Nakagawa Toru, Uchida Koichi, Ozveren Mehmet Faik, Kawase Takeshi
Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
Surg Neurol. 2004 Jun;61(6):559-63; discussion 563. doi: 10.1016/S0090-3019(03)00580-9.
Only 2 cases of abducens nerve schwannoma solely inside the cavernous sinus have been reported. In both cases, abducens nerve palsy remained after operation. We report the first case of abducens nerve schwannoma inside the cavernous sinus proper with postoperative recovery from abducens nerve palsy.
The patient was a 47-year-old female who developed left abducens and trigeminal nerve palsies. Neuroradiological examination revealed left intra-cavernous sinus tumor. Total removal of the tumor was performed. The location of the tumor was confirmed intraoperatively inside the cavernous sinus itself, with no relation to the trigeminal nerve. Further, the relation of the tumor to one particular nerve fiber within the abducens nerve bundle was confirmed inside the cavernous sinus. After surgery, the patient had transient abducens nerve palsy. It had totally disappeared by 6 months.
When the tumor origin is just within the spacious cavernous sinus rather than more posterior in the narrow dural tunnel of Dorello's canal, successful preservation of the nerve function is possible postoperatively through a thorough knowledge of the membranous anatomy and careful preoperative study of the radiographic findings.
仅报道过2例海绵窦内孤立的展神经鞘瘤。这2例患者术后均遗留展神经麻痹。我们报道首例原发于海绵窦内的展神经鞘瘤患者,术后展神经麻痹得以恢复。
患者为47岁女性,出现左侧展神经和三叉神经麻痹。神经影像学检查发现左侧海绵窦内肿瘤。遂行肿瘤全切术。术中证实肿瘤位于海绵窦内,与三叉神经无关。此外,在海绵窦内确定了肿瘤与展神经束内一条特定神经纤维的关系。术后患者出现短暂性展神经麻痹,6个月后完全消失。
当肿瘤起源于宽敞的海绵窦内,而非更靠后的狭窄的Dorello管硬脑膜通道时,通过深入了解膜性解剖结构并仔细术前研究影像学表现,术后有可能成功保留神经功能。