累及内耳道的面神经肿瘤的诊断与治疗  

The management of facial nerve tumors involving the internal auditory canal

作　　者：张小安[1] 李煜[2] 戴春富[2] 

机构地区：[1]赣州市人民医院耳鼻咽喉头颈外科南昌大学附属赣州医院,江西赣州341000 [2]复旦大学附属眼耳鼻咽喉科医院耳神经颅底外科卫生部听觉医学重点实验室

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第14期1235-1238,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:总结累及内耳道的面神经肿瘤的临床特点,探讨其鉴别诊断方法及治疗措施。方法:回顾总结复旦大学附属眼耳鼻喉科医院2013-01-2015-04期间手术治疗、病理证实的5例累及内耳道的面神经肿瘤患者的临床表现、诊断和治疗经验。结果:累及内耳道面神经肿瘤的主要症状以面瘫伴听力下降最常见。本组5例均为肿瘤全切,其中3例经迷路径路,1例经迷路耳囊径路,1例经颅中窝径路。2例进行了面神经重建,其中1例行面神经舌下神经吻合,1例行耳大神经移植。结论:累及内耳道的面神经肿瘤如出现面瘫H-B 4级以上可考虑手术,应根据患者的听力情况、面神经功能,肿瘤大小及侵犯范围选择相适应的干预策略。Objective：To summarize the clinical features of the facial nerve tumors involving the internal auditory canal and promote the management of facial nerve tumor.Method：We retrospectively reviewed the clinical manifestations,the experiences of diagnosis and treatment of the facial nerve tumor involving the internal auditory canal.All these 5 cases were enrolled during January 2013 to Apr 2015.Result：Among the 5 cases,3 cases were facial neurilemmoma and the others were facial neurofibroma.The main symptoms of facial nerve tumors involving the internal auditory canal most commonly were facial paralysis companied with hearing loss.All the patients accepted the surgical treatment with various approaches,3 cases of translabyrinthine approach,1 case of middle fossa approach,and 1 case of combination of translabyrinthine and transotic approach.Total tumor resection were achieved in all 5 cases.Facial-hypoglossal nerve anastomosis was performed in one case,another case was undergone great auricular nerve graft.Conclusion：Surgical intervention for patients with facial neuroma involving internal auditory canal should be considered when facial weakness has deteriorated to grade 4.The management should be based on the patient′s hearing,facial nerve function,tumor size and invasive extension to select the appropriate surgical procedures.

关 键 词：累及内耳道的面神经肿瘤 面瘫 诊断 手术 

分 类 号：R745.1[医药卫生—神经病学与精神病学]