Pre-operative embolization and excision of vagal schwannoma with rich vascular supply: A case report and literature review

RATIONALE: Schwannomas are benign tumors wrapped in the nerve sheath and can originate from the myelin sheath of the cranial nerve. In previous literature reports, most of the tumors were solid tumors, which can be removed only by surgery. This case report describes a unique case of vagal schwannoma, which, unlike previous cases, involves a dominant arterial supply, and discusses the pre-operative evaluation, relevant radiographic findings, and surgical process of the case in detail. PATIENT CONCERNS: A 31-year-old woman sought treatment for pain in the left side of the neck when turning her head. A mass on the left side of the neck was found on enhanced computed tomography with a maximum diameter of 6.8 cm, along with multiple tortuous, thickened vascular shadows, and pressure on the left pharyngeal cavity. DIAGNOSIS: The pathological results showed schwannoma. INTERVENTIONS: Considering the unusual size of the tumor and thickened blood vessels revealed by pre-operative computed tomography, general anesthesia and biopsy were conducted first to confirm the diagnosis. Excessive bleeding occurred during the process; thus, the tumor was only partially removed before the wound closed after hemostasis. Digital subtraction angiography indicated that the tumor was supplied by multiple arteries, and the tumor was removed by pre-operative embolization plus intra-operative removal. OUTCOMES: Combined with embolization and surgical resection, the tumor was completely removed, the nerve was partially preserved, and the patient had postoperative hoarseness. LESSON: The present case indicates the possibility of vascularly supplied vagal schwannoma; thus, it is necessary to conduct pre-operative digital subtraction angiography.