咽旁间隙神经鞘瘤诊断及手术入路选择

目的探讨咽旁间隙神经鞘瘤的诊断与手术入路方式的选择。方法对咽旁间隙神经鞘瘤患者14例病历资料进行回顾性分析,术前根据CT和MRI判断肿瘤与扁桃体包膜距离关系及肿瘤主体位置考虑手术径路,与扁桃体包膜距离≤1cm、肿瘤主体突入到口内者行经口内径路,与扁桃体包膜距离1cm、瘤体主体突向外侧者经颈外径路,手术径路与肿瘤大小关系不大。经口内径路4例,颈外径路10例。结果所有患者均获得顺利手术,术后随访6个月～6年均未见复发。结论颈部CT、MRI及DSA是诊断及鉴别诊断的良好手段,手术径路取决于肿瘤与扁桃体包膜的距离及肿瘤主体位置,无论采取何种径路,均无严重的并发症。

Diagnosis of parapharyngeal space schwannoma and selection of surgical approach

Objective To investigate the diagnosis of parapharyngeal space schwannoma and the selection of surgical approach modes. Methods 14 medical records of patients with parapharyngeal space schwannoma were retrospectively analyzed. According to preoperative CT and MRI, surgical approach was determined depending on the distance between the tumor and tonsillar capsule and the tumor main location: with a distance between the tumor and tonsillar capsule ≤1cm, and the main tumor breaking into the mouth, 4 cases via the mouth diameter road; with the distance >1cm, and the tumor projected to the outside of the main body, 10 cases via the neck diameter road. There was no significant relationship between surgical approach and the tumor size. Results All patients had received successful surgery, and were followed up for 6 months to 6 years without recurrence. Conclusions Neck CT, MRI, and DSA are good means of the diagnosis of parapharyngeal space schwannoma, and the selection of surgical approach depends on the distance between the tumor and tonsillar capsule and tumor main location. No matter through which pathway, there are no serious complications.