三叉神经鞘瘤的诊断与手术治疗

目的：报告位于中颅窝及中、后颅窝三叉神经鞘 瘤的诊断与手术治疗的经验。方法：回顾性分析13例中颅窝及中、后颅窝三叉神经鞘 瘤的临床及影像学特征、手术方式及疗效。结果：三叉神经鞘瘤病人的临床表现以患偶三叉神经症状及体症为主，常同时伴有Ⅲ、Ⅳ、Ⅵ、Ⅶ对脑神经症状，CT和MRI对临床诊断及病变累及范围有重要意义。本组三叉神经鞘瘤仅位于中颅窝者5例，同时长入后颅窝者8例。采用额颞硬膜外入路全切肿瘤11例，次全切除2例。术后10例脑神经症状得到改善，2例脑神经症状无变化，1例脑神经症状加重，无新的脑神经症状出现，无残疾及死亡病例。随访10例，时间6-36个月，无肿瘤复发。结论：MRI检查可提高三叉神经鞘瘤的诊断率。运用额颞硬膜外入路显微手术切除中颅窝及中、后颅窝三叉神经鞘瘤能提高治疗效果。     

显微手术治疗巨大哑铃型三叉神经鞘瘤

目的：总结巨大哑铃型三叉神经鞘瘤的诊断和治疗经验。方法：回顾性分析１９９４年５月～１９９７年９月收治的７例骑跨于中后颅窝的哑铃型三叉神经鞘瘤的临床资料。结果：三叉神经鞘瘤病人的临床表现多不典型,诊断主要依靠ＣＴ及ＭＲＩ,７例中肿瘤全切除６例,次全切除１例,无手术死亡。结论：显微手术切除三叉神经鞘瘤是最佳的治疗方法。三叉神经鞘瘤的手术入路,应根据肿瘤的具体部位、大小及其发展的方向而选择。骑跨于中后颅窝巨大的三叉神经鞘瘤可采取硬膜外－经硬膜－天幕入路或分期手术,分别取小脑脑桥角（ＣＰＡ）入路和颧颞下入路。     

侵入颅内的颞骨内面神经鞘膜瘤

报告侵入颅内的颞骨内面神经鞘膜瘤2例,均曾以“贝尔面瘫”长期治疗。1例侵入乙状窦,经颞下窝进路结扎颈内静脉,乙状窦阻塞段分点注入IBCA胶后摘除肿瘤;1例为术后复发,肿物自鼓室顶突入颅腔,经颅中窝、乳突联合进路摘除肿瘤。讨论有关诊断及手术问题。     

头颈部非颅内神经鞘膜瘤的临床特点

神经鞘膜瘤（神经细胞瘤、神经瘤或神经鞘瘤）是神经鞘细胞衍生、有包膜的神经鞘良性肿瘤，神经鞘膜瘤通常是孤立性肿瘤，但在神经纤维瘤病的患者中可见多发性神经纤维瘤。有报道发病率为1／3000。高发年龄20～50岁，男女比例相同。     

头颈部神经鞘瘤的诊断与手术治疗

神经鞘瘤是一种比较常见的良性神经元性肿瘤,极少恶变。CT、MRI、超声、病理等辅助检查对头颈部神经鞘瘤的诊断具有重要作用,手术治疗目前是治疗头颈部神经鞘瘤的首选方法。手术入路一般依据肿瘤生长的部位、大小和术者习惯进行选择。本文通过对现有国内外头颈部神经鞘瘤文献资料进行检索复习,对这一疾病的流行病学、临床特征、辅助检查、诊断及治疗等做一综述。     

