以颈部肿块为主要临床表现的颈段椎管内外交通性神经鞘瘤的诊断与治疗  

Dumbbell-shaped cervical spinal neurilemmoma presenting as neck mass:diagnosis and treatment

作　　者：李超[1] 石芳琼[1] 伍军[2] 翦新春[1] 蒋灿华[1] 

机构地区：[1]中南大学湘雅医院口腔颌面外科,湖南长沙410078 [2]中南大学湘雅医院神经外科,湖南长沙410078

出　　处：《上海口腔医学》2011年第2期174-178,共5页Shanghai Journal of Stomatology

摘　　要：目的:发生于颈段椎管的神经鞘瘤可沿椎间孔向外生长,表现为颈椎内外交通性肿块,但多因早期出现脊髓压迫症状而就诊于神经外科。本文报告2例以颈部肿块为主要临床表现而就诊于口腔颌面外科的颈椎内外交通性神经鞘瘤,旨在提高临床医师对本病的诊断与治疗水平。方法:对中南大学湘雅医院口腔颌面外科近期收治的2例以颈部肿块为主要临床表现的颈椎内外交通性神经鞘瘤患者的临床资料进行总结与随访,并结合相关文献,探讨其临床病理特征、手术方式与预后。结果:2例患者均以颈上部肿块为主要症状就诊,术前影像学检查显示颈椎内外交通性哑铃型肿块,采用颈后正中和颈外侧联合入路切除肿瘤并重建脊柱的稳定性,随访1a未见复发。结论:发生于颈椎的神经鞘瘤可表现为颈部肿块而脊髓压迫症状并不明显,详细的体格检查与影像学检查可以明确诊断,手术切除具有一定难度。PURPOSE： Cervical neurilemmoma originating from cervical spine could extend through foramen intervertebrale and displayed a radiographic features as a cervical intra-and extra-spinal dumbbell-shaped mass.Because of its early compressive spine cord,patients usually visited neurosurgery at first.In this paper,two patients of cervical intra-and extra-spinal dumbbell-shaped neurilemmoma visiting oral and maxillofacial surgery complained of upper cervical mass were reported,aiming to improve the diagnostic and therapeutic skill for oral and maxillofacial surgeons.METHODS： Two case of cervical dumbbell tumors who complained of a neck mass underwent surgery and were followed up by oral and maxillofacial surgeons.The pathogenesis,operative approach and prognosis were discussed by reviewing relevant literatures retrospectively.RESULTS： Both of the two patients＇ presenting symptoms were upper-cervical masses.Preoperative imaging suggested trans-cervical vertebra dumbbell masses.The tumors were removed through combining the posterior midline and lateral cervical approach,and a gross total resection was achieved.No evidence of recurrence was noted after one-year of follow-up.CONCLUSIONS： The initial symptom of cervical intra-and extra-spinal dumbbell-shaped neurilemmoma may be a cervical mass and inconspicuous compressive spine cord.Analysis is essentially devoted to the radicality of tumor resection,nerve root preservation,relation to the vertebral artery,and compromise of spinal stability.The surgical resection of dumbbell-shaped cervical spinal neurilemmoma can pose a formidable challenge.

关 键 词：颈部肿块 神经鞘瘤 颈椎 手术治疗 

分 类 号：R739.4[医药卫生—肿瘤]