面神经鞘膜瘤诊断和治疗分析(附2例报告)

The diagnosis and treatment of facial nerve schwannoma

目的探讨面神经鞘膜瘤的诊断和治疗。方法分析我科2002～2004年收治并于术中诊断为面神经鞘膜瘤患者的临床资料,复习面神经鞘膜瘤诊断和治疗的有关文献。结果2例患者于术中诊断为面神经鞘膜瘤,其中1例行肿瘤切除,并取耳大神经行面神经移植吻合;另1例行腮腺深叶肿瘤切除。结论原发于面神经的良性肿瘤,由于病变部位的不同所引起的临床表现不同为诊断带来了困难。在临床症状和全面体检的基础上,影像学检查可确定病变范围及其与周围组织的关系,并为手术进路的选择提供必要的信息。治疗原则是全部切除肿瘤组织,保留或恢复面神经功能,保存听力。影响术后面神经功能恢复的主要因素是术前面神经损伤时间的长短,损伤时间达1年以上,术后面神经功能恢复较差,而病变部位和术前面神经功能的分级并不影响面神经功能的恢复。

Abstract Objective：To discuss the diagnosis and treatment of facial nerve （FN） schwannomas. Method：Two cases of FN schwannoma between 2002 and 2004 in Shanghai Sixth People＇s Hospital were reviewed. Result： Both cases were diagnosed during operation. Conclusion： Because of its rarity and various presentations, facial nerve schwannoma is difficult to diagnose. In addition of the common presenting symptoms and physical examination, radiographic studies can delineate the erosion area and the relationship with surrounding tissues. These studies are essential for preoperative planning. The main factors that influence on the recovery of facial nerve function after operation are the preoperative presence of facial nerve deficit and its duration. If the facial nerve deficit lasts over one year, the recovery of facial nerve function will be worse. However, the location and the preoperative grading of facial nerve function has nothing with the recovery.