原发性面神经肿瘤的诊断与治疗(附14例报告)

The diagnosis and treatment of primary tumors of facial nerve: a report of 14 cases

目的 总结面神经肿瘤的临床特点 ,探讨诊断方法和治疗措施。方法 回顾性总结解放军总医院 1986年 1月～ 2 0 0 0年 12月间手术治疗、病理证实的 14例原发性面神经肿瘤病例的临床表现、诊断和治疗的经验。结果 14例患者中面神经鞘瘤 9例 ,面神经纤维瘤 3例 ,面神经血管瘤 2例。面神经肿瘤的首发症状最常见为面瘫 (10 / 14) ,其次是听力下降 (5 / 14)。最常见体征是面瘫 (10 /14) ,其次是鼓室内肿物 (5 / 14) ,再次是外耳道肿物 (4 / 14)。本组 14例面神经肿瘤均经手术切除治疗 ,手术中保留面神经完整 1例 ,术后随访 3年 ,面神经功能正常。保持部分面神经连续 2例 ,分别随访 1年和 3 5年 ,1例面神经功能为Ⅱ级 ,1例为Ⅲ级。耳大神经移植桥接面神经 6例 ,平均随访 4 5年 ,面神经功能Ⅱ级 2例 ,Ⅲ级 3例 ,Ⅳ级 1例。股外侧皮神经移植桥接面神经 1例 ,随访 6年 ,面神经功能Ⅲ级。 1例桥小脑角面神经鞘瘤患者 ,在肿瘤切除术后 9个月时行二期面神经 舌下神经吻合 ,术后随访 3年 ,面神经功能恢复为Ⅱ级。面神经中断者因断端寻找困难而未处理 3例 ,平均随访 2 5年 (6月～ 4年 ) ,均为完全性面瘫 (Ⅵ级 )。结论 面神经肿瘤常见首发临床表现为面神经麻痹。一旦考虑为面神经肿瘤 ,应尽早手术。

Objective To summarize the clinic characteristics of the tumors of facial nerve and discuss the diagnosis and treatment. Methods Fourteen cases of primary facial nerve tumors confirmed pathologically and treated in the Chinese PLA General Hospital from 1986-2000 were reviewed. The clinic manifestation, diagnosis and treatment in this series were analyzed. Results Among the 14 cases, there were 9 of facial neurilemoma, 3 of facial neurofibroma and 2 of facial nerve hemangioma. The commonest first symptom was facial paralysis (10/14), the next was hearing loss(6/10).The commonest sign was the facial paralysis. The following was tumor in tympanic cavity (5/14) and the next was tumor in external auditory canal(4/14). The tumors in all 14 cases were totally resected surgically. The function of the facial nerve was normal in one case with nerve being preserved intact during operation, and in grade Ⅱ in one case and grade Ⅲ in other one case with nerves being preserved partly continuous. Facial - great auricular-facial nerve cable grafting were done in 6 cases, as result their facial nerve were in grade Ⅱ in 2 cases, grade Ⅲ in 3 case and grade Ⅳ in 1 case. The facial- lateral femoral cutaneous-facial nerve cable grafting was done in one case, and the facial nerve function was in grade Ⅲ with 6 years of following-up. The second-stage facial-hypoglossal nerve anastomosis was done in one case, and the facial function consequently recover to grade Ⅱ with 3 years of following-up. Three cases of facial nerve remained discontinuity and their facial nerve function showed no recovery (in grade Ⅵ). Conclusions Once the facial nerve tumors were diagnosed, the surgical treatment should be done as early as possible. At the same time of tumor resection, the continuity of facial nerve should be kept and reconstructed in one stage as possible as we can, otherwise the second-stage surgery have be conducted soon after.