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。

Surgical management for 11 cases of schwannoma of facial nerve

Objective: To investigate the diagnosis and surgical management of schwannoma of facial nerve(SFN) and discuss the methods of repairing of facial nerve after operation. Methods: Of all 11 patients with SFN,up to 100% had been misdiagnosed.All 6 cases with simple mastoid-tympanic cavity SFN underwent nerve transplantation,and in 5 of them great auricular nerve was transplanted and in 1 great auricular nerve was bridged with dried and heated skeletal muscle.And in 2 cases with tympanic-mastoid cavity-intracranial SFN,1 underwent hypoglossal nerve transplantation to replace the facial nerve(loop of hypoglossal nerve was transplanted to replace the hypoglossal nerve),while the other 1 underwent loop of hypoglossal nerve transplantation into the distal end of facial nerve.All other patients had suffered from facial palsy for a long time and their facial nerve functions could not be recovered and only 1 of them underwent fascia lata femoris musculus orbicularis oris ventrofixation,while others gave up the reconstruction of facial nerve.Results: Three patients with mastoid-tympanic cavity-parotic gland SFN and intra-cranial tumor,not receiving reconstruction of facial nerve,were left with complete facial palsy.In 6 cases with simple mastoid-tympanic cavity SFN,the functional recovery of facial nerves was graded with Brakmann-House gradings in 5 cases: grade 2 in 3 cases;grade 3 in 2;recovery was not found in 1 case.Two cases whose facial nerves were reconstructed with hypoglossal nerve and loop of hypoglossal nerve were graded as level 2 and level 3, respectively.Conclusion: We believe that clinical manifestations of schwannoma of facial nerve are variform,and all round and systemic KG*3]inspections should be performed to prevent misdiagnosis when necessary.After complete excision of the tumor,facial nerve redirect anastomosis and facial nerve transplantation can be performed,and the broken ends can be protected by sleeve-jointing with veins and by adhesion with oto-encephalo glue.The bridging of heated skeletal muscles can be applied clinically.