局限于内听道及桥小脑角的面神经肿瘤临床分析

Clinical Analysis of Facial Nerve Neuroma in Internal Auditory Canal and Cerebellopontine Angle

目的对局限于内听道和桥小脑角的面神经肿瘤临床诊治进行观察和探讨。方法收集7例局限于内听道和桥小脑角面神经肿瘤手术治疗患者的临床资料,对其诊断和治疗进行回顾性分析。手术入路:迷路入路5例,乙状窦后入路2例。面神经修复方式:2例术中保留了面神经连续性而未行修复,面神经改道吻合1例,耳大神经移植2例,面神经-舌下神经吻合2例。结果本组患者均行面神经肿瘤全切,术后随访1-14年均无复发。病理检查面神经鞘瘤6例,面神经血管瘤1例。面神经功能恢复House-Brackmann(H-B)分级:Ⅱ级1例,Ⅲ级1例,Ⅳ级3例,Ⅴ级2例。结论局限于内听道和桥小脑角的面神经肿瘤术前难以与听神经瘤相鉴别,因此术前需要与患者充分沟通并制定预案,术中仔细甄别肿瘤来源。手术时机和方式需根据肿瘤的大小、位置、面瘫程度和听力情况个性化制定。

Objective To report experience with diagnosis and treatment of facial neuroma within the internal auditory canal(IAC) and cerebellopontine angle(CPA). Methods Data from 7 patients with facial neuroma in the IAC and CPA were retrospectively reviewed. The operation involved translabyrinthine(n=5) and retrosigmoid approaches(n=2).The methods of facial nerve repair included end-to-end anastomosis(n=1), facial-hypoglossal nerve anastomosis(n=2)and great auricular nerve grafting(n=2). The facial nerve was kept intact in the rest 2 cases. Results Total tumor resection were achieved in all 7 cases with no relapse during the 1-14 years follow-up. Pathological results indicated schwannoma in 6 cases and angioma in 1 case. Facial nerve recovery was rated as House-Brackmann level Ⅱ in 1 case,Ⅲ in1 case,Ⅳ in 3 cases and Ⅴ in 2 cases. Conclusion It is difficult to distinguish the facial nerve neuroma from acoustic neuroma in IAC and CPA before surgery. It is essential to fully communicate with the patient and make plans before surgery, while carefully identify the tumor source during operation. The timing and approach of surgery should be customized according to tumor size, location, severity of facial paralysis and hearing function.