原发性面神经瘤

Primary Facial Neuroma

目的:讨论原发性面神经瘤的病理学特点、临床表现的差异性、诊断要点、误诊原因、手术切除方法及神经移植等问题。方法:结合文献分析、报告了面神经瘤4 例,其中桥小脑角1 例、乳突段向颅内浸润1 例、鼓室段1 例、乳突段1 例。结果:根据肿瘤侵犯的部位分别采用乳突根治、扩大乳突根治及乙状窦后入路等方法切除肿瘤。对肿瘤未侵犯面神经纤维者用显微手术方法行神经鞘瘤剥离,切除肿瘤而保留面神经。肿瘤大,已破坏面神经者则在安全范围之外切除肿瘤和受累的面神经再作神经移植。结论:明确诊断并实施不同的手术方法具有重要意义。

Objective: To analyse the pathological characteristics ,variable clinical manifestations, diagnostic essentials, reasons of misdiagnosis, surgical treatment and nerve grafting of facial neuroma. Methods: This article reviews literatures on this subject and reports 4 new cases of facial neuroma.One neuroma was found in the cerebellopontine angle, and the mastoid segment with intracranial invasion, the tympanic segment and the mastoid segment one for each. Results: The tumors were resected by way of tympanotomy trans-mastoid retrosigmoid and infratemporal approaches respectively according to the site and extent of tumor.If the tumor did not involve the facial nerve fibers, we stripped off the neurilemmoma from the facial nerve fibers under the operating microscope. For those with tumor infiltrating the facial nerve fibers, we resected the tumor with the nerve and repair the facial nerve by use of nerve graft in order to restore the function of the facial nerve. Conclusion: It is very important to confirm the diagnosis of this disease and select the proper surgical management.