Vagal nerve schwannoma

Case contributed by Ian Bickle


Right-sided neck lump for 2 years. Increased in size of late. Wasting of the right side of the tongue, consistent with a 12th nerve palsy.

Patient Data

Age: 40 years
Gender: Female

5.6 x 3.2 cm well-defined minimally enhancing mass centered on the right carotid space and extending into the parapharyngeal space.

The mass extends inferior to the carotid bifurcation with the internal and external carotid arteries both anteriorly displaced lying on the anterior surface of the mass. The upper limit of the mass is at the jugular foramen.

No skull base or mandibular destruction, erosion or hyperostosis.

No cervical lymphadenopathy.

Comment: Right carotid space mass in keeping with biopsy-proven schwannoma. No bony destruction.


6.7 x 5.6 cm well-defined T2W and FLAIR hyperintense mass centered on the right carotid space extending from the carotid bifurcation to the skull base. The mass has displaced the ICA anteromedially and splayed the external carotid laterally. No evidence of encasement.

The lesion is isointense on T1W with intense heterogeneous enhancement.

The nasopharyngeal space is normal. Right parotid and submandibular glands are normal.

No evidence of any cervical lymphadenopathy. 

Case Discussion

This case is a large carotid space-based mass with displacement of the carotid bifurcation.

The MRI signal characteristics and enhancement pattern were most suggestive of a schwannoma.  The centering on carotid space would indicate it is vagal (CN 10) nerve-derived, however clinically the patient has a hypoglossal (CN 12) palsy.

At surgery the explanation was evident - the hypoglossal nerve was tightly stretched over the lateral aspect of the mass.

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