Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy

Background  Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation. 
Methods  A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed. 
Results  Total tumor resection was achieved in 140 cases (96.6%) and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% (132/145) of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients (Grade I and Grade II, 79.3%). No patient died in this series. Preservation of nerves and vessels were as important as tumor removal during the operation. CT thinner scan could show the relationship between the posterior wall of the internal acoustic meatus and bone labyrinths, that is helpful for a safe drilling of the posterior wall of the internal acoustic meatus.
Conclusions  The goal of every surgery should be the preservation of function of all cranial nerves. Using the retrosigmoid approach with small craniotomy is possible even for large schwannomas. Knowing the microanatomy of the cerebellopontine angle and internal auditory meatus, intraoperating neurophysiological monitoring of the facial nerve function, and the microsurgical techniques of the surgeons are all important factors for improving total tumor removal and preserving facial nerve function.

     

Oncol2012: 带有液平的囊性听神经瘤

Cystic vestibular schwannoma with a fluid-fluid level has rarely been described in the literature and only 2 described cases in the previous literature. Herein, we report the 3rd case of this kind of vestibular schwannoma. The clinical presentation, radiological features, pathological ?ndings, and the management of this particular case are discussed in light of the available literature.     

Facial nerve schwannoma of the internal auditory canal

Background  

Facial nerve schwannoma of the internal auditory canal is a very rare tumour.     

动眼神经鞘瘤一例报道

临床上,单纯的动眼神经鞘瘤罕见,我国在2000年和2002年各报道过1例。动眼神经鞘瘤的诊断和手术治疗难度较大,治疗后多遗留颅神经的功能障碍。现报道1例动眼神经鞘瘤,并对其诊断和手术方式进行探讨。     

动眼神经鞘瘤一例报道

临床上,单纯的动眼神经鞘瘤罕见,我国在2000年和2002年各报道过1例[1-2].动眼神经鞘瘤的诊断和手术治疗难度较大,治疗后多遗留颅神经的功能障碍.现报道1例动眼神经鞘瘤,并对其诊断和手术方式进行探讨.     

腮腺内面神经鞘瘤1例

面神经鞘膜瘤为来自面神经雪旺氏细胞的良性肿瘤。腮腺内的面神经鞘瘤非常少见,术前不易诊断,多数面神经鞘瘤无疼痛及面神经麻痹症状,术前细胞学穿刺往往也不能做出准确诊断,早期诊断对患者的治疗和面神经功能的保护有着重要作用。本研究报道了1例来源于面神经下颌颈支的孤立的神经鞘瘤。     

动眼神经鞘瘤1例

患者 ,女性 ,15岁。因右眼睑下垂 8年 ,右眼球固定 ,复视 3年于 2 0 0 1年 7月 3 0日收住院。入院后神经系统检查 ,视力 :(远 )左眼 0 9,右眼 0 3 ,(近 )左眼 1 2 ,右眼 0 2。眼底正常 ,右眼睑下垂 ,眼裂 8ｍｍ ,左眼裂 15ｍｍ ,右侧瞳孔散大 ,直径 6ｍｍ ,直接及间接光反射消失 ,左侧瞳孔直径 3ｍｍ ,右眼球固定 ,外展露白 14ｍｍ ,内收露白 6ｍｍ ,上下视不能 ,有复视 ,右眼稍突。右侧面部痛觉减退 ,角膜反射敏感。　　辅助检查 :腰穿示脑脊液清亮无色透明 ,初压 13 0ｍｍＨ2 Ｏ ,细胞总数 48× 10 9 Ｌ ,白细胞数 12× 10 9 Ｌ ,蛋白 …     

面神经鞘瘤诊断和治疗(附3例报告)

目的:探讨鼓室内面神经鞘瘤的临床特征、诊断和治疗。方法:3例术前均误诊,均行手术治疗。其中经上鼓室径路切除肿瘤者2例,经乳突径路切除肿瘤者1例。结果:3例随访4~10年,均无复发,1例术后出现面瘫加重,1例好转,1例治愈。结论:神经鞘瘤须依靠病理确定诊断,应手术完整摘除,以避免并发症发生。     

Intraparotid facial nerve schwannoma: a case report

Schwannoma in the head and neck region is very rare. The tumour occurring in the intraparotid facial nerve is even rarer. A patient presenting with a parotid swelling with facial nerve paralysis is not pathognomonic of a facial nerve schwannoma. However it may occur because enlargement of the parotid, by any kind of tumour especially a malignant one can cause facial nerve paralysis. We report a case of an intraparotid facial nerve schwannoma, in a patient who presented with parotid enlargement and facial nerve paralysis.     

