桥小脑角区面神经鞘瘤的诊断与治疗

Diagnosis and treatment of facial schwannoma in the cerebellopontine angle

目的探讨桥小脑角区(cerebellopontine angle,CPA)面神经鞘瘤的临床特点和诊疗经验。方法回顾性分析10例CPA面神经鞘瘤病例临床资料。7例术前误诊为前庭神经鞘瘤,4例病人术前增强MRI出现“音符征”。结果8例行保留面神经的肿瘤切除术,其中1例对术后残余肿瘤组织行立体定向放射治疗;2例行肿瘤全切除术;全组病例全切除率达90%。经治疗后,面神经功能达House-BrackmannⅢ级4例,病侧听力保留2例。结论CPA面神经鞘瘤为颅内罕见良性肿瘤,临床表现与辅助检查缺乏特异性,术前易误诊为前庭神经鞘瘤。面神经保留的肿瘤切除术可使病人获得较好术后面神经功能,“音符征”有助于术前诊断CPA面神经鞘瘤。

Objective To explore the clinical characteristics and experience of diagnosis and treatment of facial schwannoma in the cerebellopontine angle(CPA).Methods Clinical data of 10 patients with facial schwannoma in the CPA were analyzed retrospectively.Seven patients were misdiagnosed with vestibular schwannoma before operation.There was"note sign"on preoperative contrast enhanced MRI in 4 patients.Results The tumor resection with facial nerve preservation was performed in 8 patients,one of them received stereotactic radiotherapy for residual tumor tissue after operation.The total tumor resection occurred in 2 patients.The total resection rate was 90%in all the cases.After treatment,facial nerve function reached House-Brackmann Ⅲ in 4 cases and hearing preservation was acieved in 2.Conclusions Facial schwannoma in the CPA is a rare benign tumor in the brain.Its clinical manifestations and auxiliary examination are not specific.It is easy to be misdiagnosed as vestibular schwannoma preoperation.Tumor resection with facial nerve preservation can provide preferable facial nerve function postoperation."Note sign"is helpful for preoperative diagnosis of facial schwannoma in the CPA.