舌下神经鞘瘤的诊断和治疗

Diagnosis and surgical management of hypoglossal schwannomas.

研究舌下神经鞘瘤的临床特点和治疗方法。方法５例舌下神经鞘瘤病人经神经系统检查、ＣＴ和ＭＲＩ检查，并分别采用经枕下乳突后入路联合颌下入路分期切除肿瘤和经枕髁入路切除肿瘤或术后再辅以伽玛刀立体定向放射治疗。结果５例病人均获肿瘤大部分切除，但随访中经分期手术的２例肿瘤复发；经枕髁入路切除肿瘤并行伽玛刀立体定向放疗的２例肿瘤未增大，另１例术后因严重颅内感染而死亡。结论根据肿瘤发生部位不同，舌下神经鞘瘤可分为颅内型、颅外型及混合型，ＣＴ及ＭＲＩ检查是本病主要的诊断方法，运用经枕髁入路切除肿瘤及伽玛刀治疗是较好的治疗途径。

Objective To evaluate the clinical features and treatment methods of hypoglossal neurinomas(HN). Methods Neurological examinations, CT and MRI were performed preoperatively in 5 cases with HN involving intra -and extracranial components. Surgical modalities contain: (1) 2-stages surgical removal of the tumors via retrosigmoid transoccipital and submandibular approach respectively, (2) surgical removal of the tumors through transcondylar route(1 cases) and combined postoperative radiosurgery as a supplement(2 case). Results Large tumor removal was achieved in all cases, follow- up study revealed that the tumors recurred in 2 cases (2-stages surgical removal) and tumors being stable in other 2 cases treated with surgical removal and radiosurgery. One died of intracranial infection secondary to severe CSF leakage. Conclusions A classification based primarily on the tumor origination and location was devised for the diagnosis and choice of surgical management. CT and MRI examinations were essential for the correct diagnosis. Transcondylar approach for tumor resection may provide the best opportunity for achieving a total intracranial tumor removal under direct vision and radiosurgery could offer a good supplement for controlling the extracranial residual tumor.