手术治疗面神经鞘瘤11例

目的:探讨诊断面神经鞘瘤的方法、手术治疗该病的效果及修复面神经功能的途径。方法:入住本院的面神经鞘瘤患者11例,在确诊前全部误诊为他病,确诊后,对6例中耳乳突腔面神经鞘瘤患者行神经移植,其中5例应用耳大神经移植,1例行干热骨骼肌桥接;对2例中耳乳突腔-颅内面神经鞘瘤的患者,1例行舌下神经移植(舌下神经攀植入舌下神经),1例直接将舌下神经襻植入面神经远端;其余患者面瘫时间较长,已不能恢复面神经功能,仅1例行阔筋膜口轮匝肌悬吊术,其他放弃面神经功能的重建。结果:3例未行面神经功能重建的患者,遗留完全面瘫;6例中耳乳突腔面神经鞘瘤的患者,面神经功能恢复分别为(Brakmann-House功能分级)功能2级3例3、级2例、未恢复1例;2例舌下神经以及攀支重建面神经的患者,功能2级1例3、级1例。结论:面神经鞘瘤的临床症状多种多样,应进行系统检查排除误诊。术中为了完整切除肿瘤,可采用面神经改道吻合术、面神经移植等方法,在断端套用静脉血管给予保护,予以耳脑胶进行粘合。另外,干热骨骼肌的桥接在临床上应该推广使用。     

大型前庭神经雪旺细胞瘤与面神经病理解剖关系的临床研究

目的 探讨大型前庭神经雪旺细胞瘤与面神经的解剖关系。方法 采用枕下乙状窦后入路，术中直接观察了40例肿瘤直径大于4cm以上的前庭神经雪旺细胞瘤的面神经与肿瘤解剖关系。结果 面神经解剖位置：（1）腹侧方中部：23（58%）；（2）背侧方；1例（2%）；（3）腹侧方上级；4例（10%）；（4）腹侧方下极；8例（20%）；（5）术中面神经迷行4例（10%）。面神经形态；扁片状31例，圆隆状9例，扁片状的面神经以实质性前庭神经雪旺细胞瘤为主，圆隆状的面神经以囊性前庭神经雪旺细胞瘤为主。结论 面神经与前庭神经雪旺细胞瘤的解剖变异较大，加强术中监测可提高手术安全性。     

防晕帽各组成部分对前庭自主神经反应作用的分析

目的分析防晕帽各组成部分对前庭自主神经反应的作用。方法将90名年轻健康飞行人员随机分为三组：A组为对照组，戴空白帽，将防晕帽中磁片、风扇及负离子发生器去掉者；B组为戴去掉风扇及负离子发生器帽子组；C组为戴防晕帽组。三组均在戴帽15min后进行科里奥利加速度试验，受试者出现I。前庭自主神经反应时停止转椅并观察20min，依照前庭自主神经反应程度进行分度，对受试时间和前庭自主神经反应程度进行比较。结果三组科里奥利加速度试验持续时间分别为（349．43±31．60）s、（366．23±32．62）s、（385．17±35．54）s，差异均有统计学意义（P〈0．05），前庭自主神经反应程度发生率差异亦有统计学意义（P〈0．05）。结论防晕帽中穴位磁片、风扇和负离子发生器的综合作用可有效降低前庭自主神经的反应程度，为运动病的防控提供了新的思路和措施。     

鸡前庭神经节节前纤维计算机辅助显微测量

目的：对鸡水平壶腹神经、后壶腹神经、上壶腹神经、球囊神经、椭圆囊神经的神经纤维进仃计数和显微测量。方法：计数缚支神经的纤维束数、有髓纤维数和尢髓纤维数。每支神经随机选择100根有髓纤维,测量其直径、纤维及轴突截面积、髓鞘截面积及厚度。结果：构成水平壶腹神经、后壶腹神经、上壶腹神经、球囊神经、椭圆囊神经的纤维束数分别是37、43、48、30和59;有髓纤维的数量分别是2155、2341、2809、1386和4199;无髓纤维的数量分别是99、161、174、38和199。5条神经的有髓纤维截而积中位数分别为4．59μm^2、7．89μm^2、5．19μm^2、4．71μm^2、3．79μm^2;轴突截面积中位数分别为1.17μm^2、2.32μm^2、1．44μm^2、1．42μm^2、1．02μm^2;髓鞘截而积中位数分刖为3．43μm^2、5．3μm^2、3．8μm^2、3．02μm^2、2．63μm^2;髓鞘厚度巾位数分别0．67μm、0．79μm、0．68μm、0．56μm和0．53μm.结论：鸡的前庭神经节前5条分支是由不同数量和直径的有髓纤维和无髓纤维构成的。     

Epithelioid angiosarcoma of esophagus

Epithelioid angiosarcomas (EAS) are very uncommon tumors accounting for less than 1％ of all sarcoma and most frequently occur in the skin and subcuits.Primary angiosarcomas in alimentary tract are very rare,especially in esophagus and only one case has been reported in the Chinese literature.1 Evidence-based advice regarding optimal management is lacking.Here,we reported a case of 54-year-old man who was found to have EAS in the esophagus.     