骑跨中后颅窝哑铃型三叉神经鞘瘤的手术治疗

目的探讨两种入路切除向中后颅窝侵犯的哑铃型三叉神经鞘瘤的手术效果。方法对两种入路治疗的24例中后颅窝哑铃型三叉神经鞘瘤的手术效果进行分析,手术入路选择为幕上额颞开颅为基础辅以硬膜间（Dolenc）入路,幕下开颅枕下乙状窦后开颅为基础的硬膜下入路。结果经幕上组入路共16例,全切7例,次全切9例,经幕下组入路共8例,肿瘤全切6例,次全切2例。结论额颞硬膜间（Dolenc）入路残存率、死亡率较经枕下乙状窦后入路低,但肿瘤全切率及神经功能保留率较幕下入路低。     

面神经鞘膜瘤的颞骨薄层CT诊断

原发性面神经鞘膜瘤较少见。临床首发症状多为面瘫，常易误诊为贝尔麻痹而延误治疗，先进的影像技术有助于本病的早期诊断。我院近１５年来收治颞骨内面神经瘤７例，现报告其中２病例ＣＴ表现，就其ＣＴ诊断及鉴别诊断作一讨论。     

腮腺面神经鞘瘤的诊断治疗

目的探讨腮腺中面神经鞘瘤临床特点、治疗方法。方法对11篇腮腺面神经鞘瘤相关文献及本院1例个案进行分析总结。结果68例腮腺面神经鞘瘤中,除腮腺区均有肿块外,自觉症状约占40％（27/68）：术前B超、CT及MRI均无明显诊断意义;术前腮腺穿刺阳性15％（2／13）;术前误诊86％（43／49,余19例未报）：术中快速冰冻病理切片基本均能确诊（29／30）;68例中（5例未报,术前面瘫5例,1例术后面瘫复发）,术后39例不同程度周围性面神经瘫痪,占约69％（39／57）;包膜内切除瘤体24例,造成轻中重瘫痪15例,占约63％,术后6个月至7年随诊,中位数4年,只有4例恢复,其余不同程度恢复（Ⅳ级降为Ⅱ级）或残留永久性面瘫;肿瘤与面神经一同切除4例;术后随访30例,长达6个月～10年,中位数6年,未见肿瘤复发。结论腮腺中面神经鞘瘤临床上较罕见,治疗以外科为主。术前无特异性检查,术中快速冰冻病理检查具有显著的临床意义;术中应充分暴露肿瘤及面神经,尽量行包膜内切除瘤体,且不要盲目检查神经延续性,减少面神经损伤;一旦神经断离即行神经移植或标志神经断端为二期面神经吻合做准备,以尽快恢复或改善面神经功能;肿瘤术后复发可能性小。     

鼻咽癌放疗后局部复发或残留的CT与MRI影像表现分析

目的 探讨CT与MRI影像特征对鼻咽癌放疗后局部复发或残留的诊断价值.方法 放疗后3月～2年经CT和/或MRI检查发现异常块影的鼻咽癌患者85例,进行鼻咽局部肿块活检以确定病变性质.活检阴性者继续行CT或MR随访,直至得出最后结论,对比分析CT、MRI影像特征与病理结果的相关性,总结其诊断价值.结果 病理活检、CT与MRI随访复查证实41例（41/85,48.2%）为放疗后局部复发或残留,44例（44/85,51.8%）为放疗后改变.CT诊断鼻咽癌放疗后局部复发或残留的敏感性、特异性、准确性分别为61.9%、84.2%、74.3% MRI分别为69.2%、83.8%、77.8%.结论 CT和MRI诊断鼻咽癌放疗后局部复发或残留的准确性相对均较低,但MRI要优于CT,且两者结合可减少误诊率.     

