头颈部神经鞘瘤23例临床分析

目的：探讨头颈部神经鞘瘤的临床特征，以提高对头颈部神经鞘瘤的诊治水平。方法：23例均行手术切除，其中颈侧切开切除颈部肿瘤15例，鼻侧切开切除鼻腔肿瘤1例，经口径路切除肿瘤3例，2例面神经鞘瘤分别经中耳乳突中后颅窝联合径路和乳突根治径路切除，1例位于梨状窝的神经鞘瘤在食管镜下钳取完整取出，1例气管内神经鞘瘤行气管切开切除。结果：20例术后随访3个月－7年，19例无复发；1例鼻腔、鼻窦肿瘤术后3年复发。1例术后出再霍纳征，2个月后消失，1例术后出现声嘶。结论：神经鞘瘤术前诊断困难，确诊有赖于病理检查；一旦确诊应尽早手术完整摘除，尽可能保护神经功能，避免并发症的发生。     

头颈部神经鞘瘤33例临床分析

目的:探讨头颈部神经鞘瘤的诊断和治疗。方法:回顾性分析1980~2004年收治的33例头颈部神经鞘瘤的临床资料。结果:全部患者均行手术治疗,术后经病理学检查确诊良性32例,恶性1例。术后30例患者获随访,其中27例治愈,1例恶性肿瘤患者死于复发,2例死于其他疾病;3例失访。结论:手术彻底切除肿瘤是治疗该病最有效的方法,手术尽可能保留来源神经的完整性。该病预后良好,对恶变者应行扩大切除。     

头颈部神经鞘瘤临床病理研究(附22例分析)

目的探讨头颈部神经鞘瘤的诊断、治疗及病理特点.方法回顾分析49例头颈部神经鞘瘤患者的临床资料.其中男18例,女31例,2～73岁,肿瘤原发部位为咽旁7例,颈侧19例,鼻腔鼻窦6例,鼓室、乳突,咽后壁、口底、牙龈各2例,腮腺区、声门下气管、外耳道、舌根部、颊部、颌下区及腭部各1例.术前能确诊仅5例.结果患者均行手术切除,术后病理确诊,良性47例,恶性2例.经随访,治愈48例,复发1例,经再次手术治愈.健在47例,死亡2例,1例恶性神经鞘瘤死于全身转移,1例良性肿瘤死于脑出血.结论手术切除是治疗本病的唯一方法;神经鞘瘤多为单发、包膜完整,易完整切除,但应尽量保留来源神经的完整性,如术中必须切除来源或受累神经,术后应予以即刻修复.影像学检查有助于了解病变范围、性质及选择术式;术前肿块针吸活检是确诊的重要手段,应列为常规.本病预后良好,倘若恶变,应按恶性肿瘤处理.     

头颈部神经鞘瘤

目的探讨头颈部神经鞘瘤的临床表现、诊断方法及治疗。方法回顾分析1990～2000年收治的19例头颈部神经鞘瘤的临床资料并复习文献。结果全部病例均行肿瘤完全切除。术后并发症为左侧副神经损伤1例,右侧喉返神经损伤1例。所有病例术后随访3年,无复发。结论在头颈部肿块的诊断中,应对该病有足够的认识,以期早期诊断、治疗。手术彻底切除肿瘤是本病最有效的治疗方法。     

头颈部神经源性肿瘤145例回顾性分析

目的 总结头颈部神经源性肿瘤的诊疗经验.方法 回顾性分析我院于 2001 年 1 月～2021 年 7 月收治并经病理确诊的头颈部神经源性肿瘤 145 例,总结其临床病理特点及诊疗体会.结果 本组病例中,包括神经鞘瘤 99 例,恶性周围神经鞘瘤5例,神经纤维瘤 21 例,副神经节瘤 18 例,节细胞神经母细胞瘤 1 例,节细胞神经瘤 1 例.其中 111 例以局部无痛性肿块为主要临床症状,96 例肿瘤位于颈部.本组患者中 144 例接受了手术治疗,术后并发症主要为血管神经损伤.结论 头颈部神经源性肿瘤多见青年、中年群体,神经鞘来源者最常见.手术完整切除是主要治疗手段,术中应尽量避免损伤重要的血管神经,恶性者需辅助放化疗.     

