彩色多普勒超声对颈三角区神经鞘膜瘤诊断价值

目的评价高频声像图和彩色多普勒血流显像（CDFI）对颈三角区神经鞘膜瘤的诊断价值及临床意义。方法回顾性分析总结46例颈三角区神经鞘膜瘤患者术前经彩色多普勒超声检查及术后病理诊断结果。结果肿瘤大多边界清楚，外形尚规则，内部为分布不均匀的暗淡粗光点或伴数量不等的不规则液性暗区，常使颈动脉、静脉受压移位，45例颈总动脉及其分支和颈内静脉位于肿瘤的浅面偏外或内侧，其中15例颈内、外动脉分叉角度扩大，13例颈总动脉与颈内静脉在瘤体下部呈“杯状”分离。CDFI显示肿瘤内血供多数Ⅰ～Ⅱ级。超声诊断正确率为95．7％。结论彩色多普勒超声在颈三角区神经鞘膜瘤诊断方面有一定的特征，其效率高、无创并对临床诊治具有重要的指导意义。     

腮腺内面神经鞘瘤12例临床病理分析

目的 :分析腮腺内面神经鞘瘤的临床、病理特点 ,以免误诊、误治。方法 :对山东省莱阳中心医院 2 0年间收治的 12例腮腺内面神经鞘瘤的临床、病理特点 ,进行回顾性分析。结果 :6例术前误诊为混合瘤 ,1例误诊为腺样囊性癌 ,1例误诊为淋巴瘤。 2例做了穿刺活检 ,3例做了术中快速病检 ,皆得以确诊。术中保留面神经的 10例 ,虽然术后出现面瘫 ,但于术后 6～ 12月恢复 ,切除面神经颅外段 2例 ,面瘫未见恢复。本组 5例肿瘤来源于面神经总干 ,3例来源于上、下颊支 ,2例来源于颧支 ,2例来源于下颌缘支。肿瘤镜下分型 :囊状型 9例 ,网状型 3例。术后随访 5～ 10年 ,无 1例复发。结论 :此瘤极易误诊 ,确诊有赖于术前 (或术后 )病理检查。术中应尽力保留面神经 ,虽然术中刺激、牵拉面神经等致术后面瘫 ,但大多数患者可自然恢复     

肝十二指肠韧带内细胞性神经鞘瘤1例报告

1临床资料患者女性,69岁,因"腹胀2年余加重3 d"入院。该患者2年前无诱因出现腹胀,未介意,无发热,近期自觉腹胀加重。病程中患者无恶心、呕吐,无反酸、嗳气,无胸闷、气短,二便正常,体质量未见明显减轻。入院查体:皮肤及巩膜无黄染,腹部平坦,未见胃肠型及蠕动波,无腹壁静脉曲张。腹软,右上腹轻压痛,无反跳痛及肌紧张,肝脾肋下未触及,Murphy征阴性,全腹叩诊呈鼓音,移动性浊音阴性,肝肾区叩击痛阴性,肠鸣音约     

Neurilemmoma of the diaphragm

Diaphragmatic neurilemmomas are rare tumors. We report here such a case and also review five cases from the English-language medical literature. Neurilemmomas of the diaphragm are benign tumors that display slow, progressive growth. They remain encapsulated and do not invade adjacent structures. Surgical resection is both diagnostic and therapeutic. Thoracotomy is the operative approach of choice. © 1994 Wiley-Liss, Inc.     

Long term phonatory function following acoustic neuroma surgery: a cohort study

Abstract

Background: Acoustic neuroma (AN) is a well-recognized cause of neurological morbidity, peripheral facial paralysis being one of the most prevalent. Phonatory dysfunction in the late post-operative term has not been properly addressed so far.

Objective: The objective of this study is to describe the outcomes of phonatory function on the long-term follow-up of AN surgery and identify its prognostic factors.

Material and methods: This cohort study included patients submitted to AN surgery from 1999 to 2014, with a mean follow up of 6.4?±?4.5?years. To evaluate the phonatory function, we performed a combination of noninvasive acoustic and aerodynamic measurements including vocal intensity and stability, maximum declination rate of the glottal airflow (MDR) and transglottal pressure scale (TP).

Results: 101 patients were studied. 25 (24.7%) presented a deficit in phonatory function. Women comprised 56% and the mean age was 42.4?±?13.8 years (range19–80). 100% presented reduced expiratory airflow capacity with excessive manifestation of the laryngeal musculature (TP > 1,23s ;MDR/z/<MDR/s/). Dysphonic patients presented more neurofibromatosis II (NF II) (40% vs 12.7% p?=?.002), large tumors (3.8?±?1.1 p?=?.002) and needed less surgeries (≥256.7% vs 74.6%, p?=?.0073) in univariate analysis. NFII and tumor size were predictive of dysphonia according to multivariate analysis (NFII-OR 5.57, p?=?.006; tumor size-each 1?cm, OR1.68, p?=?.062).

Conclusion: The late postoperative prevalence of dysphonia corresponded to 24.7%. Dysphonia could be secondary to the hyperfunction of laryngeal musculature explained by the reduced expiratory airflow found in our patients. Tumor size and NF II were predictors for the occurrence of dysphonia in the present study.

• Highlights

• The comprise of phonation function can be a morbidity of AN surgery

• NF II and tumor size were predictive of dysphonia on late postoperative period

• Data of hypofunction secondary to the phonatory hyperfunction were unanimous in the dysphonic patients.

• The early diagnosis and treatment of phonation function could avoid alterations of pneumophono-articulatory coordination and projection deficiency.

     

'Ancient' schwannoma of the orbit

A 65-year-old woman presented with a 3 month history of right eye discomfort and protrusion. Examination revealed right proptosis with hypoglobus and diplopia in extremes of upgaze. Computed tomographic scanning revealed a large extraconal mass in the superotemporal orbit. The mass was excised through an extended superior skin crease incision. Histopathology revealed a benign tumour of Schwann cell origin showing advanced cystic degeneration, the so-called 'ancient schwannoma'. The authors could find only two previously reported cases of such tumours arising in the orbit.     

腹腔神经鞘瘤12例影像表现及其病理对照

目的探讨腹腔神经鞘瘤的影像表现以及与病理学之间的关系,了解影像表现的病理学基础。材料与方法回顾性分析经手术、病理证实的腹腔神经鞘瘤12例的CT及MRI表现,其中增强扫描7例,并和手术病理结果进行比较。结果CT平扫表现为密度均匀者4例,增强呈均匀轻、中度强化;密度不均匀者8例,中心可见点状、片状低密度区,增强呈轻度至明显不均匀强化。其中3例MRI扫描,T1WI低信号,T2WI呈不均匀略高信号。上述表现和病理对照,密度或信号均匀者多由AntoniA区组成,密度或信号不均匀者多由AntoniA区和AntoniB区相互交错组成,AntoniB区集中在囊变、出血区。结论腹腔神经鞘瘤的影像表现与其病理改变有关,这些变化对正确诊断具有指导意义。     

Giant ancient schwannoma of the pelvis

A 43-year-old man with a large ancient schwannoma of the pelvis, presenting with varicose veins, is reported. Ancient schwannoma (neurilemmoma) is a benign tumour of nerve sheath origin characterised histologically by features of severe degeneration and which rarely can grow to a large size. Malignant transformation, though reported, is extremely rare. Received: 17 September 1999 Revision requested: 13 October 1999 Revision received: 22 June 2000 Accepted: 28 June 2000     

Benign esophageal schwannoma: Report of a case

(Received for publication on Mar. 5, 1999; accepted on Jan. 7, 2000)