舌下神经孔区神经鞘瘤的诊断与显微外科治疗

目的 探讨起源于舌下神经的神经鞘瘤的诊断和手术入路以及手术后并发症的处理。方法 对9例舌下神经鞘瘤的临床症状、影像学特征、生长方式、分型、发病率、手术入路和随访结果进行分析。结果 舌下神经神经鞘瘤仅占同期颅底肿瘤的1．9％,本组病例多数肿瘤呈颅内外哑铃型生长,少数病例病变向颅向生长为主。本组远外侧经髁上入路7例,远外侧－颈部联合入路1例,后颅窝正中入路1例,9例肿瘤全切除。7例得到随访,时间6－36个月,5例恢复工作,1例生活自理,1例生活需要照顾。结论 舌下神经孔毗邻颈静脉孔和枕骨大孔,术前常易误诊为颈静脉孔区肿瘤或枕骨大孔区肿瘤。首发症状以舌肌萎缩最为常见。全切肿瘤是最佳的治疗选择,术后病人预后较好。

Diagnosis and treatment of hypoglossal neurinoma

Objective To investigate the symptoms, diagnosis, operative approaches and prognosis of hypoglossal neurinoma. Methods The clinical symptoms, radiological features, prevalence, operative approaches and prognosis of 9 cases of hypoglossal neurinoma were analyzed. Results Cases of neurinoma of the hypoglossal nerve accounted for 1.9% of the cases of skull base neoplasm in the same period. Most of the tumor was in the shape of dumbbell, involving both intracranial and extracranial segments of the nerve. In a few cases, the tumor mainly involved the intracranial segment of hypoglossal nerve. All the cases were operated on, of which 7 through extreme far lateral approach, 1 through extreme far lateral approach combined with cervical approach, and one through the midline approach. Total resection was achieved in all cases. Follow up was performed in 7 cases, among which 5 cases returned to their work, 1 resumed the ability of self care, and one still required care of others. Conclusion As the hypoglossal canal is next to the jugular foramen and foramen magnum, preoperative diagnosis of the hypoglossal neurinoma is difficult. The most common initial symptom is atrophy of tongue muscle. Radical resection is the best choice of treatment. The extrem far lateral approach is the best approach for operation. The prognosis is inspiring after operation.