鼻腔神经鞘瘤15例临床分析CSCD

目的探讨鼻腔神经鞘瘤的临床特征、诊断方法及治疗。方法回顾分析1995年3月～2017年2月收治的15例鼻腔神经鞘瘤的临床资料。结果鼻腔神经鞘瘤表面可见皮肤或黏膜血管扩张,全部病例术前行MRI或CT检查,4例符合,术前经鼻腔肿物活检明确诊断为神经鞘瘤3例,8例术中冰冻病理会诊提示梭形细胞肿瘤(神经鞘瘤可能)。完全切除肿瘤后鼻外形及鼻腔功能恢复良好,无并发症发生,术后随访1～5年不等,未见复发。结论术前鼻内镜、CT或MRI检查有助于作出初步诊断,确诊则有赖于病理检查,手术彻底切除肿瘤是本病最有效的治疗方法。     

鼻腔神经鞘瘤15例临床分析

目的　探讨鼻腔神经鞘瘤的临床特征、诊断方法及治疗。方法　回顾分析1995年3月～2017年2月收治的15例鼻腔神经鞘瘤的临床资料。结果　鼻腔神经鞘瘤表 面可见皮肤或黏膜血管扩张，全部病例术前行MRI或CT检查，4例符合，术前经鼻腔肿物活检明确诊断为神经鞘瘤3例，8例术中冰冻病理会诊提示梭形细胞肿瘤（神经鞘瘤可能）。完全切除肿瘤后鼻外形及鼻腔功能恢复良好，无并发症发生，术后随访1～5年不等，未见复发。结论  术前鼻内镜、CT或MRI检查有助于作出初步诊断，确诊则有赖于病理检查，手术彻底切除肿瘤是本病最有效的治疗方法。     

改良颈-腮腺入路高位咽旁间隙肿瘤切除术探讨

目的总结改良颈-腮腺入路切除高位咽旁间隙肿瘤的可靠性和安全性。方法回顾性分析经我科手术治疗的35例高位咽旁间隙肿瘤患者,术前均进行增强CT和MRI评估。其中24例采用单纯的颈-腮腺入路完整切除肿瘤,3例颅底受累者采取颈-腮腺入路联合颞枕侧颅底入路,2例混合瘤患者采用颈-腮腺入路联合下颌角部分切除,3例神经鞘瘤和1例淋巴血管瘤尝试采用颈-腮腺入路联合内镜辅助下手术,1例癌肉瘤和颅底受累及1例颈动脉体瘤术中改行联合下颌骨裂开入路。结果术后病理混合瘤13例,神经鞘瘤11例,副神经节瘤4例,颈动脉体瘤4例,淋巴血管瘤1例,脊索瘤1例和癌肉瘤1例。患者随访11个月～10年,无严重并发症,癌肉瘤患者术后13个月出现脑转移死亡。结论多数高位咽旁间隙良性肿瘤可以经传统颈-腮腺入路完整切除,改良的颈-腮腺入路可以得到清晰的术野暴露,完整切除高位咽旁间隙肿瘤,只有在恶性肿瘤或需要颈内动脉重建时才考虑联合下颌骨裂开术。     

手术治疗上颌窦巨大神经鞘瘤一例

神经鞘瘤为神经源性肿瘤,可发生在身体任何部位,以头颈部为多,但发生在鼻窦者甚少。我科手术治疗1例上颌窦神经鞘瘤患者,术后随访6年未见复发,报告如下。     

颅底脊索瘤外科手术治疗探讨

目的探讨颅底脊索瘤的临床特点,诊断和手术治疗方法。方法回顾性分析54例接受手术治疗的颅底脊索瘤患者临床资料并介绍典型病例。结果54例颅底脊索瘤患者头痛、视力受损症状最为常见,肿瘤全切19例(35.2%),次全切28例(51.8%),大部分切除7例(13.0%) 。41例患者术后临床症状有不同程度的缓解,35例肿瘤未达到全切者术后均行辅助放射治疗。随访3个月至4年,复发14例,脑脊液漏8例,颅内血肿6例,其中11例患者行二次手术。结论颅底脊索瘤手术治疗为主要方法,根据肿瘤的部位、特点及病变侵犯程度,辅助神经导航及神经电生理监测技术,选择不同手术入路,必要时联合入路,可提高肿瘤全切率,术后辅助放射治疗可延缓肿瘤复发。     

