顱外頭頸部神經鞘瘤手術切除後的神經缺損

Post-operative Neurological Deficits of Extracranial Schwannoma of the Head and Neck

黃正池(Cheng-Chih Huang) ； 蔡森田(Sen-Tien Tsai)

《台灣耳鼻喉頭頸外科雜誌》 40卷1期 (2005/01) Pp. 33-37

https://doi.org/10.6286/2005.40.1.33

摘要

背景：頭頸部神經鞘瘤是一少見的良性腫瘤，術前很難確定診斷及神經起源。本研究的目的，是要對於此腫瘤手術切除後的神經缺損，加以探討及分析。
方法：從1988年11月至2002年4月，本院共經歷30例接受手術切除，且病理切片確認為頭頸部神經鞘瘤之病患，針對其症狀、腫瘤位置、治療方式、併發症以及預後等加以分析探討。
結果：男性16例，女性14例，平均年紀為43.7歲。1例於右舌側，l例於右耳後，其餘28例位於頸部。位於頸部之病例中，19例位於側頸部，5例位於鎖骨上區，4例只能經由口腔看到其咽部有突出的腫塊。臨床症狀依次為無痛性腫塊(96%)、呑嚥困難(l0%)、聲音改變(6.7%)、四肢麻木(6.7%)。術後產生Horner's syndrome有4例(l3.3%)、舌萎縮有3例(l0%)、上肢肌力降低有3例(l0%)、聲帶麻痺有2例(6.7%)、四肢張力增加及麻木有2例(6.7%)、肩下垂有l例(3%)，l例(3%)產生同側聲帶麻痺、舌萎縮及軟齶麻痺，14例(46.7%)於術後無任何神經缺損。目前為止並無病例有腫瘤復發現象。
結論：神經鞘瘤是頭頸部腫塊中必須列入鑑別診斷的項目之一，手術切除是唯一確定診斷的方法。由於術後有53.3%的病例產生神經缺損，因此術前的預後說明非常重要，只要適當的切除，須再次接受手術的機會非常低。

關鍵字

神經鞘瘤 ； 頭頸部 ； 神經缺損

並列摘要

BACKGROUND: Head and neck schwannoma is a rare, benign neoplasm which is difficult to definitively diagnose prior to surgery. The post-operative neurological deficits rate remains high.
METHODS: Thirty cases of pathologically proven extracranial head and neck schwannomas treated between November 1988 and April 2002 were retrospectively reviewed. Gender, symptoms and signs, tumor location, neurological deficits and prognosis were collected and analyzed.
RESULTS: Sixteen of the thirty subjects were male. The mean age was 43.7 years (range: 10 to 74). Except for one tumor within the tongue and one in the posterior auricular area, the other 28 tumors affected the neck. The clinical symptoms were as follows: painless mass (96%), dysphagia (10%), voice changes (6.6%), and limb numbness (6.6%). Neither vocal palsy nor Homer's syndrome were found before surgery. Postoperative neurological deficits included four cases (13.3%) with Homer's syndrome, three cases (l0%) with tongue atrophy, three cases (l0%) with upper limb weakness, two cases (6.6%) with vocal palsy, two cases (6.7%) with increasing limb spasticity, one case (3.3%) with vocal palsy combined with tongue atrophy and soft palate palsy and one case (3.3%) with a drop shoulder. Fourteen (46.7%) did not develop any neurological deficits. There was no tumor recurrence during the follow up period.
CONCLUSION: Schwannoma should be considered in the differential diagnosis of neck masses. Since over fifty percent of patients will develop neurological deficits after excision, patients must always be informed of the possible neurological deficits before surgery.

並列關鍵字

schwannoma ； head and neck ； neurological deficit