Background: Schwannomas originating from the ansa cervicalis represent an exceptionally infrequent occurrence. To date, less than 5 cases have been reported in the English literature. We present a multimedia case report of an ansa cervicalis schwannoma, accompanied by a surgical video, in a patient whose initial clinical assessment suggested potential thyroid pathology. Case Presentation: A 51-year-old woman was referred to the otolaryngology department following an incidental finding of a thyroid nodule on a head and neck CT scan. Imaging revealed the presence of two lesions: a TIRADS 3 left thyroid nodule, and a benign tumor originating from the peripheral nerve sheath of the ansa cervicalis, located adjacent to the right thyroid lobe. Intraoperatively, the second lesion was discovered to originate from a branch of the superior root of the ansa cervicalis. Subsequent histopathological analysis confirmed the diagnosis of a schwannoma. Conclusion: Schwannomas originating from the ansa cervicalis pose a diagnostic challenge, often susceptible to misinterpretation and confusion with other lesions. This case report highlights radiological and surgical techniques that can be used to identify the origin of these tumors, both preoperatively and intraoperatively.

Keywords: Keywords: Schwannoma, ansa cervicalis, ansa hypoglossi, descending hypoglossal ramus, neuroma, case report.