OBJECTIVES: To present a case of cervical vagal schwannoma and describe our experience with the clinical presentation, surgical and outcome of an elderly patient with this pathology.

METHODS:
Design: Case report
Setting: Tertiary Public Hospital
Patient: One

RESULTS: A 65-year-old lady presented with a recently enlarging, pulsatile right sided neck mass that had been asymptomatic for 15 years. Contrast CT revealed a circumscribed non-enhancing heterogenous 4 x 4 x 7 cm mass splaying the right internal jugular vein and common carotid artery. A neurogenic tumour was considered, and the mass was exercised from the vagus nerve with preservation of adjacent structures. Final histopathologic reading was schwannoma. However, the patient succumbed to complications following a second surgery for expanding hematoma.

CONCLUSION:  Schwannomas are benign, slow growing tumours that arise from Schwann cells of the nerve sheath. Cervical schwannomas originating from the vagus are rare but should be considered in patients presenting with solitary neck masses. Surgical extirpation is still the treatment of choice for nerve sheath tumours and recurrence is uncommon. Efforts should be made to preserve unaffected structures and patients should be counseled preoperatively on the possible high risk of morbidity especially in the elderly group where close follow up and aggressive rehabilitation should be instituted following surgery.