颈静脉孔区颅内外沟通型神经鞘瘤的外科治疗

目的总结颈静脉孔区颅内外沟通型神经鞘瘤的手术经验。方法回顾性分析10例颈静脉孔区颅内外沟通型神经鞘瘤的临床资料。肿瘤均由神经外科和头颈外科联合经颅-颈入路一期切除。结果 肿瘤全切除9例,次全切除1例。术后新出现面瘫1例;脑脊液鼻漏3例,再次手术修补1例;术前神经功能障碍加重3例。无手术死亡病例。随访18~60个月,神经功能障碍均明显好转,无肿瘤复发。结论神经外科和头颈外科联合经颅-颈入路手术切除是治疗颈静脉孔区颅内外沟通型神经鞘瘤,尤其是伴有明显的颈部扩展者的理想方法 。     

神经母细胞瘤与腰椎神经鞘瘤误诊并文献分析

目的:探讨神经母细胞瘤与腰椎神经鞘瘤容易出现误诊的原因,提高诊治的针对性及有效性。方法:对二例误诊为腰椎间盘突出症的肿瘤患者以往手法等诊疗过程进行反思并结合文献进行回顾性分析。结果:多以神经根痛为首发症状,继而出现感觉、运动及植物神经功能障碍;腰穿显示椎管梗阻,脊髓腔造影表现不典型,应仔细询问病史,认真查体,结合临床症状与影像学检查,可有效降低误诊率,反之是引起肿瘤常见的误诊的原因。结论:神经母细胞瘤临床少见,脊椎神经鞘瘤临床特征无特异性,明确诊断依赖于脊髓造影及MRI检查,确诊需病理检查,因误诊、漏诊率高,早期诊断是改善预后的前提。手术可完整切除肿瘤及其宿主神经,早期手术为二种肿瘤有效的治疗方法。     

椎管内神经鞘瘤的MRI诊断

目的 分析椎管内神经鞘瘤的MRI表现,提高鉴别诊断能力。方法 27例椎管内神经鞘瘤术前均行MRI平扫＋增强检查,并将诊断结果与手术病理对照。结果 肿瘤均单发,良性25例,恶性2例。良性包膜均完整;18例硬膜内生长的良性肿瘤呈长圆形或结节状,7例跨硬脊膜生长而呈类哑铃形,其中6例良性伴椎管骨质压迫吸收,5例见T1WI及T2WI均呈低信号的硬化带。恶性包膜欠完整,椎管骨质显破坏;1例椎旁软组织广泛侵犯。T1WI肿瘤呈低或等信号（较脊髓）,T2WI呈高信号,增强后显强化;12例瘤内伴囊变,囊变区近似脑脊液信号,4例出血,多呈高信号,增强后均不强化。27例肿瘤病理均无钙化,囊变情况术前均正确提示,MRI对椎管内神经鞘瘤定位诊断符合率100％（27／27）,定性诊断符合率88．9％（24／27）。结论 椎管内神经鞘瘤的MRI表现有一定的特征性,MRI是诊断椎管神经鞘瘤的有效手段,对术前指导有较大价值。     

Diagnosis and treatment of trigeminal schwannomas extending into both the middle and posterior cranial fossa

Trigeminal schwannomas ( TSs ) account for 0.1^-0.4% of all intracranial tumors and 1%-8% of intracranial schwannomas.Yoshida and Kawase classified TSs into 6 types according to their locations;M(TS involving the middle cranial fossa),P(TS involving the posterior cranial fossa).E(TS located at extracranial space),     

