Introduction
Vagal schwannomas are rare peripheral nerve sheath tumors arising from
the vagus nerve.1 Typically diagnosed in adulthood at
a median age of 44 years,2 pediatric vagal schwannomas
are exceedingly uncommon. Tumors may arise intracranially or
extracranially, with the parapharyngeal space being the most common
extracranial site in the head and neck.3
Surgical resection remains the treatment of choice for vagal
schwannomas. Described operative techniques include gross total
resection or intracapsular enucleation. However, the merits of either
approach are dependent on the lesion size, location and baseline nerve
function.
We describe herein an unusual case of a young girl presenting with a
large vagal schwannoma with an associated hypoglossal nerve palsy
necessitating a combined transcervical-mandibulotomy approach for total
tumor resection. The presentation is unique due to the size of the
lesion, the patient’s age, the operative approach required, as well as
the paralysis of a cranial nerve that was not its nerve of origin.