CAJ | 학술논문

目的：探讨面神经肿瘤的临床特点、影像学特征、鉴别诊断、手术入路、肿瘤切除后面神经的修复方法和效果。方法通过检索Pubmed、Medline、LWW、Elsevier、Springer等英文数据库以及中国知网、维普等中文数据库，检索出2002年至今报道面神经肿瘤的文献，结合我们自己诊治的病例，对文献报道的面神经肿瘤病例进行归纳、总结及分析。结果共检索出文献23篇，报道的病例共计354例。354例面神经肿瘤患者的平均发病年龄是43.90岁，男女比例1：1.1。面瘫、听力下降、耳鸣是最常见的临床症状。354例患者中有271例报告了术前面神经功能H-B分级，其中H-BⅠ级113例，H-BⅡ级30例，H-BⅢ级38例，H-BⅣ级29例，H-BⅤ级29例，H-BⅥ级32例。面神经水平段、膝状神经节是最易受累部位。手术入路根据肿瘤位置及是否保留听力选择，乳突入路及迷路入路最常用。面神经修复方式根据面神经缺损长度、面神经中枢断端能否利用选择，耳大神经移植吻合是最常用的面神经修复方法。随访病例共208例，术后面神经功能H-BⅠ级34例，Ⅱ级27例，Ⅲ级76例，Ⅵ级48例，Ⅴ级6例，Ⅵ级17例。结论面瘫、听力下降、耳鸣是面神经肿瘤常见的临床症状，对于不明原因的特发性面瘫患者，要考虑面神经肿瘤的可能；面神经水平段及膝状神经节是肿瘤好发部位；手术入路要根据肿瘤的位置、大小以及是否保留残余听力来选择；术前面神经功能越好，获得良好预后的可能性越大
목적：탐토면신경종류적림상특점、영상학특정、감별진단、수술입로、종류절제후면신경적수복방법화효과。방법통과검색Pubmed、Medline、LWW、Elsevier、Springer등영문수거고이급중국지망、유보등중문수거고，검색출2002년지금보도면신경종류적문헌，결합아문자기진치적병례，대문헌보도적면신경종류병례진행귀납、총결급분석。결과공검색출문헌23편，보도적병례공계354례。354례면신경종류환자적평균발병년령시43.90세，남녀비례1：1.1。면탄、은력하강、이명시최상견적림상증상。354례환자중유271례보고료술전면신경공능H-B분급，기중H-BⅠ급113례，H-BⅡ급30례，H-BⅢ급38례，H-BⅣ급29례，H-BⅤ급29례，H-BⅥ급32례。면신경수평단、슬상신경절시최역수루부위。수술입로근거종류위치급시부보류은력선택，유돌입로급미로입로최상용。면신경수복방식근거면신경결손장도、면신경중추단단능부이용선택，이대신경이식문합시최상용적면신경수복방법。수방병례공208례，술후면신경공능H-BⅠ급34례，Ⅱ급27례，Ⅲ급76례，Ⅵ급48례，Ⅴ급6례，Ⅵ급17례。결론면탄、은력하강、이명시면신경종류상견적림상증상，대우불명원인적특발성면탄환자，요고필면신경종류적가능；면신경수평단급슬상신경절시종류호발부위；수술입로요근거종류적위치、대소이급시부보류잔여은력래선택；술전면신경공능월호，획득량호예후적가능성월대
Objective To discuss on clinical features, radiological characteristics, differential diagnosis and surgical approaches in treating facial nerve tumors and repairing the nerve, as well as treatment outcomes. Methods Cases of facial nerve tumor cases reported after 2002 in Pubmed, Medline, LWW, Elsevier, Springer, CKNI and CQVIP were reviewed in comparison to cases treated by the authors. Results A total of 23 reports were identified covering a total of 354 cases. The average onset age 43.90 years and sex ratio was 1:1.1. Facial palsy, hearing loss and tinnitus were the most common present-ing symptoms. In 271 of the 354 cases, facial nerve function before operation were reported (normal=113, House-Brackman grade II=30, H-B grade III=38, H-B grade IV=29, H-B grade V=29, H-B grade VI=32. The horizontal segment and geniculate ganglion were the most location of involvement. Surgical approach selection depended on tumor location and hear-ing level before operation. Mastoid and labyrinthine approach were commonly used. Facial nerve repairing method was dictat-ed by the length of facial nerve defect and the availability of facial nerve stump . Greater auricular nerve grafts were the most common material used to repair facial nerve in our cases. Of the 208 cases with followed-up data, facial function reached H-B grade I in 34 cases, H-B grade II in 27 cases, H-B grade III in 76 cases, H-B grade IV in 48 case s, H-B grade V in 6 cases and H-B grade VI in 17 cases. Conclusion Facial palsy, hearing loss and tinnitus are the most common symptoms in facial nerve tumors. The seemingly impossible facial nerve tumors must be considered in patients with facial palsy. The hori-zontal segment and geniculate ganglion are most often involved in facial nerve tumors. Selection of operation approach is de-termined by the location and site of the tumor and if residual hearing is to be preserved. Facial nerve repair should be consid-ered unless examination indicates complete loss of facial function and electromyography shows no action potentials before op-eration. Better facial nerve function before operation often suggest better prognosis of facial function recovery.