Paragangliomas of the Head & Neck: the KMC experience

To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unilateral, painless, pulsatile swelling in the upper neck. Intra-operatively, three of the tumors were classified into Shamlin's Grade II and one each into Grade III and Grade I. A carotid blow-out occurred in one of the patients with Grade II disease, which was managed. ECA resection had to be done in one case. Seven patients were diagnosed to have glomus jugulare and two with glomus tympanicum. Six glomus jugulare tumors presented with hearing loss, ear discharge and obvious swelling. Glomus tympanicums presented with hearing loss but no bleeding from the ear. On examination, tumors presented with an aural polyp with no VII nerve deficits. Both tympanicums were classified as Fisch Type A, three of the jugulares classified as Type B, two as Type D2 and one as Type D1. Tumors were found to be supplied predominantly by the ascending pharyngeal artery. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare. The transcanal approach was used for both patients with glomus tympanicum. Paragangliomas are uncommon tumors that need accurate diagnosis and skilled operative techniques. Though the surgical approaches may appear complicated, the removal provides good cure rates with minimal morbidity and recurrence. Lateral skull base approaches should be the armamentarium of every head and neck surgeon.     

Myxoma of the middle ear-a rare cause of facial palsy

In case of the co-occurrence of facial palsy and inflammation-like symptoms of the same ear, the differential diagnosis is focused on viral (herpes zoster) or bacterial diseases. We report a patient for whom the surgical exploration of the middle ear revealed a benign tumor: a myxoma. These neoplasias are rare tumors in the head and neck region. The typical tumor site is the atrium of heart. In the ear, the tumor grows slowly and remains asymptomatic unless it irritates structures such as the facial nerve or the vestibular organ. Histologically, the tumor presents a “myxoid” matrix that is rich in acid mucopolysaccarides. The treatment of choice is complete surgical resection. Using the case presented, we discuss the causality between the tumor and the facial palsy, although during the operation the bony canal of the nerve was found to be intact. In any cases with clinically and radiologically unclear findings of the ear in connection with facial palsy, surgical exposure should be considered.     

Neurilemmoma of the head and neck--report of 3 cases

BACKGROUND: Neurilemmoma are benign tumors of the nerve-sheath, also known as schwannoma. Beside intracranial manifestation, neurilemmoma are found at other peripheral nerves of the head and neck. CASE REPORT: We present three cases of patients with seldom manifestation of neurilemmoma of the supraglottis, the retropharyngeal space and a neurilemmoma of the hypoglossal nerve. The histological examination showed two types of Antoni-A-neurilemmoma, whereas one tumor was found with mixed type A and B-neurilemmoma. CONCLUSION: Although extracranial neurilemmoma of retropharygeal space, neck or supraglottic larynx are rare tumors, neurilemmoma should be involved in differential diagnosis of tumors in these areas. The therapy of choice consists of complete surgical removal and histological examination.     

