三叉神经鞘瘤的伽玛刀治疗

目的 回顾性分析评价伽玛刀(γ刀)对三叉神经鞘瘤的治疗作用。方法应用γ刀治疗三叉神经鞘瘤38例,其中8例为术后复发或残留,30例经MRI诊断首选γ刀治疗。肿瘤平均直径32mm,肿瘤的平均体积9cm^3。照射肿瘤的平均中心剂量为26Gy,平均周边剂量13Gy。结果 35例患者获随访,平均随访时间65个月。症状变化：首选γ刀治疗的患者12例症状完全消失,11例好转,9例症状无变化或轻微加重,3例因肿瘤增大症状加重。肿瘤变化：5例肿瘤消失,24例肿瘤缩小,2例肿瘤未增大,1例未复查MRI,3例肿瘤分别于γ刀术后5、26和60个月增大。其中1例肿瘤有间变,未再治疗;1例行手术切除大部肿瘤,肿瘤未增大;1例再次γ刀治疗,肿瘤再次缩小。本组肿瘤控制率91％。结论 γ刀对中小型三叉神经鞘瘤有良好的中长期控制作用,肿瘤控制剂量为13～14Gy。     

Solitary benign schwannoma of the brachial plexus

A solitary benign Schwannoma of the brachial plexus unassociated with von Recklinghausen's disease is presented. The initial presentation is usually that of a painless, supraclavicular mass, but this patient had a tingling sensation in the right forearm. Local excision was performed. The literature is reviewed.     

Solitary Schwannoma of the Colon: Report of Two Cases

Some patients with gastrointestinal schwannoma (GIS) have been previously reported in the literature. However, GIS of the colon is quite rare. In addition, it is sometimes difficult to differentiate neurogenic tumors from other soft tissue tumors. We herein describe two cases of schwannoma of the colon, while also reviewing the relevant Japanese literature. The first case, a 73-year-old woman underwent a sigmoidectomy with lymph node dissection following the diagnosis of submucosal tumor. In the second case, a submucosal tumor was located in the cecum of a 44-year-old man. An endoscopic tumor resection was performed in the second case. The resected tumors measured 3.6 and 1.0 cm in maximal diameter, respectively. Microscopically, the tumors consisted predominantly of spindle-shaped cells that proliferated in an interlaced fashion. Mitosis was rarely seen in these tumors. Immunohistochemically, the tumor cells were strongly positive for S-100 protein, weakly positive for glial fibrillary acidic protein, and negative for CD34, α-smooth-muscle actin, and cytokeratin (CAM 5.2) in both cases. The tumors in the two cases were both diagnosed to be benign schwannoma of the colon. In general, schwannoma of the gastrointestinal tract is considered to be benign and should therefore be distinguished from other spindle-cell tumors or malignancies. Once diagnosed as schwannoma, extensive surgery should be avoided. Actually, such patients tend to show a good postoperative course with no evidence of recurrence. Received: November 2, 2000 / Accepted: May 15, 2001     

Extra Vestibular Schwannoma: A Two Year Experience

We present series of head, neck extracranial non-vestibular schwannomas treated during 2-year period. All patients with head and neck schwannomas treated at our department from April 2007 to July 2009 were reviewed. There was female predominance (72%). The mean age at diagnosis was 38 years. All (100%) presented with a neck mass. Most common nerves of origin were the vagus and the cervical sympathetic chain. Treatment for all cases was complete excision with nerve preservation. Among all schwannoma patients, postoperative neural deficit occurred in four with partial to complete resolution in three. The follow-up period was 24 months. Non-vestibular extracranial head and neck schwannomas most frequently present as an innocuous longstanding unilateral parapharyngeal neck mass. Preoperative diagnosis may be aided by fine-needle cytology and magnetic resonance imaging or computed tomographic imaging. The mainstay of treatment is complete intracapsular excision preserving the nerve of origin.     