60例咽旁隙肿块的CT及MRI影像学特征分析

目的探讨咽旁隙肿块的CT及MRI表现,了解其影像学特征。方法回顾性分析2014年6月~2016年6月收治的60例咽旁隙肿块患者的CT及MRI影像学特征,观察肿块的位置、形态、与周围组织关系、密度、信号高低等情况。结果在60例咽旁隙肿块患者中,神经鞘瘤36例、涎腺混合瘤15例、颈动脉体瘤5例、鼻咽癌颅底咽旁隙转移4例。神经鞘瘤表现为包膜完整、边界光滑、呈椭圆形或圆形的肿块,与腮腺深叶间分界清楚,涎腺混合瘤为包膜完整的圆形肿块,与腮腺深叶间没有脂肪间隙,茎突、二腹肌、腭帆张肌等周围组织均出现移位。颈动脉体瘤表现为形态规则的软组织肿块,CT平扫呈等密度、增强后明显强化;MRI扫描,T1W1呈等或稍高于肌肉信号,T2W1呈不均性的高信号,并可见流空血管影像。鼻咽癌颅底咽旁隙转移的MRI显示,T1W1呈低密度信号的椭圆形肿块,增强后高信号内可见坏死囊变区。结论正确地认识咽旁隙肿块的CT及MRI影像学特征,有助于提高其临床诊断率,为咽旁隙肿块的治疗提供一定的依据。     

MRI versus CT in assessment of cochlear patency in cochlear implant candidates

Objective To investigate how cochlear patency as seen on preoperative CT and MRI scans correlates with findings at surgery in cochlear implant patients.

Material and Methods CT and MRI scans of 25 patients were reviewed by 3 independent observers. The reviewers classified the cochlear patency and recorded the location of any suspected decrease in patency. Their results were compared with the findings noted during surgery.

Results Decreased cochlear patency was found in six patients at surgery. The mean sensitivity/specificity of CT and MRI assessment was 33%/88% and 41%/91%, respectively.

Conclusion Our study suggests that CT, using axial and semi-longitudinal planes, is equivalent to MRI in predicting cochlear patency.     

Radiological studies in trigeminal nerve pathology

Summary The authors have used CT scans and MRI to study pathology in anatomical and radiological correlations of brain slices. The CT scan was particularly useful for studying structures at the skull base, although at the level of the posterior fossa such scans could visualize only those tumors that were larger than 8 mm, even after injection. The CT scan was found to be the most useful examination before surgery for facial neuralgia. In contrast MRI gave a precise cisternal course of the trigeminal nerve and its relations with vascular structures.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris, 26–29 September 1988     

Primary B cell lymphoma of the sphenoid sinus: CT and MRI characteristics with correlation to perfusion and spectroscopic imaging features

Primary non-Hodgkin lymphoma (NHL) of the paranasal sinuses is a rare neoplasm that cannot be easily diagnosed and differentiated as its clinical, histological, and imaging features are similar to those of other inflammatory and tumorous diseases in their early stages. We evaluated the morphological and functional imaging characteristics of primary NHL of the sphenoid sinus using CT and MR imaging. Morphological CT and MR imaging as well as perfusion CT imaging and proton MR spectroscopy (PRESS technique, TE = 135) was performed in three patients with the histological diagnosis of highly malignant primary B cell lymphoma of the sphenoid sinus. In all patients an inhomogeneous contrast agent enhancement as well as bony erosion of the sphenoid sinus was identified in CT and MR sections. In one patient an infiltration of the adjacent dura was present. The mean blood flow of the lymphomas was 135 ml/min per 100 g tissue, the mean blood volume was 8.06 ml/min, while the mean transit time and the mean permeability surface area product values were 5.11 s and 26.53 ml/min per 100 g, respectively. The mean choline to creatine ratio in the proton MR spectroscopy was 5.7. Cross-sectional imaging findings are not sufficient to establish the diagnosis of a primary NHL in the sphenoid sinus. Physiologic imaging offers valuable information that may be characteristic of the tumor. Future studies may lead to a safe differentiation of the lymphomas from other pathologic entities based on the combination of morphological and functional imaging.     

