Chennupati Sri Kiran, Schipor Ioana, Mirza Natasha
Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Laryngoscope. 2006 Nov;116(11):2086-8. doi: 10.1097/01.mlg.0000235940.10124.52.
This case report describes the excision of a large neck neurofibroma causing compression of the esophagus and airway in a young patient with neurofibromatosis type 2 (NF2). At the conclusion of this article, readers should be able to describe a novel method of excising large encapsulated neck masses using microdebridement for decompression. The safety and efficacy of this method is discussed.
The subject of this report was a 26-year-old woman with NF2. She presented with an enlarging right neck mass extending from the mandible to the clavicle that was compressing both her airway and esophagus. Given her auditory brainstem implant, unipolar cautery was contraindicated. Therefore, it was planned to decompress the patient's neck mass using a microdebrider before attempting to fully dissect out the mass.
The neck mass was exposed and then entered. Using a Xomed XPS microdebrider (Medtronic Inc., Minneapolis, MN), the mass was debrided and debulked in all directions taking care not to violate the capsule. After this, the entire capsule was dissected out using only bipolar cautery and suture ligatures for hemostasis.
Microdebrider decompression of the neck neurofibroma allowed for preservation of the capsule without injuring vital structures in the neck. Postoperatively, the patient's swallowing and laryngeal function improved markedly.
Microdebrider debulking before dissection of the patient's large neck mass safely relieved compression of the airway and esophagus. This method may be applied to other large benign masses in the neck as well.
本病例报告描述了一名患有2型神经纤维瘤病（NF2）的年轻患者，其颈部巨大神经纤维瘤压迫食管和气道，对该肿瘤进行切除的过程。在本文结尾，读者应能够描述一种使用微型清创术切除颈部巨大包膜性肿块以实现减压的新方法。本文还讨论了该方法的安全性和有效性。
本报告的研究对象是一名26岁的NF2女性患者。她右侧颈部有一肿块不断增大，从下颌骨延伸至锁骨，压迫气道和食管。鉴于她已植入听觉脑干植入物，禁忌使用单极电灼术。因此，计划在尝试完整切除肿块之前，先用微型清创器对患者颈部肿块进行减压。
暴露颈部肿块后进入肿块内部。使用Xomed XPS微型清创器（美敦力公司，明尼阿波利斯，明尼苏达州），从各个方向对肿块进行清创和减容，注意不要破坏包膜。之后，仅使用双极电灼术和缝合结扎止血，完整切除整个包膜。
使用微型清创器对颈部神经纤维瘤进行减压，得以保留包膜且未损伤颈部重要结构。术后，患者的吞咽和喉部功能明显改善。
在切除患者颈部巨大肿块之前，先用微型清创器减容可安全缓解气道和食管的压迫。该方法也可应用于颈部其他大型良性肿块。