前庭康复对前庭神经炎患者平衡功能恢复的作用

目的 探讨前庭康复对前庭神经炎前庭功能恢复的作用.方法 将研究对象分为行前庭康复试验组和未行前庭康复对照组,每组25例,比较两组患者的眩晕症状消失时间、眩晕残障程度(DHI)和日常活动前庭功能障碍等级(VADL)量表评分.结果 试验组患者头晕症状消失时间为(3.24±1.51)周,对照组为(4.84±1.62)周,差异有统计学意义(P＜ 0.01).治疗后4周,试验组和对照组的DHI评分分别为(2.3±0.8)分和(26.9±7.6)分,差异有统计学意义(P＜0.01);两组VADL评分分别为(0.2±0.1)分和(9.8±2.3)分,其差异亦有统计学意义(P＜0.01).结论 前庭康复能缩短病程,改善动态前庭功能障碍,提高了生活质量.     

上皮样血管平滑肌脂肪瘤的临床病理特征

目的 探讨上皮样血管平滑肌脂肪瘤(epithelioid angiomyolipoma,EAML)的临床病理特点和生物学行为的判定.方法 复习6例上皮样血管平滑肌脂肪瘤的临床资料和病理切片,选取典型病变蜡块进行相关标记物免疫组化染色,检测指标主要包括HMB45、Melan-A和SMA.并依据相应的分级体系对6例进行生物学行为判定.结果 6例中女性4例,男性2例;年龄从21岁到58岁,平均年龄36.2岁;4例来源于肾脏,2例来自于肝脏;肿瘤大小从5 cm到18 cm不等.临床上无远处转移证据.镜下见肿瘤主要由弥漫的上皮样肿瘤细胞构成,细胞表现出不同程度的异型性,胞质丰富,呈弱嗜酸性或透明状.免疫组化示HMB45、Melan-A和SMA均有阳性表达.生物学行为判定,5例属于不确定恶性潜能范畴,1例为恶性上皮样血管平滑肌脂肪瘤.结论 上皮样血管平滑肌脂肪瘤多属于不确定恶性潜能的肿瘤,极少病例依据组织学特点可以判定为恶性肿瘤.这种依据组织学特点定性的体系有助于临床采取正确积极的治疗方案.     

阴道上皮样平滑肌瘤的临床病理分析

目的 探讨阴道上皮样平滑肌瘤的病理学特征、免疫学表型、鉴别诊断及预后.方法 采用免疫组织化学染色和分子原位杂交技术,观察和分析1例阴道上皮样平滑肌瘤患者的病理学特征、hTERT蛋白表达和EBERs基因表达.结果 阴道上皮样平滑肌瘤的肿瘤细胞较小,呈上皮样,为圆形、卵圆形,细胞排列呈巢片状或簇状,细胞质弱嗜酸性或呈透明状;细胞核呈圆形、卵圆形,位于细胞中央,核分裂(2～4)个/50HPF,细胞无异型.间质黏液样变、胶原样变明显.肿瘤内可见巨菊形团,巨菊形团中央为嗜伊红的胶原纤维.免疫组织化学:波形蛋白(Vimentin)、结蛋白(Desmin)、雌激素受体、孕激素受体、hTERT均阳性;原位杂交EBERs基因表达阴性.结论 阴道上皮样平滑肌瘤是一种罕见类型肿瘤,倾向于良性,局部手术切除多能治愈.肿瘤细胞hTERT阳性,提示肿瘤的发生可能与端粒酶的激活有一定的相关性.肿瘤细胞EBERs基因阴性表达,提示肿瘤的发生可能与EB病毒感染无关.肿瘤细胞雌激素受体和孕激素受体高表达,说明该肿瘤可能对雌激素、孕激素有比较高的反应性.     

Epithelioid leiomyosarcoma of gastrointestinal tract.

Nine patients with rare epithelioid leiomyosarcoma in gastrointestinal tract studied in this series showed a long course of disease and survived for over 5 years even after evident metastasis occurred. Morphologically, the neoplasm was similar to epithelial tumors, so often misdiagnosed as carcinoma unless special strains such as reticulum, Van Gieson and Masson trichrome or immunohistochemical staining were given. Prognosis cannot be predicted only on the basis of histologic appearance because of its slow development, late metastasis and long survival time.

     

Image features of two rare mediastinal tumors: schwannoma of intrathoracic phrenic nerve and clear cell chondrosarcoma of the rib

The current report focuses on two patients of the same age who presented similar appearances on initial anteroposterior chest images. Follow-up images showed superoanterior and superoposterior mediastinal lesions. The first patient with noninvasive cystic thymoma was suspected before surgery, while the pathologic diagnosis was intrathoracic phrenic nerve schwannoma. The second patient was with an asymmetric, dumbbell-shaped paravertebral tumor over T3 and T4 on the left side. The preoperative diagnostic images were interpreted as showing a neurogenic tumor. However, the pathologic report was cell chondrosarcoma.