儿童头颈部淋巴管畸形的外科治疗

目的 探讨儿童头颈部淋巴管畸形的外科治疗方法和疗效.方法 回顾性总结北京大学第一医院自1998年1月至2008年12月住院治疗的11例儿童短径大于4 cm的头颈部淋巴管畸形.11例儿童头颈部淋巴管畸形均行增强CT或MRI扫描检查,治疗均采用外科手术治疗,其中行肿物及腮腺浅叶切除4例,肿物及腮腺全切除2例,颈清扫术式切除肿物2例,颈清扫术式联合开胸术切除肿物1例,颌下肿物切除术2例.术中采用假包膜外剥离法及顺行解剖面神经主干法,肿物与面神经粘连紧密的2例行肿物剔除术.其中6例行外周面神经解剖,2例行面神经下颌缘支解剖.结果 11例儿童头颈部肿物均彻底切除,无器官功能异常,无明显外形变化,治愈率为100%.3例在行面神经下颌缘支解剖和肿物切除时牵拉下颌缘支出现轻度面瘫(下颌缘支力弱),1例颈部广泛肿物行颈清扫术后出现Homer综合征,均在神经营养治疗后术后1～3个月内恢复.1例1岁患儿行颈清扫术式联合开胸术切除肿物的术中输血150 ml.所有病例随访6～121个月,随访中位数32个月,未见肿物复发.结论 采用面神经解剖及(或)颈部解剖、肿物假包膜外剥离法等手术可以根治儿童头颈部大型淋巴管畸形,是保留功能、防止畸形的有效方法.     

侵犯颅底的头颈部肿瘤的手术治疗

目的：探讨侵犯颅底的头颈部肿瘤的手术治疗方法。方法：对32例侵犯前、侧颅底的头颈部肿瘤患者进行手术治疗,采用鼻内镜下鼻腔入路5例,颅-面联合入路3例,上颌骨切除入路15例,口腔硬腭入路1例,经下颌入路1例,颈侧-下颌骨切开入路2例,耳后-颈联合入路1例,额颞入路2例,经面入路2例。结果：4例鼻窦黏液囊肿仅作开放引流,1例脊索瘤作次全切除,其余27例患者均全切肿瘤,无手术死亡及严重颅脑并发症。8例良性肿瘤患者随访6个月~8年情况良好,无肿瘤复发及死亡。24例恶性肿瘤患者,术后随访3年以上19例,生存12例;随访5年以上12例,生存5例;术后3、5年生存率分别为63.2%（12/19）和41.7%（5/12）。结论：根据病变性质、部位及范围设计手术入路,力求全切肿瘤并保护重要结构,采用适当的颅底修复方法,可获得良好的治疗效果。     

头颈部淀粉样变性23例临床分析

目的 探讨头颈部淀粉样变性的临床表现、诊断、治疗和预后。 方法 对南京医科大学第一附属医院2007年4月至2018年10月收治的23例头颈部淀粉样变患者的临床资料进行回顾性分析并总结。 结果 23例患者均行手术治疗,其中16例为原发性局部性淀粉样变,7例为继发性局部性淀粉样变。术后随访5个月至11年,其中2例多发性局部淀粉样变患者术后复发,表现为声嘶及咽部异物感,5例失访,余患者未见明显复发。 结论 头颈部淀粉样变性临床表现多变,内镜下形态无特异性,确诊依赖于病理切片刚果红染色;该病症发展缓慢,有复发倾向;治疗应根据病变范围选择合理术式并彻底切除病灶,术后需长期随访观察。     

Clinical Presentation and Management of Jugular Foramen Paraganglioma

Objectives

Jugular foramen paraganglioma is a locally invasive, benign tumor, which grow slowly and causes various symptoms such as pulsatile tinnitus and low cranial nerve palsy. Complete surgical resection is regarded as the ideal management of these tumors. The goal of this study is to identify the clinical characteristics and most effective surgical approach for jugular foramen paraganglioma.

Methods

Retrospective analysis of 9 jugular foramen paraganglioma patients who underwent surgical resection between 1986 and 2005 was performed. Clinical records were reviewed for analysis of initial clinical symptoms and signs, audiological examinations, neurological deficits, radiological features, surgical approaches, extent of resection, treatment outcomes and complications.

Results

Most common initial symptom was hoarseness, followed by pulsatile tinnitus. Seven out of 9 patients had at least one low cranial nerve palsy. Seven patients were classified as Fisch Type C tumor and remaining 2 as Fisch Type D tumor on radiologic examination. Total of 11 operations took place in 9 patients. Total resection was achieved in 6 cases, when partial resection was done in 3 cases. Two patients with partial resection received gamma knife radiosurgery (GKS), when remaining 1 case received both GKS and two times of revision operation. No mortality was encountered and there were few postoperative complications.

