Tsutsumi Satoshi, Mishima Yumiko, Nonaka Yasuomi, Abe Yusuke, Yasumoto Yukimasa, Ito Masanori
Department of Neurosurgery, Juntendo University Urayasu Hospital, Chiba, Japan.
No Shinkei Geka. 2010 Nov;38(11):1019-24.
A 33-year-old male sustained hearing disturbance in the left ear that exacerbated over a period of three years. The patient was referred to the department of otorhynolaryngology for severe stenosis of the left external auditory canal, where neuroimaging study revealed a huge tumor in the left temporal fossa. On first examination, he showed a significant facial nerve paresis and conductive hearing loss. CT scans identified a 4.5×4.5×4.5 cm mass with intralesional calcification and extensive bony destruction in the squamous and petrous parts of the temporal bone and middle cranial fossa floor. MR imaging demonstrated the tumor of heterogenous intensity on T1-and hypointensity on T2-weighted image. The patient underwent gross total resection of the lesion via frontotemporal craniotomy. The bony and ligamentous structures around the temporomandibular joint appeared mostly intact and did not need any reconstructive surgery after tumor resection. Postoperatively the patient's facial nerve paresis showed a transient exacerbation which resolved gradually, while hearing disturbance did not improve. Histological findings of the tumor were consistent with the qualities of chondroblastoma. We should assume chondroblastoma as differential diagnosis when we encounter a temporal bone tumor that is curable by surgical resection.
一名33岁男性左耳出现听力障碍,在三年时间里逐渐加重。该患者因左外耳道严重狭窄被转诊至耳鼻喉科,神经影像学检查显示左颞窝有一个巨大肿瘤。初次检查时,他表现出明显的面神经麻痹和传导性听力损失。CT扫描发现一个4.5×4.5×4.5 cm的肿块,病灶内有钙化,颞骨鳞状部和岩部以及中颅窝底有广泛骨质破坏。磁共振成像显示该肿瘤在T1加权像上呈不均匀信号强度,在T2加权像上呈低信号。患者通过额颞开颅术接受了病灶的全切除。颞下颌关节周围的骨质和韧带结构大多完好,肿瘤切除后无需任何重建手术。术后患者的面神经麻痹出现短暂加重,随后逐渐缓解,而听力障碍没有改善。肿瘤的组织学检查结果与软骨母细胞瘤的特征相符。当遇到可通过手术切除治愈的颞骨肿瘤时,我们应将软骨母细胞瘤作为鉴别诊断之一。