Cervical sympathetic chain schwannomas (CSCS) are rare benign carotid space tumors that are often difficult to diagnose preoperatively because of their deep location and proximity to major vessels. We retrospectively reviewed five patients with histologically confirmed CSCS treated at a tertiary referral center between 2016 and 2024. Inclusion criteria were histopathological confirmation, preoperative magnetic resonance imaging (MRI), surgical treatment at our institution, and at least 12 months of follow-up. Patients without histological confirmation, complete MRI evaluation, treatment at our institution, or adequate follow-up were excluded. Three patients showed the classic MRI pattern of anterior displacement of the carotid artery and internal jugular vein without separation, whereas two showed atypical vascular displacement. Complete excision was achieved in all cases. One patient developed permanent Horner’s syndrome. No recurrences were observed after 12–108 months of follow-up. CSCS should be considered in carotid space masses with vessel displacement on MRI. Awareness of both typical and atypical imaging patterns may improve diagnosis, surgical planning, and preoperative counseling.
