Eugene N. Myers, MD International Editor: Intracapsular Enucleation of Vagus Nerve-originated Tumors for Preservation of Neural Function

Tumors arising from the cervical vagus nerve are relatively rare. Most of them are neurilemmomas, neurofibromas, and paragangliomas. In the management of neurilemmomas, because they are benign and encapsulated, intracapsular enucleation is often performed in an effort to preserve function of the nerve.1 In previous reports, however, postoperative nerve palsy frequently occurred, and in some cases the nerve function did not recover. On the other hand, there have been few attempts to preserve nerve function in the resection of neurofibromas.1 In this report, we performed intracapsular enucleation for 2 vagal tumors: neurilemmoma and neurofibroma. In both cases tumors were completely excised with nerve fibers preserved. In the first case, postoperative palsy did not occur. In the second case transient incomplete vocal cord palsy was observed, but the cord recovered in 6 months. During the ablation of tumors, we monitored nerve function using a nerve stimulator and avoided damaging nerve fibers as much as possible. This procedure may have helped us to preserve nerve function in the resection of not only a neurilemmoma but also a neurofibroma.