桥小脑角肿瘤继发性舌咽神经痛的外科治疗-附3例报告

Surgical treatment of glossopharyngeal neuralgia associated with neoplasms in the cerebellopontine angle: a report of 3 cases

目的探讨肿瘤继发性舌咽神经痛的致病机理和外科治疗。方法回顾性分析1993年1月-2002年6 月收治的3例桥小脑角肿瘤继发性舌咽神经痛的临床和病理组织学资料。结果 3例患者均为女性,分别为桥小脑角的舌咽神经鞘膜瘤、微小血管瘤样脑膜瘤和脉络丛乳头状瘤。主要临床表现是咽部和舌根部疼痛或伴有耳深部疼痛。1例行肿瘤切除及舌咽神经切断术,另2例行肿瘤切除、舌咽神经切断及迷走神经1-2支感觉支切断术,3例均取得满意疗效。3例术后出现轻度声嘶。随访平均2．3年,3例肿瘤及疼痛均无复发。结论桥小脑角肿瘤是引起舌咽神经痛的原因之一。切除肿瘤同时行舌咽神经根及迷走神经1-2支感觉支切断是治疗肿瘤继发性舌咽神经痛的有效方法。

Objective To investigate the pathogenesis and surgical treatment of glossopharyngeal neuralgia （GPN） associated with neoplasms. Methods Three cases of GPN associated with neoplasms were collected from 1993 to 2002 and analyzed clinicopathologically. Results Three cases were all female patients individually harboring neurilemmoma of glossopharyngeal nerve, meningioma and choroids plexus papilloma in the cerebellopontine angle. The most common presenting symptoms were paroxysmal tongue root and pharynx or ear pain. One patient＇s neuralgia disappeared after complete surgical resection of the tumor and rbizotomy of the glossopbaryngeal nerve. The other two patients were successfully treated by complete surgical resection of tumors and rbizotomy of glossopharyngeal nerves with sectioning of the upper rootlets of vagus. In all patients, mild hoarseness occurred postoperatively. All patients were followed up for an average of 2.3 years with norecurrence of pain and tumour. Conclusion Neoplasms may be one of the causes of glossopharyngeal neuralgia. It is a safe, effective treatment for GPN associated with neoplasms that complete surgical resection of tumors and combined section of the glossopharyngeal nerve and the upper rootlets of vagus.