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目的 提高舌下神经鞘瘤的诊治水平。方法 回顾性分析 10例舌下神经鞘瘤患者的临床表现、影像学特征、诊断、治疗和随访情况 ,并对我科早期 5例和近期 5例舌下神经鞘瘤的治疗方案及结果进行比较。结果 10例患者均有患侧舌肌萎缩表现 ,颅底CT薄层扫描可以显示骨性舌下神经管 ,但肿瘤较小时不一定能判定肿瘤的存在 ,MRI是最佳的诊断措施。早期 5例均为哑铃型肿瘤 ,其中 2例采用分期手术分别切除肿瘤的颅内部分和颅外部分 ,3例经远外侧入路切除肿瘤 :1例经髁入路 ,2例经髁上入路 ;肿瘤全切除 1例 ,次全切除 4例 ;术后 1例并发脑脊液漏 ,颅内感染 ;Karnofsky预后评分 :良 4例 ,死亡 1例。近期 5例 ,其中 4例 ( 2例哑铃型 ,1例颅内型和 1例管内型 )经改良远外侧入路切除肿瘤 :经枕髁入路 1例 ,经髁上入路 3例 ;1例颅外型肿瘤 2次经颈入路切除肿瘤 :首次手术大部切除肿瘤 ,肿瘤残余部分行伽马刀治疗无效后在导航及内窥镜辅助下再次手术全切除肿瘤 ;肿瘤全切除 4例 ,次全切除 1例 ;术后无并发症发生 ;失访 1例 ,其余 4例Karnofsky预后评分 :优 3例 ,中 1例。近期 5例疗效优于早期 5例。结论 舌下神经鞘瘤罕见 ,手术难度大。根据肿瘤部位和大小设计手术方式 ,尽可能一期全切肿瘤 ,减少侵袭性操作对提高治疗?
Objective To improve diagnosis and treatment of hypoglossal schwannoma. Methods The clinical manifestations, imaging features, diagnosis, treatment and follow-up of 10 cases of hypoglossal schwannoma were retrospectively analyzed. The treatment options and results of 5 cases of hypoglossal schwannoma in the early stage of our department were compared with those of the recent 5 cases . Results All ten patients had lateral tongue muscle atrophy. Skull base CT scan showed the hypoglossal neural tube. However, the smaller the tumor, the less likely to determine the existence of the tumor. MRI is the best diagnostic measure. All 5 cases were dumbbell-typed tumors in the early stage, of which 2 cases were removed the intracranial and extracranial parts of the tumor by staging surgery, and 3 cases were removed by the distal lateral approach: 1 case passed the condyle, 2 cases passed the supracondylar One case had complete tumor resection and four cases had subtotal resection. One case had cerebrospinal fluid leakage and intracranial infection after operation. Karnofsky prognosis score was good in 4 cases and death in 1 case. The recent 5 cases, of which 4 cases (2 dumbbell type, 1 intracranial type and 1 type of tube type) by the far lateral approach to remove the tumor: 1 case of transcranial approach, 3 cases via supracondylar approach; 1 2 cases of extracranial tumors by transcranial approach to remove the tumor: the first surgical resection of most of the tumor, the remaining part of the tumor after gamma knife treatment ineffective navigation and endoscopic assisted re-operation of the total resection of the tumor; tumor resection in 4 cases , Subtotal resection in 1 case; postoperative complications; lost in 1 case, the remaining 4 cases of Karnofsky prognosis score: excellent in 3 cases, in 1 case. The recent 5 cases better than the early 5 cases. Conclusion The hypoglossal schwannoma is rare and difficult to operate. According to the tumor site and the size of the design of surgical procedures, as possible, a total resection of the tumor, reduce the invasive operation to improve treatment?