Surgical management of parapharyngeal vagal schwannomas: a systematic review and practical considerations for approach selection.

Abstract

Objective: Vagal schwannomas of the parapharyngeal space are rare benign tumours and the optimal surgical approach remains debated. This study aimed to identify clinical and tumour-related factors associated with different surgical strategies.

Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses ('PRISMA') 2020 guidelines. Studies published between January 1997 and March 2026 were identified, and analyses were restricted to surgically treated patients.

Results: Twenty-five studies including 87 patients were analysed. The transcervical approach was most frequently used, followed by transoral and combined approaches. Tumour size was not associated with surgical approach selection. Pre-operative hoarseness and oropharyngeal bulging were more common in transoral cases, whereas cervical mass predominated in transcervical and combined approaches. Overall, complications were infrequent and recurrence was rare.

Conclusion: Selection of the surgical approach appeared to be influenced by anatomical considerations rather than tumour size. These findings describe contemporary surgical decision-making patterns without demonstrating superiority between approaches.