CAJ | 학술논문

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T2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.
목적 분석원발성면신경종류적림상특정,제고대원발우면신경적종류진단화치료적인식.방법 회고성분석자료완정、병리진단명학적10례면신경류환자적림상자료.면신경공능평고채용House-Brackmann분급.결과 수발증상이면신경마비발병병진행성가중7례;이이부류농8년、이후종통반면신경마비2주급증입원1례;단순면부종물1례;이이하종물10년、종물종창극통반면신경마비입원1례.7례환자행CT검사,5례동시행MRI검사,6례통과영상학검사발현종물위우면신경불동부위.4례MRI검사균표현이장T1장T2신호위주적불균균신호영,1례MRI무명현양성정상발현.2례표현위면부혹시선부위종물적환자B초현시위병변구적실성점위.환자균행수술치료,9례환자완전절제종류,무복발,1례부분절제종류;완정척제종류화부분절제종류각1례,술후면신경공능무변화;완정절제보류부분면신경섬유2례,면신경공능균개선,행면신경수복4례,실패1례,개선3례.결론 면신경류가루급면신경적다개부위,림상표현이진행성면신경마비다견;대우면신경종류적치료응해고필도면신경적공능、생장적속도、수술적경험화환자적의원등인소종합판단;경위유효적치료방법환수요적겁탐색.
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.