at greater risk for tumor recurrence. At the same time, a single
mother of 5 kids, youngest being 5 years old, presents another challenge. Aggressive
resection carries a significant complication risk which could prevent the patient
from taking care of her young kids. Our plan is to proceed with radiation and closely
monitor cranial nerve function. If the tumor progresses after radiation treatment,
considering her young, we will proceed with more aggressive surgical resection. As
for now, she remains asymptomatic.
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