以非典型症状就诊面神经鞘瘤误诊分析并文献复习

Misdiagnosed Analysis of Facial Nerve Schwannoma with Atypical Symptoms and a Literature Review

目的分析以非典型症状就诊面神经鞘瘤的误诊原因,并通过文献复习,总结该病的临床特点、诊断及鉴别诊断要点,以减少误诊。方法回顾性分析2015年11月—2021年5月4例以不典型症状就诊面神经鞘瘤的临床资料,并复习相关文献。结果本组1例主因左耳听力下降就诊,1例主因右侧耳鸣、右侧外耳道肿物就诊,1例主因左耳听力下降伴耳鸣就诊,1例主因头痛、右侧耳痛及乳突处轻微压痛就诊。4例均出现听力异常,在发病初期经常规检查后均未及时明确诊断,分别被误诊为特发性面神经麻痹、中耳乳突炎、乳突部占位性病变、分泌性中耳炎;后行CT、MRI等检查并综合分析病情,4例均诊断为面神经鞘瘤。3例行手术治疗后经病理检查确诊,1例因肿物未侵及颅内,且术后有面瘫风险,暂不手术治疗,定期随访观察。结论由于面神经鞘瘤可发生于面神经的不同节段,使得其临床表现多样、首发症状不尽相同。临床医师应充分认识不同节段面神经鞘瘤的临床特点,并了解影像学检查的重要性,才能避免面神经鞘瘤的误诊误治。

Objective To analyze misdiagnosed causes of facial nerve schwannoma(FNS)with atypical symptoms,and to summarize clinical features,diagnosis and differential diagnosis of the disease through literature review so as to reduce misdiagnosis.Methods Clinical data of 4 FNS patients with atypical symptoms admitted between November 2015 and May 2021 was retrospectively analyzed,and related literature was reviewed.Results Of the 4 patients in the group seeking medical advices,1 was mainly due to hearing loss in the left ear;1 due to right tinnitus and right external auditory canal mass;1 due to hearing loss in the left ear with tinnitus,and 1 due to headache,right ear pain,and mild tenderness at the mastoid process.The 4 patients had hearing abnormalities,but they were not diagnosed in time after routine examinations at the early stage of the disease,and they were misdiagnosed as idiopathic facial paralysis,middle ear mastoiditis,occupying lesions in the mastoid process,and secretory otitis media respectively.The 4 patients were diagnosed as having FNS after undergoing CT and MRI examinations combined with comprehensive analysis of their conditions.Three patients were confirmed by results of pathological examination after surgery,and 1 patient did not undergo surgery at the time due to no tumor invasion into the brain and the postoperative risk of facial paralysis,but was followed up regularly.Conclusion FNS may occur in different segments of the facial nerves,which leads to diverse clinical manifestations and different primary symptoms.Clinicians should obtain a comprehensive understanding of clinical features of FNS in different segments and are aware of the importance of relevant imaging examinations so as to avoid misdiagnosis and mistreatment of this disease.