颈交感神经鞘瘤与迷走神经鞘瘤的CT定位诊断

CT diagnosis on localization of schwannoma of cervical sympathetic and vagus nerve

目的 探索CT在术前确诊颈交感神经鞘瘤 (SSN)与迷走神经鞘瘤 (SVN)的价值。方法 搜集经手术探查摘除及病理检查证实并有术前CT资料的 4 5例SSN与 14例SVN ,分析在CT轴面上SSN或SVN与颈总、内动脉及颈内静脉的不同位置关系。结果 4 5例SSN的颈动脉皆移位于肿瘤的外半周 ,其中 4 3例位于颈动脉分叉 (或 )以上颈部者 ,其动、静脉皆紧贴肿瘤 ,显示的 35例颈内静脉也皆移位于肿瘤的外半周 ;另 2例SSN位于颈根部者 ,其动、静脉不紧贴肿瘤。SVN中 2例由于扫描层面不足导致颈内静脉显示不清外 ,其余 12例SVN皆将颈总 (颈内或无名 )动脉与颈内 (或无名 )静脉撑开 ,动脉位于肿瘤内半周 ,静脉位于肿瘤外半周 ,两者在弧形线上呈 90°～ 180°。结论 发生SSN或SVN后CT仍能准确反映颈交感神经或迷走神经与颈总 (内 )动脉及颈内静脉等原有的解剖定位关系。故CT是很有价值的术前确诊SSN或SVN的工具。

Objective To study the value of CT in confirming the diagnosis of schwannoma of the cervical sympathetic nerve ( SSN) or vagus nerve (SVN) before operation.Methods From October 1988 to March 2001,45 SSNs and 14 SVNs confirmed by surgery and pathology were analyzed to discover the rules of displacement of common carotid artery (A),internal carotid artery (I) and internal jugular vein (V). Results 43 SSNs located at the level of common carotid bifurcation or/and upper neck with A or/and I abutting against and displacing to the lateral periphery of the tumor.In 35 SSNs with enhanced CT,the V was also abutted against and displaced to the lateral periphery of the tumor.The rest two SSNs located at the root of the neck with A and V anterolateral to but not abutting against the tumor.The growth of 12 SVNs all resulted in separation between the A or I and the V.The A or I was displaced to the medial periphery of SVN and the V to the lateral periphery.Their distance was 90° to 180°. Conclusion During the growth of SSN or SVN,the CT axial scan can still accurately reflect the anatomical positional relationships among A,I,and V with the cervical sympathetic nerve or vagus nerve.So CT is a very valuable tool in confirming the diagnosis of SSN or SVN preoperatively.