Conclusion

Neurologic examination of low cranial nerve palsy is crucial since most patients had at least one low cranial nerve palsy. All tumors were detected in advanced stage due to slow growing nature and lack of symptom. Angiography with embolization is crucial for successful tumor removal without massive bleeding. Infratemporal fossa approach can be considered as a safe, satisfactory approach for removal of jugular foramen paragangliomas. In tumors with intracranial extension, combined approach is recommended in that it provides better surgical view and can maintain the compliance of the patients.     

Granular Cell Tumor on Larynx

Granular cell tumors (GCTs) are uncommon neoplasm. They can originate in any part of the body. The most common sites of origin are in the head and neck, while the larynx is a relatively uncommon location. Patients affected with a laryngeal GCT typically present with persistent hoarseness, stridor, hemoptysis, dysphagia, and otalgia but, the tumor may be asymptomatic. Care must be taken to differentiate this lesion from others due to the presence of pseudo-epitheliomatous hyperplasia which overlies the GCT and may occasionally mimic squamous cell carcinoma. Therefore, a confirmative diagnosis should be made histopathologically and should be supported by immunohistochemical staining. These tumors are treated by complete surgical resection. Examining the complete removal of the tumor through securing a negative free margin is considered to be a consequential procedure. We experienced a 64-yr-old man with a laryngeal granular cell tumor involving the right true vocal cord. He was treated by surgical resection under a fine dissection laryngomicroscope. Here we present this case and a review of literature.     

桥小脑角肿瘤继发性舌咽神经痛的外科治疗-附3例报告

目的 探讨肿瘤继发性舌咽神经痛的致病机理和外科治疗。方法 回顾性分析1993年1月-2002年6月收治的3例桥小脑角肿瘤继发性舌咽神经痛的临床和病理组织学资料。结果 3例患者均为女性，分别为桥小脑角的舌咽神经鞘膜瘤、微小血管瘤样脑膜瘤和脉络丛乳头状瘤。主要临床表现是咽部和舌根部疼痛或伴有耳深部疼痛。1例行肿瘤切除及舌咽神经切断术，另2例行肿瘤切除、舌咽神经切断及迷走神经1-2支感觉支切断术，3例均取得满意疗效。3例术后出现轻度声嘶。随访平均2．3年，3例肿瘤及疼痛均无复发。结论 桥小脑角肿瘤是引起舌咽神经痛的原因之一。切除肿瘤同时行舌咽神经根及迷走神经1-2支感觉支切断是治疗肿瘤继发性舌咽神经痛的有效方法。     

Neurogenic tumors of the head and neck in children

Soft tissue tumors make up 63% of all tumors in children. Tumors of the sympathetic chain make up 7.4% of tumors arising in children (nine new cases a year for every million children in USA) while neurofibrosarcomas make up 3.4% (2.4 new cases per year for every million children). There is a certain difference between the frequency of benign forms (rather elevated) and that of malignant forms (rather low). Diagnosis is possible by echo-scan, computed tomography, magnetic resonance imaging and fine-needle aspiration biopsy. As regards therapy, surgical resection represents the treatment of choice. In our experience, 35 neurogenic tumors in pediatric patients (8-16 years), arising in head and neck spaces, were observed and treated in the period 1976 and 1995. Twenty-six cases were schwannomas, six were neurofibromas and three were olfactory neuroblastomas. All the patients underwent surgery. Sacrifice of the affected nerve was necessary in 12 cases (all neurofibromas and eight neurinomas). In one case of olfactory aesthesioneuroblastoma a combined approach (extra-intracranial approach) was employed. Two patients are alive and disease-free with 5 and 7 years follow-up. As regards dysfunctional pathology following surgical resection, we report definitive facial nerve palsy in two cases, permanent laryngeal palsy in six cases, tongue dysfunction in one case and cheek hypoaesthesia in one case.