听神经瘤组织包膜结构的4例临床病理学分析  

Clinical pathological analysis of the capsule structures of acoustic neuromas

作　　者：张翔宇 岳树源[1] 王东[1] Zhang Xiangyu;Yue Shuyuan;Wang Dong(Department of Neurosurgery,Tianjin Medical University General Hospital,Tianjin 300052,China;the Neurosurgery Department of South China Hospital Affiliated to Shenzhen University,Shenzhen 518111,China)

机构地区：[1]天津医科大学总医院神经外科,天津300052 [2]深圳大学附属华南医院神经外科,深圳518111

出　　处：《中华神经外科杂志》2025年第1期18-24,共7页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82171359)。

摘　　要：目的分析4例听神经瘤(AN)患者肿瘤组织包膜的病理学结构及临床意义。方法回顾性研究2024年1—6月在天津医科大学总医院神经外科经乙状窦后入路切除的4例AN患者的肿瘤组织标本。术中于鞘瘤包膜游离面、与脑神经交界面、内听道口的包膜等部位留取组织标本。术后对组织分别进行HE、S100和髓鞘碱性蛋白免疫组织化学染色和Masson三色染色并对AN包膜结构进行病理学分析。结果4例患者术后AN组织的一般特征分析显示,肿瘤组织游离面被覆有一层极薄的结缔组织层,大多数区域厚度<10μm,是AN起源前庭神经的神经束膜。部分肿瘤表面仅存有神经束膜;部分肿瘤表面可见神经纤维层与肿瘤细胞的交叉层。AN-面神经(FN)交界面组织病理学分析显示,AN-FN交界面存在2种结构类型:(1)由内及外依次是肿瘤实质、变性前庭神经纤维与FN神经纤维交叉带、FN神经纤维。(2)由内及外依次是肿瘤实质、肿瘤实质-FN神经纤维交叉带、FN神经纤维。AN-前庭神经交界面的组织病理学分析显示,AN与前庭神经神经纤维无清楚分界,AN起源于前庭神经。内听道口附近硬膜样膜与前庭神经分界面有时分界清晰、界面为载瘤前庭神经束膜;有时分界不清,硬膜样膜组织内存在较多侵入的肿瘤细胞。鞘瘤包膜最外层的蛛网膜无肿瘤细胞侵入。结论AN与脑神经交界面存在多种类型的膜结构;术中正确处理AN包膜结构可在有效切除肿瘤的同时保护患者的面、听神经功能。Objective To analyze the pathological structure of the acoustic neuroma (AN) capsule in 4 patients, and to explore the clinical surgical resection strategy of AN.Methods A retrospective study was conducted on pathological specimens from 4 patients who underwent resection of acoustic neuroma via the retrosigmoid approach at the Department of Neurosurgery, Tianjin Medical University General Hospital from January 2024 to June 2024. During the operation, tissue samples were taken from the free surface of the sheath tumor capsule, the interface with the cranial nerve, and the dural-like membrane capsule of the internal auditory canal. After surgery, the tissues were stained with HE, immunohistochemistry (including S100 and myelin basic protein) and Masson three-color staining, and pathological analysis of the AN capsule structure was performed.Results Preliminary pathological analysis of AN tissues in 4 patients showed that the free surface of the tumor was covered with a very thin layer of connective tissue, which was thinner than 10 μm in most areas and the perineurium of the vestibular nerve originating from AN. Only the perineurium remained to be on the surface of some tumors, and the cross-layer of nerve fiber layer and tumor cells could be seen on the surface of some tumors. The histopathological analysis of the AN-facial nerve (FN) interface showed that there were two types of structures at the AN-FN interface. For the first type, tumor parenchyma, cross-band of degenerative vestibular nerve fibers and FN nerve fibers, and FN nerve fibers were found from the inside to the outside. For the second type, the tumor parenchyma, tumor parenchymate-FN nerve fiber cross band, FN nerve fiber were observed from the inside to the outside. The histopathological analysis of the AN-vestibular junction showed that there was no clear boundary between AN and vestibular nerve fibers, and AN was originated from vestibular nerve. Sometimes, the boundary between the dural membrane and the vestibular nerve near the internal auditor

关 键 词：神经瘤 听 病理学 临床 面神经 前庭神经 包膜结构 神经功能 

分 类 号：R739.4[医药卫生—肿瘤]