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

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.