Extracranial neurogenic tumors of the head and neck

IntroductionPeripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis.ObjectiveTo report the experience of a tertiary care department.MethodsForty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study.ResultsThe mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5 cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin.ConclusionsExtracranial neurogenic tumors presented with a mean size of 5.5 cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.     

Schwannoma of infratemporal fossa in a young child

Schwannomas in children are rare. A nine-year-old boy presented with swelling right side of face and proptosis for 4 months. CT scan showed a heterogenous mass in the right infratemporal fossa and extending to the posterior ethmoid. There was erosion of the bony walls of the infratemporal fossa. A biopsy through the sublabial approach was reported as schwannoma. The tumour was approached by Weber-Ferguson approach and excised in toto with complete relief of symptoms.     

高频超声对体表部位神经鞘瘤的诊断价值

目的探讨高频超声在体表部位神经鞘瘤诊断及鉴别诊断中的价值。 方法回顾性分析常州第二人民医院普外科2011年1月至2017年1月收治的97例体表部位神经鞘瘤患者的超声诊断结果。超声检查记录肿块部位、数量、大小、形态、内部及周边回声、边界、包膜、后方回声、病灶与周围组织的关系;彩色多普勒血流显像检测肿块内部及周边血流情况。 结果97例神经鞘瘤(四肢53例,颈部19例,体表其他部位25例)具体如下：(1)病灶数量：97.9%(95/97)的病例为单发病灶;(2)肿块包膜：边界清晰,所有肿块均见较完整或完整的包膜回声;(3)肿块内部回声：71例肿块(73.2%,71/97)内部为均匀或不均实质性低回声;26例(26.8%,26/97)肿块内部可见大小不等的暗区,其中有12例"呈蜂窝"样改变,另有3例为囊性;(4)"鼠尾征"：71例肿块一端或两端见"鼠尾征";(5)彩色多普勒血流显像观察肿块内部及周边血流情况：71例(73.2%,71/97)肿块内部及周边可见血流信号。97例中71例术前超声提示神经鞘瘤,超声总体诊断符合率为73.2%(71/97)。误诊及未明确诊断的情况：颈部4例误诊为肿大淋巴结;颈部2例误诊为颈动脉体瘤;四肢3例误诊为神经纤维瘤;腘窝处有3例误诊为腘窝区囊肿;下肢2例误诊为纤维瘤;12例仅限于超声物理诊断,未能提示神经鞘瘤。颈部与四肢两组共72例,其中颈部19例中12例超声提示符合病理,四肢53例中45例超声提示符合病理。四肢组神经鞘瘤的超声提示符合率(84.9%,45/53)高于颈部组(63.2%,12/19),两组差异具有统计学意义(χ²＝4.01,P<0.05)。 结论多数体表部位神经鞘瘤声像图具有一定特征,高频超声具有一定的诊断准确率;四肢部位较颈部诊断准确率更高;当声像图缺乏特征性表现时,应结合病史、临床表现及其他影像学检查,以免误诊。     

下颌骨骨内神经鞘瘤:1例报告及文献复习

神经鞘瘤是来源于神经髓鞘的良性肿瘤,多见于头颈部软组织.骨内神经鞘瘤较为罕见,但以下颌骨相对常见.本文报告1例首发表现为下颌下肿块的下颌骨多发性骨内神经鞘瘤,详细描述其临床特征、影像学表现、手术所见、病理结果以及术后随访情况,并回顾国内外文献将其好发因素、临床表现、影像学表现、组织病理学表现以及治疗情况和预后作了系统性总结和分析.大多数骨内神经鞘瘤临床表现一般为进行性无症状性下颌骨膨胀,也可表现为颌面畸形,牙移位或拥挤.     

Robot-assisted resection of paraspinal Schwannoma

Resection of retroperitoneal tumors is usually perfomed using the anterior retroperitoneal approach. Our report presents an innovative method utilizing a robotic surgical system. A 50-yr-old male patient visited our hospital due to a known paravertebral mass. Magnetic resonance imaging showed a well-encapsulated mass slightly abutting the abdominal aorta and left psoas muscle at the L4-L5 level. The tumor seemed to be originated from the prevertebral sympathetic plexus or lumbosacral trunk and contained traversing vessels around the tumor capsule. A full-time robotic transperitoneal tumor resection was performed. Three trocars were used for the robotic camera and working arms. The da Vinci Surgical System® provided delicate dissection in the small space and the tumor was completely removed without damage to the surrounding organs and great vessels. This case demonstrates the feasibility of robotic resection in retroperitoneal space. Robotic surgery offered less invasiveness in contrast to conventional open surgery.     

