Surgical Considerations in Management of Cervical Vagal Schwannomas: A Systematic Review and Meta-Analysis.

Abstract

The choice between intracapsular enucleation (IE) versus extracapsular resection (ER) for cervical vagal schwannomas remains controversial due to the challenge of preserving nerve function while minimizing recurrence risk. A systematic review and meta-analysis were conducted using Cochrane Central, EMBASE, Medline, and Web of Science. Studies were included if they reported (1) patients with cervical schwannomas, (2) resection type, (3) confirmed vagal nerve origin, and (4) at least one postoperative complication (vocal cord paralysis [VCP], dysphagia, recurrence). Of 2881 articles, 35 were included in qualitative analysis and 15 in quantitative analysis. IE was associated with significantly fewer cases of postoperative VCP (OR: 0.05; 95% CI: 0.01-0.24). IE had a prevalence of postoperative VCP of 0.39 (95% CI [0.17, 0.63]) versus 0.90 (95% CI [0.60, 1.00]) for ER. Recurrence occurred in three IE cases. IE is less likely than ER to result in postoperative VCP. Recurrence risk after IE appears low.