Sciatic Neurilemoma a Benign Lesion with Potential Devastating Sequelae-A Case Report

坐骨神經鞘瘤一個伴隨潛在嚴重後遺症的良性腫瘤－一病例報告

李曜洲(Yao-Chou Lee) ； 謝式洲(Shyh-Jou Shieh)

《中華民國整形外科醫學會雜誌》 18卷4期 (2009/12) Pp. 381-387

https://doi.org/10.7096/JPSA.200912.0381

摘要

背景：
神經鞘瘤是一種良性的神經鞘膜腫瘤，儘管神經鞘瘤是個良性腫瘤，但它也可造成嚴重的手術併發症，像是開刀過程中傷害到鄰近的神經，造成不可挽回的神經缺損，這種情況尤其在腫瘤體積較大或位於較深的位置時更容易發生。
目的及目標：
透過完整的報告一個罕見的坐骨神經鞘瘤，增加外科醫師對這個良性腫瘤的熟悉度，來避免掉令人無法接受的災難性後遺症。
材料及方法：
一個四十七歲的婦女，最近兩個多月抱怨右大腿後側有一腫塊，相關的檢查疑似為神經源起之腫瘤，最大直徑為4.8公分，術中發現腫瘤本身被撐開的坐骨神經束包覆住，而腫瘤可在小心剝開這些神經束後被移除掉，坐骨神經可被完全的保留而不需要犧牲。病理報告證實為良性的神經鞘瘤。
結果：
手術後病人症狀獲得解除且無任何神經學上的後遺症。
結論：
我們相信對於這個疾病有良好的知識和謹慎的手術技巧，是成功處理坐骨神經鞘瘤的必要條件，手術最重要的原則是「不傷害」，也就是在切除神經鞘瘤的過程中，要儘量保留神經的完整性。

並列摘要

Background:
A neurilemoma, also known as a schwannoma, is a benign nerve sheath tumor. Although the neurilemoma is benign, it poses potential severe surgical complications such as an iatrogenic injury causing an irreversible deficit to the involved nerve, especially when the tumor is large and deep-seated.
Aim and Objectives:
By presenting a rare case of sciatic neurilemoma thoughtfully, surgeons may increase the familiarity of this benign lesion to avoid the unexpected devastating sequelae.
Materials and Methods:
A 47-year-old woman complained of a right posterior thigh mass that she had discovered two months earlier. Serial examinations showed a large neurogenic tumor about 4.8 cm in maximal diameter originating from the right sciatic nerve. Intraoperatively, we found the tumor encapsulated by the stretching nerve fibers. It was feasible to peel off these fibers from the tumor; therefore, we removed the tumor without severing the sciatic nerve. The pathology confirmed the diagnosis of neurilemoma.
Results:
This patient recovered uneventfully without any neurological sequelae.
Conclusion:
We believe that complete familiarity with the specific lesion, respect for the involved soft tissue, and meticulous surgical techniques are required to manage a deep-seated sciatic neurilemoma. The main principle is ”Do No Harm”, which means that the innocent nerve should be protected.

並列關鍵字

neurilemoma ； nerve sheath tumor ； ciatic nerve ； schwannoma