右胫骨下段皮质下骨膜神经鞘瘤一例

患者男,17岁,因“偶然发现右胫骨下段鸡蛋大小包块”入院。查体:右胫骨下段触及6.0 cm×4.0 cm质软肿块,局部压痛明显,皮温不高,皮肤无红肿及破溃,肌力及肌张力正常。实验室检查未见异常。X线片:右胫骨下段骨皮质呈膨胀性破坏,边界清楚,内见细线状分隔,边缘可见薄层硬化边(图1A)。MRI:右胫骨下段见等T1长T2信号肿块,约4.6 cm×2.7 cm,呈膨胀性生长,边缘可见浅分叶,骨皮质呈受压改变(图1B、1C)。影像学诊断:右胫骨下段占位性病变,考虑良性肿瘤,纤维骨皮质缺损或非骨化性纤维瘤可能性大。遂行右胫骨下段肿瘤切除内固定+植骨术,术中见右胫骨下段内侧肉芽样组织,大小约5.0 cm×3.0 cm×2.0 cm,血供丰富,质地较软,压迫胫骨皮质,未见明显骨膜反应。术后病理:镜下见肿瘤细胞呈梭形,胞质弱嗜酸性,胞核长梭形,瘤细胞核呈栅栏状排列(图1D)。免疫组织化学染色:CD117(-),CD34(-),CK(-),Ki-67(5%+),S-100(+),SMA(-),Caldesmon(-),Des(-),Vim(+)。病理诊断:右胫骨下段神经鞘瘤。     

Intraosseous neurilemmoma of the proximal ulna

INTRODUCTION

Neurilemmoma is a benign nerve sheath neoplasm commonly located in the soft tissue. Intraosseous neurilemmoma is rare, constituting less than 1% of primary bone tumors.

PRESENTATION OF CASE

A 21 year-old woman was presented with left elbow pain of 1-month duration. Plain radiographs showed a well-defined, lytic and expansile lesion of the proximal ulna. Computed tomography revealed cortical destruction and soft tissue extension. Because the tissue of origin for the tumor was uncertain, an open biopsy was performed. The specimens demonstrated a benign spindle cell tumor suggestive of a neurilemmoma, similar to a soft tissue neurilemmoma. The diagnosis of intraosseous neurilemmoma was established. Marginal excision of the soft tissue component and curettage of the lesion in the bone were performed. After 3.5 years of follow up, there is no clinical or radiographic finding to suggest any recurrence.

DISCUSSION

The major site of intraosseous neurilemmoma is the mandible. Occurrence in the long bone is particularly rare. Only two cases of intraosseous neurilemmoma involving the bones around the elbow have been reported to our knowledge; these cases arose in the distal humerus. We describe the first case of intraosseous neurilemmoma of the proximal ulna of the left elbow. The recommended treatment is conservative resection and bone grafting, as malignant change is extremely rare.

CONCLUSION

Although very rare, intraosseous neurilemmoma should be taken under consideration in the differential diagnosis of painful, radiographically benign-appearing osseous tumor around the elbow.     

腮腺区面神经鞘膜瘤

通过对 8例腮腺区内面神经鞘膜瘤的分析 ,认为面神经鞘膜瘤术前诊断较为困难 ,术中肿物临床表现与面神经的关系对确定诊断有较大意义 ;保持神经连续而剥离切除肿物未见引起复发 ;保留神经连续性 ,面神经功能的恢复并不理想 ,神经移植或吻合术是必要的     

Solitary cellular schwannoma (neurilemmoma) showing malignant changes: evaluation through magnetic resonance imaging (M.R.I.), surgical intervention, and histopathology

Schwannoma (neurilemmoma) are common benign tumors arising from the peripheral nerve sheath. Malignant transformation is uncommon. A unique case showing such a transformation is reported highlighting the roles of magnetic resonance imaging, surgical intervention, and histopathology. The case was thoroughly investigated by learning the details of the sequence of events leading to the current status. The evaluation was made through magnetic resonance imaging. In addition, computed tomography and conventional radiography were used to locate any foci of calcification. Subsequently, the tumor's gross and microscopic morphology was defined by surgical intervention and histopathology. Malignant schwannoma of the left leg occupying the entire calf is extremely uncommon. Only ten cases have been reported thus far, including the current one from the Indian subcontinent. Malignant transformation in a schwannoma differs significantly from malignant nerve sheath tumors (erroneously called malignant schwannomas). An endeavour has been made to differentiate malignant transformation in schwannoma from other malignant peripheral nerve sheath tumors. An innovation in this direction is magnetic resonance imaging. This investigate procedure is imperative in such situations, along with surgery and histopathology, which may also help in classifying the condition.