Postoperative diffusion weighted MRI and preoperative CT scan fusion for residual cholesteatoma localization

ObjectiveTo evaluate the ability of preoperative mastoid high resolution Computerized tomography (CT Scan) fusion with the postoperative diffusion weighted magnetic resonance imaging (Non-EPI DWI) to accurately localize the residual cholesteatoma thus sparing an unnecessary postoperative CT scan radiation.Patients and methodsthis is a prospective study performed in our tertiary care center. We followed up prospectively a consecutive group of patients presenting with middle ear cholesteatoma using preoperative mastoid CT scans, postoperative mastoid CT scan and mastoid diffusion weighted MRI (DWI) between 2012 and 2013. Postoperative DWI were fused to both: the preoperative and postoperative mastoid CT scans. Fused images were evaluated for their ability to detect accurately the location of residual cholesteatoma if any. Results were correlated to the surgical findings.ResultsTwenty-eight patients were included in this study. Ten patients showed middle ear opacity on the postoperative CT scans; the remaining negatively patients were excluded. DWI detected residual cholesteatoma in 3 out of the ten patients. Both CT scans; the pre and postoperative were able to precisely localize the residual cholesteatoma when fused to the postoperative DWI. Intra-operatively, three patients had a residual cholesteatoma that corresponded to the fused radiological images while a fourth patient presenting low signal intensity on the Non-EPI DWI had no cholesteatoma.ConclusionDiffusion weighted MRI/CT scan fusion combines the advantages of residual cholesteatoma detection and precise localization. Preoperative CT scans performed before the first surgery can be used for the fusion with the Non-EPI DWI in order to spare the patient an unnecessary another CT scan and thus decreasing radiation exposure.     

小脑脑桥角肿瘤的MRI诊断

目的 通过分析各种小脑脑桥角肿瘤的MRI表现，评价MRI在鉴别诊断方面的价值。方法回顾性分析139例经临床病理确诊的各种小脑脑桥角肿瘤的MRI图像资料，其中听神经瘤81例，三叉神经瘤23例，脑膜瘤15例，胆脂瘤11例，血管母细胞瘤2例，蛛网膜囊肿4例，脉络丛乳头状瘤、髓母细胞瘤和Ⅱ级星形细胞瘤各1例。结果小脑脑桥角肿瘤中，脑外肿瘤占96．4％，脑内肿瘤占3．6％；本组肿瘤中良性肿瘤占98．6％，恶性肿瘤占1．4％。发生于小脑脑桥角的前三位肿瘤分别为听神经瘤(58．2％)、三叉神经瘤(16．5％)和脑膜瘤(10．8％)，该区肿瘤大多具有特征性的MRI表现，术前定位、定性诊断准确率分别为100％和93．7％。结论MRI是小脑脑桥角肿瘤有效的补充检查方法，对该区肿瘤的诊断和鉴别具有重要的价值。     

鼻及鼻窦疾病的CT诊断价值

目的 认识鼻及鼻窦疾病的ＣＴ诊断价值。方法 本文对９６例慢性鼻炎、鼻窦炎,鼻及鼻窦肿瘤进行ＣＴ检查,并结合病理检查结果对其进行分析。结果 发现ＣＴ能清晰地显示鼻窦解剖结构,包括窦口－鼻道复合体及前后筛房,筛房与眼眶之间关系及后筛与蝶窦颅底间的关系。对鼻窦内组织情况也能清晰显示,用ＣＴ对慢性增生性鼻窦炎进行分期,有利于手术前制定手术方案和评估预后。对慢性鼻窦炎、上颌窦囊肿、筛窦炎的诊断准确率分别为９     

鼻眼相关疾病的CT扫描诊断

根据２８３例经临床或病理证实的鼻眼相关疾病的ＣＴ检查资料，探讨该疾病的影像学特点及其发生、发展的某些规律。方法主要是用骨窗和软组织窗技术要结合，层厚２ｍｍ，５ｍｍ，层间距５ｍｍ，必要时行增强扫描。结果示２３例累及眼眶的炎性病变中，各鼻窦均有累及，其中以筛窦最多，炎性病变鼻眼病变沟能芭眶壁骨质吸收破坏为主。１２８例肿瘤性病变全部累及眼眶、鼻窦，其中亦以累及筛窦为最多。恶性肿瘤鼻眼病变的沟通方式以骨质