【摘要】 目的讨论并分析面神经肿瘤患者的临床特征、诊断以及不同类型面神经肿瘤和不同程度面瘫患者的手术方式的选择。方法回顾性分析临床资料较为完整的面神经肿瘤6例,面神经功能评估采用House-Brackmann分级(下文简称HB分级)。结果首发症状中,面瘫3例,外耳道肿物2例,听力下降1例。肿瘤病变部位位于面神经垂直段2例,水平段1例,膝状神经节、水平段1例,锥曲段、垂直段以及颞骨外段1例,中颅窝至垂直段1例。高分辨率CT(HRCT)可见面神经膨胀性生长,表现为面神经管增粗,充满软组织影,相应骨质破坏,边缘多光滑,水平段可见听小骨向外推压;磁共振成像(MRI)多表现为信号不均匀边缘光滑的肿物占位。术前面神经HB分级I级3例,II级1例,IV级1例,VI级1例。所有病例均进行手术诊治,2例行面神经活检术,2例肿瘤切除术,2例肿瘤切除后行耳大神经修复术。术后病理报告:神经鞘膜瘤5例,神经纤维瘤1例。随访15月-5年,2例面神经肿瘤活检的患者以及1例面神经肿瘤切除的患者均无面瘫发生,1例面神经肿瘤切除的患者术后HB分级由IV级变为VI级,2例面神经肿瘤切除后行耳大神经移植术的患者术前术后面瘫程度无变化。结论对面瘫发生时间长或者反复发作的患者,HRCT、MRI等影像学检查是排除肿瘤的必要手段,其治疗方案可根据其面神经功能来确定,面瘫轻的患者可考虑面神经活检与减压手术,面瘫重的患者可考虑肿瘤切除与神经移植术。更多还原

【Abstract】 Objective To report clinical features of facial nerve tumors and their diagnosis and management. Methods Clinical information of 6 patients with facial nerve tumors were reviewed retrospectively. The House-Brackmann grading system was used to evaluate facial function. Results Patients presented with facial paralysis as initial symptom in 3 cases, with mass in external auditory canal in 2 cases and with hearing loss as initial symptom in 1 case. The tumor was located in the vertical segment in 2 cases, in the horizontal segment in 1 case, between the geniculate ganglion and horizontal segment in 1 case, between the pyramidal eminence and extratemporal segment in 1 case and between the middle cranial fossa and vertical segment in 1 case. High resolution CT(HRCT) showed expansive facial nerve growth,manifested as enlarged facial nerve canal filled with soft tissue shadow with corresponding bone erosion and always smooth demarcation. Ossicles could be seen pushed outward next to the horizontal segment. Magnetic resonance imaging(MRI) usually revealed a space occupying mass shadow with heterogeneous signals but smooth borders. All patients received surgery, including facial nerve biopsy(n=2), tumor resection(n=2) and repair using the auricular nerve after tumor resection. Postoperative histopathology reported schwannoma(n=5) and neuofibroma(n=1). There was no facial paralysis in the 2 cases of tumor biopsy and in 1 case of tumor resection. HB grade changed from IV to VI postoperatively in 1 case of tumor resection. Facial function showed no change in the 2 cases treated with tumor resection and great auricular nerve transplantation at the last follow up. Conclusion HRCT and MRI are necessary to help diagnose especially in patients with long time or recurrent facial paralysis. The treatment scheme can be determined according to facial nerve function. Facial nerve biopsy and decompression may be considered in patients with mild facial paralysis, while tumor resection and nerve transplantation may be appropriate for patients with severe facial paralysis.更多还原