Clinicoradiological Correlation in Vagal Nerve Schwannomas with Jugular Foramen and Carotid Space Extension: A Retrospective Case Series of Four Patients

Background: Vagal nerve schwannoma is a rare benign peripheral nerve sheath tumor arising from the vagus nerve, commonly involving the carotid space and jugular foramen. Owing to its indolent growth and nonspecific clinical manifestations, diagnosis is frequently delayed. Magnetic resonance imaging (MRI), complemented by computed tomography (CT), plays a pivotal role in defining tumor origin, extent, vascular displacement, and skull-base involvement. This case series highlights the clinic-radiological correlation of vagal nerve schwannomas and emphasizes the role of imaging in diagnosis and surgical planning. Methods: A retrospective descriptive case series was conducted at Maharishi Markandeshwar Medical College, Mullana, Ambala, including four adult patients with radiologically suspected and histopathologically confirmed vagal nerve schwannomas managed during 2025. Clinical presentation, MRI and CT findings, operative details, histopathological features, and postoperative outcomes were reviewed. Particular emphasis was placed on correlating radiological characteristics with the presenting clinical manifestations. Results: The patients presented with dizziness, gait imbalance, dysphagia, and hoarseness of voice, choking episodes, and painless neck swelling. MRI consistently demonstrated well-defined enhancing lesions involving the jugular foramen and/or carotid space with characteristic displacement of the internal carotid artery and internal jugular vein, strongly suggesting a vagal nerve origin. CT accurately demonstrated jugular foramen widening and skull-base erosion in tumors with cranial extension. Clinical manifestations closely corresponded to the anatomical extent of the lesions, with medullary compression associated with neurological symptoms and carotid space lesions presenting predominantly with hoarseness or neck swelling. Complete surgical excision was achieved in all patients, and histopathological examination confirmed benign schwannoma. Postoperative outcomes were favorable, with only transient lower cranial nerve deficits in selected cases. Conclusion: This case series demonstrates a strong clinicoradiological correlation between the anatomical location, imaging characteristics, and clinical presentation of vagal nerve schwannomas. Recognition of characteristic MRI and CT findings, including jugular foramen involvement, carotid space extension, vascular displacement, and skull-base erosion—facilitates accurate preoperative diagnosis, differentiation from other skull- base lesions, and optimal surgical planning, resulting in excellent postoperative outcomes. Conclusion: Keywords: Case series; Clinicoradiological correlation; Carotid space; Jugular foramen; Magnetic resonance imaging; Peripheral nerve sheath tumor; Vagal nerve schwannoma.