颞骨段面神经鞘瘤6例CT误诊分析

Analysis on the Misdiagnosis of 6 Cases with Neurilemmoma by CT

目的探讨颞骨段面神经鞘瘤CT影像特征并分析误诊原因。方法回顾性分析6例经手术病理检查证实但CT检查误诊的颞骨段面神经鞘瘤临床资料。结果 6例均以听力下降、面神经麻痹及搏动性耳鸣就诊,行颞骨CT扫描。CT影像表现为颞骨较大软组织肿块、颞骨骨质破坏、面神经管扩张及鼓室内软组织密度影,无明显囊变及坏死,增强扫描均有不同程度强化。6例CT检查误诊为颈静脉球瘤4例,胆脂瘤2例,均经手术病理及免疫组织化学染色检查确诊为面神经鞘瘤。结论对CT表现为颞骨较大肿瘤且以骨质破坏为主的病变,如伴有面神经管扩张时应警惕面神经鞘瘤。

Objective To investigate CT characteristics of facial nerve schwannoma CT and analyze reasons of misdiagnosis.Methods Clinical data of 6 cases with facial schwannoma which was pathologically confirmed but misdiagnosed by CT was retrospectively analyzed. Results All the 6 cases went to hospital for hearing loss, facial nerve paralysis and pulsatile tinnitus. The temporal bone CT scan showed large soft tissue masses of temporal bone, temporal bone destruction, facial nerve canal expansion and soft tissue density shadow in tympanic cavity, and no obvious cystic degeneration and necrosis. Enhanced scan showed different degrees of enhancement. All the 6 cases were confirmed of facial nerve schwannoma by surgical pathology and immunohistochemistry examination, of which 4 cases were misdiagnosed as glomus jugular tumor and 2 cases as cholesteatoma.Conclusion Lesions manifest as larger tumors of temporal bone and bone destruction and combined with facial nerve canal expansion on CT images can suggest the diagnosis of facial nerve schwannoma.