原发性面神经肿瘤的临床分析

目的分析原发性面神经肿瘤的临床特征，提高对原发于面神经的肿瘤诊断和治疗的认识。方法回顾性分析资料完整、病理诊断明确的10例面神经瘤患者的临床资料。面神经功能评估采用House—Brackmann分级。结果首发症状以面神经麻痹发病并进行性加重7例；以耳部流脓8年、耳后肿痛伴面神经麻痹2周急症入院1例；单纯面部肿物1例；以耳下肿物10年、肿物肿胀剧痛伴面神经麻痹入院1例。7例患者行CT检查，5例同时行MRI检查，6例通过影像学检查发现肿物位于面神经不同部位。4例MRI检查均表现以长T1长1、2信号为主的不均匀信号影，1例MRI无明显阳性征象发现。2例表现为面部或腮腺部位肿物的患者B超显示为病变区的实性占位。患者均行手术治疗，9例患者完全切除肿瘤，无复发，1例部分切除肿瘤；完整剔除肿瘤和部分切除肿瘤各1例，术后面神经功能无变化；完整切除保留部分面神经纤维2例，面神经功能均改善，行面神经修复4例，失败1例，改善3例。结论面神经瘤可累及面神经的多个部位，临床表现以进行性面神经麻痹多见；对于面神经肿瘤的治疗应该考虑到面神经的功能、生长的速度、手术的经验和患者的意愿等因素综合判断；更为有效的治疗方法还需要积极探索。

Clinical analysis of primary facial nerve neuroma

OBJECTIVE: To analyze the clinical features of facial nerve neuroma about its diagnosis and management. METHODS: Ten patients with facial nerve neuroma were analyzed retrospectively from February 1993 to August 2005. The period of follow-up varied from 1.5 years to 10 years (mean 5 years). Facial nerve function was evaluated with House-Brackmann grading system. RESULTS: The patients complained of facial paralysis in 7 cases, otitis media in 1 case, a mass in parotid gland in 1 case and a mass on the side of the orbital on face in 1 case. Seven patients were undergone either CT scan or MRI or both. Image studies revealed mass located along the facial nerve course from the nerve endings to the intracranial parts. All the patients accepted the surgery. Intraoperative findings showed that the tumor location matched the image findings. Postoperative pathological diagnosis demonstrated 8 Schwannoma, 2 neurofibroma. There was partial tumor resection in 1 patient accepted and his nerve function was unchanged. Four patients were undergone facial nerve graft but 1 case failed while facial nerve function was improved in 3 other patients. Two patients underwent tumor resection while the continuity of facial nerve was preserved as result their facial nerve function improved respectively. No facial nerve reconstruction was done on other 2 patients. CONCLUSIONS: Multiple origins of facial nerve neuroma were noted and the most common system was facial nerve palsy. The decision on how to treat these patients should be individualized and based on initial facial function, growth rate, surgical experience and informed patient consent. The more effective methods need being seeked for the management of facial nerve neuroma.