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顱外非前庭性頭頸部神經鞘瘤-40並例分析

Extracranial Non-vestibular Head and Neck Schwannomas-Analysis of Forty Cases

摘要


背景:顱外非前庭性頭頸部神經鞘瘤是源於神經鞘的良性腫瘤,本篇主要針對在台北榮民總醫院接受治療的病患進行分析,對於此腫瘤的好發症狀、發生位置、術前診斷方式、手術方法以及治療效果作一探討。方法:回溯性收集自1993年~2007年,在本部治療之顱外非前庭性頭頸部神經鞘瘤,其腫瘤的部位必須局限於頭頸部,且排除顱內、前庭部侵犯及神經纖維瘤病的病例,進行臨床分析。並依腫瘤移除方法,分為切除(resection)及剝除(enucleation)兩組,分析影響治療效果的相關因子。結果:本研究包含40名病患,男性佔55%。80%發生在頸部,95%以單一腫塊表現。電腦斷層及磁振造影檢查的診斷率分別為72.7%及75%。術中辨識出源發神經的比例為67.5%,以迷走神經最多佔11例。將23名腫瘤源發於運動神經的病患加以分析,術後運動神經功能異常的比例,腫瘤切除組的17名病人中有13名(76.5%),腫瘤剝除組的6名病人中有3名(50%),兩組無統計學上的顯著差異。平均追蹤時間48個月,40名病人皆無腫瘤復發之情形發生。結論:在顱外非前庭性頭頸部神經鞘瘤的病患中,最常發生的症狀是單一腫塊。術前的首選診斷工具為磁振造影檢查。在治療方面以手術移除為主,術前必須完整告知病人手術的風險以及可能造成的神經傷害,手術目標除了移除腫瘤外,應盡力維持神經功能完整性,以減少術後併發症的發生。(台耳醫誌 2012; 47:56-62)

關鍵字

神經鞘瘤 顱外 非前庭性 頭頸部 切除

並列摘要


BACKGROUND: Extracranial non-vestibular head and neck schwannomas are benign nerve sheath neoplasms. This study analyzed epidemiology, presenting symptoms and signs, anatomical location, diagnostic modality, surgical approach, and treatment outcome of 40 cases in the Department of Otolaryngology Head and Neck Surgery of Taipei Veterans General Hospital.METHODS: Retrospective chart reviews were performed for patients with extracranial head and neck schwannoma from 1993 to 2007 under the exclusion criteria of intracranial or vestibular invasion and neurofibromatosis. Patients were separated into resection and enucleation groups. Potentially significant variables for treatment outcome were analyzed.RESULTS: The final analysis comprised 40 patients. Male patients accounted for 55%. Most of the patients were symptomatic of solitary mass (95%). Eighty percent of tumors were located in the neck area. The predictive rate of schwannomas via CT and MRI are 72.7% and 75%, respectively. The rate of original nerve identification of tumors is 67.5%, and 11 tumors originated in the vagus nerve. 23 patients with schwannomas originated in motor nerves were analyzed. Of the patients who received tumor resection procedures, 13 patients (76.5%) suffered functional defects in motor nerves. Of the six patients who received tumor enucleation procedures, three patients (50%) suffered complications, resulting in nerve function impairment (P > 0.05). Neither malignant transformation nor tumor recurrence was noted in 40 patients after the median followup time of 48 months.CONCLUSION: For patients suffering from extracranial non-vestibular head and neck schwannomas, the most evident symptom is solitary mass. MRI is recommended for pre-operative evaluation. The preferred treatment is surgical removal. Prior to the operation, the surgeon must thoroughly discuss the treatment plan with patients, and explain the risk of nerve function impairment after surgery. During the operation, the surgeon should especially attempt to preserve affected nerves and functional integrity for optimal treatment outcome. (J Taiwan Otolaryngol Head Neck Surg 2012; 47:56-62)

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