面神经瘤误诊18例的回顾性分析

 目的   提高临床医师对面神经瘤的认识。方法   回顾分析18例有误诊经历的面神经瘤患者的临床资料,主要包括年龄、性别、临床表现、听力、面神经功能、面神经电图、颞骨CT和MRI结果、手术径路以及术后病理报告。结果   18例患者年龄7～62岁,平均43岁。其中12例患者被误诊为贝尔式面瘫(66.7%),3例患者被误诊为胆脂瘤(16.7%),另外3例患者分别被误诊为颞骨占位、中耳新生物和腮腺肿块。患者被误诊的时间为1～192个月,平均39个月。面神经麻痹(77.8%)和听力下降(66.7%)是最常见的临床表现,耳鸣、耳溢液、面肌痉挛、耳痛和眩晕等症状也较为常见。16例为神经鞘膜瘤(88.9%),面神经纤维瘤和骨血管瘤各1例(5.6%)。结论   若患者面瘫进行性加重,6个月内未见好转；或诊断为中耳炎但抗感染治疗无效者; 或腮腺肿块患者若肿物与面神经关系密切,均应考虑面神经瘤可能。影像学检查和病理学检查对于面神经瘤的诊断至关重要,手术切除是面神经瘤的首选治疗方法,并应积极考虑面神经重建。

A retrospective study on misdiagnoses of 18 patients with facial nerve tumors

Objective   To heighten the clinicians’ awareness of the facial nerve tumors.Methods   Eighteen cases with facial nerve tumors were initially misdiagnosed,and these clinical data were reviewed retrospectively,including age,sex,presentations,hearing threshold,facial nerve function,facial electroneurography (ENoG),temporal bone CT and MRI findings,surgical approaches and postoperative histopathological examination.Results   The 18 patients aged from 7 to 62 years with the average age of 43 years.Twelve cases were misdiagnosed as Bell′s palsy (66.7%),3 cases were misdiagnosed as cholesteatoma (16.7%),and the other 3 patients were diagnosed with space occupying lesion of the temporal bone,neoplasm of middle ear and parotid gland mass, respectively. The duration of patients underwent misdiagnosis ranged from 1 to 192 months,with the mean duration of 39 months.Facial paralysis and hearing loss were the most common presentations,which accounted for 77.8% and 66.7%,respectively.The presentations of tinnitus,otorrhea,spasm,otalgia and vertigo offen accured.In pathological type,16 cases of schwannomas (88.9%),1 case of hemangioma and 1 case of neurofibroma were reported,respectively (5.6%).Conclusions   Patients present the following symptoms or signs should be alert to diagnose as focial nerve tumers: progressive facial nerve paralysis with no improvement of facial nerve paralysis within 6 months,otitis media failed to anti-infective therapy,and a parotid gland mass closely related to the facial nerve.Image and pathological examinations play an important role in the diagnosis of facial nerve tumors.Surgical resection is the best choice for the treatment,and a reconstruction of facial nerve should also be considered.