表现为面神经麻痹的面神经瘤的诊治体会  

The management of facial nerve tumor manifested as facial paralysis

作　　者：李煜[1] 戴春富[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳神经颅底外科卫生部听觉医学重点实验室,上海200031

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第8期716-719,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:提高耳鼻咽喉科医生对面神经瘤的认识。方法:回顾分析23例主诉面瘫并手术后证实为面神经瘤的患者资料。患者听力评估采用纯音听阈测试(0.5、1、2、4kHz)。所有患者均行颞骨CT及钆增强MRI检查。面神经功能的评估采用House-Brackman(H-B)评估系统。20例患者接受面神经诱发电图检查,评估术前面神经的变性程度。肿瘤的病理类型主要依据术后病理报告。结果:23例患者中听力下降19例(82.6%),耳鸣10例(43.5%),耳痛4例(17.4%),耳溢液3例(13.0%),头晕2例(8.7%)。肿瘤最常见的累及部位为膝状神经节(20例,87.0%),其次为鼓室段(18例,78.3%),锥段(16例,69.6%),乳突段(10例,43.5%),迷路段(9例,39.1%),内听道段和腮腺(各5例,21.7%)。术后病理结果显示面神经鞘膜瘤21例(91.3%),面神经纤维瘤1例(4.3%),骨血管瘤1例(4.3%)。所有患者行面神经瘤切除术,面神经修复患者术后面神经功能最佳可恢复至H-B评分Ⅲ级。结论:面神经麻痹是面神经瘤的常见临床表现,由于该疾病的低发病率,此类患者常常被误诊,漏诊。颞骨CT、MRI等影像学检查对于诊断尤为重要,而术前听力、面神经诱发电图检查对诊断与治疗也有着重要的指导作用。手术时机和手术入路根据肿瘤的部位大小、面神经、听神经功能状况而定。Objective：To heighten the awareness of the facial nerve tumors.Method：The clinical data of twenty-three patients complaining of facial paralysis who were diagnosed postoperatively as facial nerve tumors were analyzed.The hearing assessment of all patients was based on pure tone audiometry at the frequency of 0.5,1,2,4kHz.Temporal bone high resolution CT scan and temporal bone MRI with gadolinium enhancement were conducted on all patients.Facial nerve function was assessed with the House-Brackmann（HB）grading system.Facial electroneurography（ENoG）was conducted on 20 patients to quantify the degree of nerve degeneration preoperatively.The pathological types of tumor were determined by postoperative pathological reports.Result：Nineteen out of 23 cases presented hearing loss（82.6%）,10 cases suffered from tinnitus（43.5%）,otalgia（17.4%）affected 4cases,3cases manifested otorrhea（13.0%）,and 2cases presented vertigo（8.7%）.Geniculate ganglion was the most commonly involved site（20cases,87.0%）,followed by tympanic segments（18cases,78.3%）,pyramid segment（16cases,69.6%）,mastoid segment（10cases,43.5%）,labyrinthine segment（9cases,39.1%）,internal auditory canal segment and parotid gland segment（5cases,21.7%,respectively）.Twenty-one cases（91.3%）of schwannomas,1case（4.3%）of neurofibroma and 1case（4.3%）of hemangiomas were identified with histopathology postoperatively.The tumors were all completely excised,and the facial nerve function could recovered to HB III at the best after facial nerve repairment.Conclusion：Facial nerve tumor is a rare and often misdiagnosed disease which was commonly manifested as facial nerve paralysis.Temporal bone CT and MRI can help to clarify the diagnosis preoperatively.Pure tone audiometry and electroneurography also plays a some certain roles in the diagnosis of facial nerve tumors.The tumors should be completely resected and the surgical approaches were determined based on tumor size,facial nerve function and preoperative auditor

关 键 词：面神经麻痹 面神经瘤 听力检查 

分 类 号：R745.1[医药卫生—神经病学与精神病学]