Neurilemmoma of Deep Peroneal Nerve Sensory Branch : Thermographic Findings with Compression Test

We report a case of neurilemmoma of deep peroneal nerve sensory branch that triggered sensory change with compression test on lower extremity. After resection of tumor, there are evoked thermal changes on pre- and post-operative infrared (IR) thermographic images. A 52-year-old female presented with low back pain, sciatica, and sensory change on the dorsal side of the right foot and big toe that has lasted for 9 months. She also presented with right tibial mass sized 1.2 cm by 1.4 cm. Ultrasonographic imaging revealed a peripheral nerve sheath tumor arising from the peroneal nerve. IR thermographic image showed hyperthermia when the neurilemoma induced sensory change with compression test on the fibular area, dorsum of foot, and big toe. After surgery, the symptoms and thermographic changes were relieved and disappeared. The clinical, surgical, radiographic, and thermographic perspectives regarding this case are discussed.     

臂丛神经鞘膜瘤的手术治疗

目的 探讨臂丛神经鞘膜瘤的显微外科手术治疗。方法 1975年至今共收治臂丛神经鞘膜瘤17例，源自臂丛上干7例，中干8例，C5、6神经根1例，外侧束1例。14例行显微外科手术切除肿瘤，3例曾在外院误将肿瘤与神经干一并切除，行神经移植修复术。结果14例术后神经功能正常，随访6个月至10年，无1例复发。3例误将臂丛上干切除行神经缺损修复者，术后均有不同程度的功能恢复，效果良好。结论 臂丛神经鞘膜瘤在手术显微镜下逐层剥离包膜，完整切除瘤体，保护好神经干，均能获得较满意的疗效。     

神经鞘瘤的schwannomin/merlin表达分析

目的 分析S／M蛋白在神经鞘瘤中的表达。方法 用免疫组织化学、蛋白印迹法观察36例神经鞘瘤中S／M的表达。结果 所有神经鞘瘤无Ⅱ型多发神经纤维瘤病（NF2）（A－19）免疫活性。28例（78％）S／M表达量下降（与正常比小于70％），其中听神经瘤占81％（13／16）、非听神经瘤占75％（15／20）。13例（36％）（听神经瘤3例、非听神经瘤10例）中等度下降（与正常比下降35％－69％）；15例（42％）（听神经瘤10例、其它5例）表达重度下降（与正常比小于35％）。结论 神经鞘瘤中S／M表达下降。     

颌骨內神经鞘瘤11例临床分析

目的回顾分析11例颌骨内神经鞘瘤的临床资料,旨在提高对疾病的诊断和治疗水平。方法对1993年1月～2002年2月间经治的11例颌骨内神经鞘瘤患者,从临床、病理、免疫组化、影像学检查及治疗手段等方面进行回顾分析。8例良性者行彻底刮治加烧灼术;2例下颌骨恶性者行扩大切除加颈淋巴清扫术;1例上颌骨恶性伴神经纤维瘤病患者行上颌骨扩大切除加中厚皮片修复及颈淋巴清扫术,术后辅以放疗、化疗。结果5例位上颌骨(1例恶性),6例位下颌骨(2例恶性);其X线表现有一定特异性,术后除1例上颌骨恶性者于11个月时死于广泛多发性转移外,其他10例随访7～122月无复发。结论颌骨内神经鞘瘤临床上少见。CT、MRI及穿刺细胞学检查有助于该病的早期诊断;手术仍是最有效的治疗手段,预后一般良好;辅助放疗、化疗与否,尤其是伴发神经纤维瘤病患者无多大价值。     

高频彩色多普勒超声对浅表部位神经鞘瘤的诊断价值

目的探讨高频彩色多普勒超声(CDFI)对浅表部位神经鞘瘤的诊断价值.方法对21例神经鞘瘤患者采用频率为7.5～10 MHz的超声探头检测肿块形态、大小、内部回声及其血流情况,并沿外周浅表神经干走行方向,追踪扫查肿块与周围神经干关系.对超声诊断结果与手术及病理结果相对照分析.结果本组21例神经鞘瘤患者根据其声像图特征及手术病理不同大致分为均匀型14例,囊变型6例,不规则型1例.与手术及病理诊断结果相比较,超声正确诊断19例,误诊2例.结论高频CDFI对神经鞘瘤具有较高的诊断价值,应为神经鞘瘤的首选检查方法.