Imaging characteristics and surgical management of orbital neurilemmomas

AIM: To review imaging characteristics and surgical outcomes of orbital neurilemmoma. METHODS: Retrospective review of 21 patients with orbital neurilemmoma managed at the Zhongshan Ophthalmic Center of Sun Yat-sen University from June 2005 to December 2016. All patients underwent surgical excision following preoperative imaging including ultrasonography, computed tomography(CT) and magnetic resonance imaging(MRI).RESULTS: Among these patients, 11 were male and 10 were female, with age ranging from 12 to 75y(average, 40.3 y). Ultrasound of the orbit showed a roundish well-demarcated orbital mass with low or middle internal reflectivity in each case. Dark inner liquid fields were detected in 28.6% of these cases. Doppler ultrasound demonstrated blood flow signals in these masses. CT showed that the tumors were either homogeneous or heterogeneous. MRI of T1 WI revealed isointense or hypointense tumors, while the T2 WI indicated heterogeneous hyperintense lesions. Gd contrast MRI demonstrated heterogenous or homogeneous enhancement initiating from the wide area of the lesion. Six patients underwent lateral orbitotomy and 15 anterior orbitotomy. All tumors were completely removed. After a mean followup of 1.8 y, 3 patients experienced reduced vision while the remaining 10 patients showed improved vision after surgery. One patient experienced a mild limitation of upward motility. No recurrence occurred. CONCLUSION: Orbital neurilemmoma is a relatively rare, benign orbital tumor. Effective diagnosis requires a combination of ultrasonography, CT and/or MRI. These imaging techniques are also vital to differentiate neurilemmomas from other orbital masses like that of cavernous hemangiomas and meningiomas.Successful treatment requires complete resection of the neurilemmomas as performed either by lateral or anterior orbitotomy. Recurrence is rare after complete removal.

Neurilemmomas of the nasal vestibule: report of two cases

Neurilemmomas is usually a benign neoplasm which is composed of Schwann cells, alsonamed schwannomas and originates from the peripheral nerve sheath. It most frequently （25%- 45%） occurs in the head and neck, but rarely （4%） in the nasal cavity and paranasal sinuses, especially rare in nasal vestibule. In English literature, only Alessandrinis reported one case with the tumor originating from the nasal vestibule. Here we report two cases.

颈交感链神经鞘瘤的诊断和治疗

目的探讨术中是否保留颈交感链对颈交感链神经鞘瘤(cervical sympathetic chain neurilemmoma,CSCL)患者预后的影响。方法回顾性分析2018年4月~2022年5月首都医科大学附属北京友谊医院诊治的5例CSCL患者病例资料,分析临床表现、诊断要点、手术经验、术后并发症及转归情况。结果5例CSCL患者术中均先试行包膜内核除术,4例成功保留颈交感链,术后4~14 d出现霍纳综合征(Horner syndrome,HS),术后1~3个月恢复正常,患者未有第一口综合征(first bite syndrome,FBS)并发症;1例切断颈交感链,术后3 d出现HS,随访21个月未恢复,患者出现严重的FBS并发症,随访21个月无明显减轻。所有患者中位随访时间14个月,未发现复发。结论CSCL手术时应首先尝试包膜内核除,如果能成功保留颈交感链,可以避免FBS并发症,尽管术后会出现HS,但仍可恢复。

喉杓间区神经鞘瘤1例

1临床资料患者女性,56岁,因进行性声音嘶哑5年入院。初起症状为轻度声嘶,无其他不适,声嘶症状缓慢加重,入院前饮水偶有呛咳,发声费力,时有呼吸不畅,无呼吸困难、吞咽困难、痰中带血等。入院查体：颈淋巴结无肿大,心肺腹无异常。喉镜检查示双侧杓间区可见半球形隆起,直径约1.5 cm大小,表面黏膜光滑,黏膜下可见纵行毛细血管,双侧声带活动正常,声带后段闭合差,双侧声带、室带及喉室均未见异常,

喉神经鞘瘤1例

1临床资料患者,女,42岁。因吞咽梗阻不适1个月入院,偶有饮水呛咳,无声音嘶哑、呼吸困难。曾前往当地县医院就诊,给予抗感染、雾化吸入等对症治疗,效果不佳,遂于2013-06-06来我院就诊。电子纤维喉镜检查示右侧披裂一球形肿物,淡红色、直径约2 cm大小、表面光滑、向外遮盖右侧梨状窝,无法窥见肿物基底部。双侧室带、声带光滑、活动好,声门闭合全。

