面神经瘤的诊断与处理  

Diagnosis and management of facial nerve neuromas

作　　者：迟放鲁[1] 王正敏[1] 陈泽宇[1] 吴拥真[1] 

机构地区：[1]复旦大学眼耳鼻喉科医院耳神经颅底外科,上海200031

出　　处：《中华耳鼻咽喉头颈外科杂志》2006年第4期262-265,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家"十五"科技攻关计划资助项目(2004BA720A18-01)

摘　　要：目的探讨面神经鞘瘤和面神经纤维瘤的临床和病理特点以及影像学表现,为面神经瘤的早期诊断和不同类型面神经瘤的治疗提供经验。方法采用回顾性方法,对20例面神经鞘瘤和2例面神经纤维瘤的诊断和治疗过程进行分析。面神经瘤的手术入路为:颅中窝入路2例,乳突径路8例,乳突腮腺联合径路10例,腮腺径路2例。17例面神经瘤切除后同期进行面神经移植。其中耳大神经颞内段移植3例,颞内外联合移植1例;腓肠神经颞内段移植5例,颞内外联合移植8例。2例后期行面肌悬吊术。结果面神经瘤完全切除21例,20例术后无复发,失访1例。次全切除1例,次全切除者术前和术后接受γ刀治疗,随访无复发。影像学表现:CT示面神经鞘瘤为呈膨胀性改变面神经管缺损。面神经纤维瘤主要表现为面神经管增粗,行走于面神经骨管内。磁共振成像可以显示所有面神经行走途经径,并显示面神经瘤从乳突扩展到腮腺的情况。病理诊断面神经鞘膜瘤20例,面神经纤维瘤2例。结论虽然面神经瘤的发生率低,但是只要了解其临床特点,借助影像学手段,可以早期诊断。对面神经瘤治疗可考虑不同径路摘除肿瘤并行面神经移植手术。Objective To provide the experience for early diagnosis and management of facial nerve neuromas, and to discuss the clinic and imaging feature of facial nerve schwannoma and facial nerve fibroma in 22 cases. Methods Twenty cases facial nerve schwannoma and two cases of facial nerve neurofibroma were diagnosed and reviewed retrospectively. Surgical removal were performed through the middle cranial fessa in 2 cases, through intratemporal approach in 8 cases, through intraparotid approach in 2 cases, and combined intra-tempural with out-temporal approaches in 10 cases. Seventeen cases underwent facial nerve graft for repairing a facial nerve defect. Great auricular nerve was used in 3 cases with intratemporal approach and 1 case with intratemporal combined intraparotid approach. Sural nerve graft was used in 5 cases with intratempural approach and 8 eases with intra-temporal combined intraparotid approach. Two eases were employed two-stage facial muscle flap-plasty. Results Facial nerve neuromas were totally removed in 21 cases and subtotal neuroma removed in 1 case. In these cases,20 patients were no recurrence and 1 patient was lest follow-up. One patient with subtotal neuroma removal received Gamma Knife treatment before and after surgery, and this case was no recurrence. The CT imaging of the temporal bone showed that schwannoma was separated ＂white mass＂ with smooth margin along the region of facial nerve without intact canal. But neurofibroma locate in enlarge fallopian with intact canal. Magnetic resonance imaging had the advantage of evaluating all segments of the facial nerve and showed continuity of intratemporal and intraparotid mass with the facial nerve. Pathological results indicated that 20 cases were diagnosed as facial nerve schwannoma and 2 cases were neurofibroma. Conclusions Although tumors originating from the facial nerve are extremely rare, it is possible to make early diagnosis through finding clinical feature and imaging methods. Generally, systematic surgical approach for tumor removal

关 键 词：面神经 神经鞘瘤 神经纤维瘤 神经移植 

分 类 号：R739.4[医药卫生—肿瘤]