颈部神经鞘瘤的诊断与手术治疗6例

目的 探讨颈部神经鞘瘤的诊断与手术治疗经验。方法 回顾性分析6例颈部神经鞘瘤患者的临床资料,总结患者治疗前后临床表现及准确的诊断手段、医疗方案。结果 根据病史、临床表现特点、辅助检查(B超、CT、MRI)以及细针穿刺抽吸活检可作出诊断。本组6例术前诊断正确,手术切除。术后病理诊断为良性神经鞘瘤,无明显并发症。结论 对于颈部神经鞘瘤患者,B超和CT检查特别是细针穿刺抽吸活检有助于诊断。手术切除是有效的治疗方法,细致操作,可避免并发症的发生。     

鼓室体瘤的诊治

鼓室体瘤是局限于鼓室内的起源于鼓室的舌咽神经鼓室支及迷走神经耳支的化学感受器瘤,起源于副神经节,也称为鼓室副神经节瘤,早期主要在鼓室内生长[1]。因其病变原发于中耳腔及鼓室而得名。而病变原发于颈静脉体者则称为颈静脉体瘤。两者均起源于副神经节,故又称副神经节瘤。此瘤在组织结构上属化学感受器瘤。该病临床上的典型表现为波动性耳鸣、耳闷感;有轻度传导性聋;局部检查,透过鼓膜可见鼓岬表面红色肿块,中耳CT显示鼓岬处有边缘光滑的软组织占位改变,乳突无破坏。实际工作中我们发现该病临床上比较少见,并且表现多样,不典型,容易误诊误治,现报道我院3例鼓室体瘤病例临床资料。     

腮腺腺淋巴瘤的多层螺旋CT表现特征

目的探讨多层螺旋CT对腮腺腺淋巴瘤的CT表现特征的显示。方法回顾性分析21例经病理证实的腮腺腺淋巴瘤（adenolymphomas）的影像资料及其相关病理学改变,包括：病灶数目、部位（分成4个象限）、形态、大小;平扫、增强CT值及强化特征;下颌后静脉移位情况。结果21例腮腺腺淋巴瘤患者中男性16例,女性5例,50岁以上者17例,吸烟者18例。17例病灶单发,4例多发（其中1例为双侧腮腺腺淋巴瘤）,共25个病灶,其中病灶位于腮腺后下象限者14个,下颌后静脉前外侧移位16个,病灶边界清楚24个,密度不均匀13个,内可见小血管影15个,增强CT值平均上升31．3Hu。结论〉50岁的男性患者有吸烟史,CT发现腮腺浅叶的后下象限具有良性肿瘤病灶特征,内部密度不均匀有小血管影,强化较明显,且病灶多发时,诊断时应首先考虑腺淋巴瘤可能。     

周围神经源性良性肿瘤的超声特性

目的通过分析周围神经源性良性肿瘤的超声特性,评价超声在周围神经源性良性肿瘤中的诊断作用。方法采用回顾性调查方法收集2000—2011年我院收治的有完整临床资料的良性周围神经肿瘤65例患者的术前超声检查、手术图片及病理检查结果,其中58例肿瘤患者同时包含彩色多普勒超声检查结果,由2位有丰富临床经验的超声影像医师对患者的术前超声图像进行回顾分析,评估肿瘤超声特性包括肿瘤的形状、大小、边界、包膜、内部回声特性、后方回声情况与周围神经的关系以及血流情况。结果本组65例良性周围神经源性肿瘤70处病变的超声检查结果显示42处病变(60%)为内部回声均匀的实质性低回声结构;28处病变(40%)为回声不均的低回声结构,其中18处(26%)病变为低回声结构内部可见高回声区,10处(14%)病变为低回声结构内部可见液性暗区;36处病变与知名周围神经相连。58例肿瘤彩色多普勒超声检查显示24例肿瘤(41%)有丰富血流信号,22例肿瘤(38%)有少量血流信号,12例(21%)肿瘤无血流信号。65例患者70处病变均行手术切除,术中见54处病变来源于知名的周围神经,16处病变位于肌肉内,无知名神经纤维连结。超声检查显示病变与神经相连的阳性率为67%(36/54)。65例肿瘤手术切除后病理检查结果显示,62例肿瘤为神经鞘膜瘤,2例为神经纤维瘤,1例为神经纤维瘤病。结论超声检查能提供良性神经源性肿瘤较详细的形态、内部结构、边界、包膜以及肿瘤与周围组织的关系的信息,还能显示肿瘤与周围神经的联系以及血流情况等,检查方便易行,检查费用低廉,患者易于接受。     

彩色超声多普勒、DSA在颈动脉体瘤和神经鞘瘤诊断与鉴别诊断中的应用

目的：总结彩色超声多普勒（CDFI）与数字减影血管造影（DSA）在颈动脉体瘤与神经鞘瘤诊断与鉴别诊断中的影像学特征。方法：对1990年1月～2005年12月收治的8例颈动脉体瘤和14例神经鞘瘤患者进行CDFI与DSA检查，对其影像学特征进行比较。结果：颈动脉体瘤的CDFI和DSA特征为：颈总动脉分权处单发性肿块，并与其紧密相连，瘤体内血流极为丰富，瘤体使颈外动脉向前内移位、颈内动脉向后外移位，颈内、外动脉分权角度增大明显，DSA呈高脚杯状改变；神经鞘瘤紧邻颈动脉，颈总动脉分权处角度无改变，瘤体内血流信号不丰富。瘤体使颈动脉向前、外移位。结论：颈动脉体瘤与神经鞘瘤均有明确的影像学特征，CDFI及DSA在两者的诊断与鉴别诊断方面具有重要的临床实用价值。