上颌骨翻转入路切除翼腭窝神经鞘瘤1例

1 临床资料 患者，男，51岁，因左面部麻木感3个月于2009年12月4日入院。住院常规查体一般情况尚好。鼻内镜检查主要表现为左鼻腔后部外侧壁膨出性改变。眼科检查左眼黄斑中心区反光消失，右眼鼻下视野缺损，左眼全视网膜视敏度下降，上方视野缺损。鼻窦CT检查见左侧翼腭窝为中心一类圆形软组织密度肿块影，CT值20～35Hu，边界较清楚，约4．4cm×3．6cm×4.3cm大小。

误诊为鼻咽纤维血管瘤的翼腭窝神经鞘瘤1例

1临床资料患者女,19岁,主因左侧鼻塞2年余于2011年2月入院。患者2年前无明显诱因出现左侧鼻塞,呈持续性并渐加重,抗炎治疗无效（具体药物不详）,无鼻出血、面部麻木、肿胀、头痛等症状。专科检查：左侧鼻腔后部可见红色肿块,表面光滑,周围少许脓性分泌物。影像学检查：CT扫描可见鼻腔后部、后组筛窦、蝶窦及翼腭窝区域软组织密度影,呈膨胀性生长,蝶窦下壁、蝶骨大翼、

Schwannoma of the Superficial Peroneal Nerve in 12-Year-Old Female Child: A Case Report

We present a case of Schwannoma of superficial peroneal nerve that presents as single enlarging mass in anterolateral aspect of right leg. After clinical diagnosis work-up is done with ultrasound, MRI and excision biopsy.

喉神经鞘瘤1例

1临床资料 患者,女,42岁。因＂吞咽梗阻不适1个月＂入院,偶有饮水呛咳,无声音嘶哑、呼吸困难。曾前往当地县医院就诊,给予抗感染、雾化吸入等对症治疗,效果不佳,遂于2013-06-06来我院就诊。电子纤维喉镜检查示右侧披裂一球形肿物,淡红色、直径约2 cm大小、表面光滑、向外遮盖右侧梨状窝,无法窥见肿物基底部。

鼻前庭神经鞘瘤1例

1临床资料 患者,女,26岁,因右侧鼻前庭肿胀隆起2个月,于2006-08-22入院。患者于2个月前无意间发现右侧鼻翼处隆起,渐长大,伴胀感,无疼痛、出血及头痛史,无牙痛及牙龈出血史，未经治疗。近日自觉隆起处明显长大，门诊就诊并以“鼻前庭囊肿”收入院。查体：右鼻前庭底部皮下有一个肿块，约2．5cm×1cm×1cm大小，表面光滑，质中，无压痛，活动度小，部分遮盖右鼻腔，左鼻腔及鼻咽部未见异常。在局麻下经唇龈切口行右鼻前庭肿块摘除术，术中见肿块外观近似椭圆形，约2．5cm×1cm×1cm，超越唇系带，包膜完整，呈灰白色，周围软骨未破坏。完整摘除肿块送检，病理诊断为鼻前庭神经鞘瘤。术后四角绷带加压包扎，术后第5天拆除缝线，切口愈合良好，鼻通气流畅。术后随访半年，无复发。

颈静脉孔区颅底贯通神经鞘膜瘤

1临床资料 患者,女性,44岁,因右耳听力下降2年,双眼视物不清1年余入院。患者2年前无明显诱因出现右耳听力下降,于当地医院诊治效果欠佳,后未继续诊治。10个月前自觉枕部疼痛，呈闷痛，经针灸治疗后好转。

Laparoscopic resection of primary retroperitoneal schwannoma:A case report

BACKGROUND Schwannomas are rare,often benign,tumors deriving from Schwann cells that have low incidence in the retroperitoneal region(0.5%to 5%).Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs,symptoms and imaging tests.Thus,it is necessary performing guided punch biopsy in order to identify it.Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy.CASE SUMMARY Forty-seven years old female patient who was hospitalized for elective orthopedic procedure,without complications,evolved with severe pain in the lower limbs,thigh and gluteal region associated with neurogenic claudication.Persistent pain required magnetic resonance imaging(MRI)of the lumbar spine,which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion.The surgical team opted for draining the collection,as well as requested an MRI of the abdomen and pelvis,whose analysis showed expansive lesion in the retroperitoneum,in close contact with the inferior vena cava and with the right renal vein.A guided puncture was performed for diagnostic clarification,which showed immunohistochemical profile compatible with schwannoma.The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy.The patient was discharged and remained stable after 4-mo follow-up;she remains under followup to check the need of cancer investigations.CONCLUSION Schwannoma features requires surgical treatment based on laparoscopic resection,which often presents low relapse rates and optimistic prognosis.

