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Program Number: B130
Session Name: Poster Session

Comparative Outcomes of Intracapsular Enucleation vs. Extracapsular Resection in the Management of Cervical Vagal Schwannomas: A Systematic Review and Meta-Analysis

Valentina Montanez-Azcarate, MD¹; Brett Campbell, MD¹; Alexa Kacin, MD¹; Agustin Posso, MD¹; Daniela Mendoza-Millan, MD¹; Carolina Cotes Jambooz, MD²; Scharukh Jalisi, MD, MBA¹; ¹Beth Israel Deaconess Medical Center; ²NA

Introduction: Cervical vagal nerve schwannomas are rare, slow-growing tumors. Surgical resection is the preferred management approach, with two primary techniques usually used. Intracapsular enucleation aims to preserve the vagal nerve but may carry a higher risk of recurrence, and extracapsular resection seeks to achieve complete tumor removal but often involves vagal nerve sacrifice, leading to complications like ipsilateral vocal cord paralysis and dysphagia. Given the rarity of cervical vagal schwannomas, data on treatment outcomes is limited. The role of intracapsular enucleation remains controversial as balancing nerve preservation against recurrence risk poses a significant clinical dilemma. This review aims to inform surgical decision-making by analyzing outcomes associated with each technique, focusing on vocal cord paralysis, dysphagia, and recurrence rates.

Methodology: A systematic review was performed according to PRISMA guidelines. A web search of the Cochrane Central Register of Controlled Trials (Cochrane Library), EMBASE (Elsevier), Medline (PubMed), and Web of Science – Core Collection (Clarivate) databases was conducted to identify studies published up to September 2024.  We included studies with adult patients diagnosed with cervical schwannoma, where the type of resection was specified, the vagal nerve was confirmed as the nerve of origin, and at least one postoperative complication was assessed (vocal cord paralysis, dysphagia, or recurrence). Given this condition’s rarity, we included case reports and case series. Statistical analyses were performed using RStudio, with heterogeneity assessed through I² statistics.

Results: The initial search identified 2,881 articles; after removing 37 duplicates, 2,844 studies were screened by title and abstract. Based on inclusion and exclusion criteria, 2,690 studies were excluded, leaving 150 articles for full-text review. Of these, 35 observational studies were included in the qualitative analysis, with 3 studies qualifying for quantitative analysis. Altogether, the studies reported on 162 patients with cervical vagal schwannomas treated with either intracapsular enucleation (102, 62.96%) or extracapsular resection (60, 37.04%). Recurrence was noted in 3 cases following intracapsular enucleation. The quantitative analysis included 49 patients from 3 studies. Among these, 29 patients (59.1%) underwent intracapsular enucleation, which was associated with significantly fewer cases of postoperative vocal cord paralysis (OR 0.05; 95% CI 0.01–0.24; p < 0.001; I² = 0%). Dysphagia and recurrence outcomes could not be assessed in the meta-analysis due to insufficient reporting in the included studies.

Conclusion: Intracapsular enucleation is less likely to result in postoperative vocal cord paralysis. The true recurrence risk after intracapsular enucleation of cervical vagal schwannomas is unclear due to limited data, but evidence suggests it is low. Surgeons considering extracapsular resection should carefully weigh the risks of this technique against the potentially insignificant improvement in recurrence rate. This systematic review and meta-analysis were registered on PROSPERO (ID: CRD42024568672).

 

 

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