Li Yang, Gao Zhi-qiang, Jiang Hong, Chen Xing-ming, Wu Hai-yan, Feng Guo-dong, Zha Yang
Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Jul;47(7):549-53.
To investigate the diagnosis and treatment of facial nerve schwannomas with facial nerve function House-Brackmann grade (HB) ≤ grade II.
A retrospective study was conducted in Peking Union Medical College Hospital. We reviewed eight cases of facial nerve schwannomas with facial nerve function HB ≤ grade II, which were diagnosed and managed between Jan 1996 and March 2011.
The initial presenting symptoms of the eight patients were not facial paralysis. Eight patients were misdiagnosed and six had mistreatment histry. CT and(or) MRI results in all patients showed that the tumors originated from different part of the facial nerves. All patients received operation. Facial nerves were completely preserved in four patients because of easy separation of the tumors from the facial nerves in surgery, facial function was gradeII-III over 17 - 180 months' follow-up. The tumors were attached with the facial nerves in two patients with wide extension involving cochlea and labyrinth, therefore the tumors were removed together with the attached facial nerves, and the nerves were repaired by using the greater auricular nerves. Facial function was grade VI over 56 - 79 months' follow-up. One patient refused to sacrifice the facial nerve, wide decompression of facial nerve and tumor was undertaken, facial function was grade III over 8 months' follow-up. One chorda tympani neuroma was removed with the branch of the facial nerve, facial function was grade II over 8 months' follow-up.
The facial nerve schwannomas with facial nerve function HB ≤ grade II is difficult to diagnosis. The therapy strategy should depend on the patients' choice, position of the tumor and adherences of the tumor to facial nerve. Facial nerve could be preserved if the tumor is easy to be separated from the facial nerve during operation, if not, total remove the tumor and nerve repairment are indicted when invasion into the inner ear canal, cerebro pontine angle, cochlea or labyrinth. If patients refuse to sacrifice the facial nerve, facial nerve decompression and periodic follow-up are recommended.
探讨面神经功能House-Brackmann分级（HB）≤Ⅱ级的面神经鞘瘤的诊断与治疗。
在北京协和医院进行一项回顾性研究。我们回顾了1996年1月至2011年3月期间诊断和治疗的8例面神经功能HB≤Ⅱ级的面神经鞘瘤病例。
8例患者的首发症状均不是面瘫。8例患者均被误诊，6例有治疗不当史。所有患者的CT和（或）MRI结果显示肿瘤起源于面神经的不同部位。所有患者均接受了手术。4例患者因术中肿瘤与面神经易于分离而面神经得以完全保留，随访17 - 180个月，面部功能为Ⅱ - Ⅲ级。2例患者肿瘤与面神经粘连且广泛累及耳蜗和迷路，因此肿瘤与附着的面神经一并切除，并用耳大神经进行神经修复。随访56 - 79个月，面部功能为Ⅵ级。1例患者拒绝牺牲面神经，进行了面神经广泛减压及肿瘤切除，随访8个月，面部功能为Ⅲ级。1例鼓索神经瘤与面神经分支一并切除，随访8个月，面部功能为Ⅱ级。
面神经功能HB≤Ⅱ级的面神经鞘瘤难以诊断。治疗策略应取决于患者的选择、肿瘤的位置以及肿瘤与面神经的粘连情况。如果术中肿瘤易于与面神经分离，则可保留面神经；如果肿瘤不易分离且侵犯内耳道、脑桥小脑角、耳蜗或迷路，则应切除肿瘤并进行神经修复。如果患者拒绝牺牲面神经，建议进行面神经减压并定期随访。