DIAGNOSIS AND TREATMENT OF MEDIASTINAL NEUROGENIC TUMORS--REPORT OF 110 CASES

Object.To study the clinical manifestations,diagnostic methods,surgical management ,and prognosis of various neurogenic mediastinal tumors.Method.One hundred and ten cases of neurogenic tumors of mediastinum were reviewed and retro-spectively analyzed.Results.Operative or hospitalization death happened in2cases,complications occurred in8cases,mostly were Horner’s syndrome or recurrent nerve paralysis.During the follow?up,there were2recur-rences in102benign tumors,and4cases of neurofibrosarcoma or malignant neurilemmoma died within3years postoperatively.Conclusion.Most mediastinal neurogenic tumors are benign.It is enough to establish diagnosis by chest X?ray and CT scan.There are different features in the clinical manifestations,diagnosing methods,and surgical management for the dumbbell tumors.Minimal invasive surgery and video?assisted thora-coscopy surgery(VATS)have a special value in treatment of the selected neurogenic mediastinal tumors.Benign neurogenic tumors rarely recur after complete resection,whereas malignant neurogenic tumors have poor prognosis.

Primary intratracheal neurilemmoma in a 10-year-old girl:A case report

BACKGROUND Tracheal tumors are relatively rare in adults and uncommon in children.Tracheal neurilemmoma is a rare condition in adults that usually affects middle-aged people,but it can also occur in children.Because the clinical presentation is nonspecific and insidious,diagnosis is often delayed.The most common symptoms in these patients are stridor or wheezing(especially positional)and cough.A few patients are misdiagnosed and mistakenly treated for asthma.CASE SUMMARY A 10-year-old girl was admitted to our unit with a 2-mo history of recurrent cough,dyspnea,and tachypnea.Her condition was more severe after exercise.Her symptoms progressed despite treatment with inhaled fluticasone/salmeterol.Flexible electronic laryngoscopy showed a red,smooth,and round mushroomshaped mass in the trachea,about 1 cm below the vocal cords.The surface of the mass was covered with several small and discontinuous blood vessels.About 90%of the tracheal lumen was occupied by the mass.A multidisciplinary operation was performed.The surgically resected mass was diagnosed as benign neurilemmoma by immunohistochemical analysis.CONCLUSION Intratracheal neurilemmoma is fairly rare in children.The main symptoms include coughing,wheezing,and dyspnea.The tumor’s size,location,and degree of intratracheal and extratracheal invasion can be measured by chest computed tomography.The main treatment strategies used for tracheal neurilemmoma are surgical resection and endoscopic excision.Long-term follow-up is warranted for the evaluation of outcomes and complications.

Giant schwannoma of thoracic vertebra: A case report

BACKGROUND It is relatively rare for schwannomas to invade bone,but it is very rare for a large mass to form concurrently in the paravertebral region.Surgical resection is the only effective treatment.Because of the extensive tumor involvement and the many important surrounding structures,the tumor needs to be fully exposed.Most of the tumors are completely removed by posterior combined open-heart surgery to relieve spinal cord compression,restore the stability of the spine and maximize the recovery of nerve and spinal cord function.The main objective of this article is to present a schwannoma that had invaded the T5 and T6 vertebral bodies and formed a large paravertebral mass with simultaneous invasion of the spinal canal and compression of the spinal cord.CASE SUMMARY A 40-year-old female suffered from intermittent chest and back pain for 8 years.Computed tomography and magnetic resonance imaging scans showed a paravertebral tumor of approximately 86 mm×109 mm×116 mm,where the adjacent T5 and T6 vertebral bodies were invaded by the tumor,the right intervertebral foramen was enlarged,and the tumor had invaded the spinal canal to compress the thoracic medulla.The preoperative puncture biopsy diagnosed a benign schwannoma.Complete resection of the tumor was achieved by a two-step operation.In the first step,the thoracic surgeon adopted a lateral approach to separate the thoracic tumor from the lung.In the second step,a spine surgeon performed a posterior midline approach to dissect the tumor from the vertebral junction through removal of the tumor from the posterior side and further resection of the entire T5 and T6 vertebral bodies.The large bone defect was reconstructed with titanium mesh,and the posterior root arch was nail-fixed.Due to the large amount of intraoperative bleeding,we performed tumor angioembolization before surgery to reduce and avoid large intraoperative bleeding.The postoperative diagnosis of benign schwannoma was confirmed by histochemical examination.There was no sign of tumor recurrence or spinal instability during the 2-year follow-up.CONCLUSION Giant schwannoma is uncommon.In this case,a complete surgical resection of a giant thoracic nerve sheath tumor that invaded part of the vertebral body and compressed the spinal cord was safe and effective.

