Saetia Kriangsak, Larbcharoensub Noppadol, Wetchagama Narongdet
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2011 Aug;94(8):1002-7.
Oculomotor nerve schwannomas are extremely rare tumors. There are only 40 cases reported in the literature. There is no standard treatment for these rare tumors.
The authors have reported a case of a 41-year-old Thai man presenting with progressive visual loss of the left eye for 6 months without diplopia. Visual acuity was 20/70 in the right and 20/400 in the left. There was no limitation of eye movement. MRI showed a 42.5 ml mass in the suprasellar region compatible with a schwannoma. The patient underwent a leftpterional craniotomy with partial tumor removal. The pathological section confirmed a diagnosis of schwannoma and the patient received postoperative stereotactic radiotherapy
Options for treating these rare tumors include clinical observation, surgical resection or stereotactic radiation. High incidence of complete third nerve palsy following surgery has been reported in the literature. Therefore, a subtotal removal of large oculomotor schwannoma followed by stereotactic radiotherapy could provide a safer alternative compared to radical surgery.
动眼神经鞘瘤是极其罕见的肿瘤。文献中仅报道了40例。对于这些罕见肿瘤尚无标准治疗方法。
作者报告了一例41岁泰国男性，左眼渐进性视力丧失6个月，无复视。右眼视力为20/70，左眼为20/400。眼球运动无受限。磁共振成像（MRI）显示鞍上区有一个42.5毫升的肿块，符合神经鞘瘤表现。患者接受了左翼点开颅术并部分切除肿瘤。病理切片确诊为神经鞘瘤，患者术后接受了立体定向放射治疗。
治疗这些罕见肿瘤的选择包括临床观察、手术切除或立体定向放疗。文献报道手术后完全性动眼神经麻痹的发生率较高。因此，与根治性手术相比，次全切除大型动眼神经鞘瘤后再进行立体定向放疗可能是一种更安全的选择。
