Atypical Presentation and Postoperative Management of Vagal Nerve Tumors.

IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Annals of Otology Rhinology and Laryngology Pub Date : 2024-12-01 Epub Date: 2024-10-06 DOI:10.1177/00034894241288416
Samuel R Shing, Maria Armache, Pablo Llerena, Mackenzie O'Connor, Kira Murphy, Joseph M Curry, Adam J Luginbuhl
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Abstract

Objectives: Tumors involving the vagus nerve are often clinically silent. We offer a case series with different clinical presentations and distinctive post-surgical sequelae that highlight some of the challenges associated with managing cervical vagal nerve tumors.

Methods: Single-institution, retrospective review of patients with tumors involving the vagus nerve. We describe clinical presentations and postoperative sequelae of five patients who underwent surgical management of vagal nerve pathology with atypical presentation or subsequent clinical course.

Results: Here, we present five patients treated at our institution for vagal tumors. In four of the five patients, the presenting symptoms resolved after surgery. Two patients presented with intractable neurogenic cough, and another two presented with autonomic symptoms, one with syncope/palpitations and the other with intractable sweating. The final patient presented with a rapidly enlarging vagal paraganglioma and developed intractable cough after resection. We present two patients with novel approach to vagal paragangliomas that underwent ligation of feeding blood supply without removing the tumor, resulting in resolution of an intractable cough in one patient and resolution of severe nighttime sweating in the other.

Conclusion: Management of tumors associated with the cervical vagus nerve that present with symptoms or rapid growth poses a clinical dilemma. Consideration of the tumor origin with either enucleation of schwannomas or ligation of feeding vessels may preserve function while addressing the presenting symptoms.

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迷走神经瘤的非典型表现和术后处理。
目的:累及迷走神经的肿瘤在临床上通常无症状。我们提供了一系列具有不同临床表现和独特手术后遗症的病例,这些病例凸显了治疗颈迷走神经肿瘤所面临的一些挑战:方法:单一机构对迷走神经肿瘤患者进行回顾性研究。我们描述了五名接受手术治疗的迷走神经病变患者的临床表现和术后后遗症,这些患者的临床表现或后续临床过程均不典型:结果:我们在此介绍了五名在我院接受治疗的迷走神经肿瘤患者。在这五名患者中,有四名患者的症状在手术后得到缓解。两名患者表现为顽固性神经源性咳嗽,另外两名患者表现为自主神经症状,其中一名患者伴有晕厥/心悸,另一名患者伴有顽固性出汗。最后一名患者的迷走神经旁管瘤迅速增大,切除后出现了顽固性咳嗽。我们介绍了两名采用新方法治疗迷走神经旁神经节瘤的患者,他们在不切除肿瘤的情况下结扎了肿瘤的供血,结果一名患者的顽固性咳嗽得到了缓解,另一名患者的夜间严重出汗症状得到了缓解:结论:对于伴有症状或生长迅速的颈迷走神经相关肿瘤的治疗是一个临床难题。考虑到肿瘤的来源,对裂隙瘤进行去核或结扎供养血管,可在保留功能的同时解决出现的症状。
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来源期刊
CiteScore
3.10
自引率
7.10%
发文量
171
审稿时长
4-8 weeks
期刊介绍: The Annals of Otology, Rhinology & Laryngology publishes original manuscripts of clinical and research importance in otolaryngology–head and neck medicine and surgery, otology, neurotology, bronchoesophagology, laryngology, rhinology, head and neck oncology and surgery, plastic and reconstructive surgery, pediatric otolaryngology, audiology, and speech pathology. In-depth studies (supplements), papers of historical interest, and reviews of computer software and applications in otolaryngology are also published, as well as imaging, pathology, and clinicopathology studies, book reviews, and letters to the editor. AOR is the official journal of the American Broncho-Esophagological Association.
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