Spinal intraosseous schwannoma without spinal canal and neuroforamina involvement:A case report

BACKGROUND Spinal intraosseous schwannomas(SIS)are rare,and as yet have not been fully described in the literature.The first case of SIS was reported in 1971,and 24 cases of SIS have been reported so far.However,including the present case,there are only seven cases without spinal canal and neuroforamina involvement.CASE SUMMARY A 56-year-old man presented with a history of neck pain for 2 years.An obvious osteolytic destruction of the seventh cervical(C7)vertebra was observed on imaging examination.Magnetic resonance imaging of the cervical spine showed space-occupying lesions in the C7 vertebra,and destruction of the anterior cortex of the vertebra.The lesions had an exophytic component that extended from the C7 vertebra into the soft tissue on the front side.The foramen transversarium on both sides were intact.The patient underwent surgical biopsy and focal excision of the C7 lesion.The diagnosis of“schwannoma”was verified by postoperative pathological examinations.In a review of the literature,this is the seventh case of SIS without spinal canal and neuroforamina involvement,and the third reported case of type VIII SIS.We discussed our case with respect to reported classification characteristics of SIS.CONCLUSION SIS is a very rare tumor.We report a rare case that may be important for further classification of osteo-schwannoma.The establishment of a complete disease classification is of high importance for the treatment and prognosis of this disease.Thus,more basic studies and retrospective analysis of related cases are necessary.

Intrabony Schwannoma of the Mandible: Case Report and Review of Literature

This paper focuses on the case of intrabony mandibular schwannoma in a 39 yrs healthy male who was addressed by his dentist for an asymptomatic radiolucency of the left mandibular corpus. Computed Tomography Dentascan showed a soft tumour continuous to the path of the inferior alveolar nerve. Confirmation was made after surgical excision and careful histological examination. Radiolucent images of the mandible are frequently met by dentists and oro-facial surgeons, and suggest first odontogenic cysts because of their high frequency. But even if sheath nerve tumours are very rare, this case report reminds the necessity to keep them in mind.

原发于下咽的巨大神经鞘瘤1例

1临床资料患者,女,25岁,因"呼吸不畅伴吞咽困难3年,加重1个月"于2020-03-19收入院。患者于3年前开始无明显诱因出现呼吸不畅,睡眠时可闻及喘鸣音,吞咽异物感明显,伴有声音改变,无明显咽痛,无咳嗽、咳血,无发热、寒战等不适,患者未予以重视,此后症状逐渐加重,约1个月前出现一次夜间憋醒、不能平卧30 min后好转,此后呼吸困难持续加重,伴吞咽困难,声嘶较前加重。

Sinonasal Schwannoma: A Case Report and Updated Review of the Literature

Sinonasal schwannomas are rare, benign and slow-growing peripheral nerve sheath tumors without age, race, or gender predilection. We present the unusual case of a 59-year-old female who pre-sented with right-sided retro-orbital pressure and rhinorrhea. Radiographic imaging revealed a mass centered in the right superior nasal cavity with extension through the cribriform plate into the right more than the left subfrontal region. Biopsy confirmed the diagnosis of a sinonasal schwannoma, which was resected via nasal endoscopic surgery and ethmoidectomy. These tumors, albeit rare, should be considered in the differential diagnosis for patients presenting with a para-nasal sinus mass to ensure inclusion of this benign lesion and avoid unnecessary aggressive in-tervention.

Microsurgical treatment of neurilemmoma in upper cervical spinal canal:59 cases report

Objective To explore surgical techniques and curative effects of microsurgical treatment for neuriemmoma in upper cervical spinal canal. Methods Form Jan. 2004 to Nov. 2007. 59 cases of schwannoma was resected through microoperation, the operation was conducted through a posteromedial approach,using German Laika microscope resection