Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Carolina Neuroscience Institute, Raleigh, North Carolina, USA.
World Neurosurg. 2014 May-Jun;81(5-6):798-809. doi: 10.1016/j.wneu.2012.11.067. Epub 2012 Nov 24.
Schwannomas originating from the oculomotor nerve are extremely rare. We report our experience in the management of oculomotor schwannomas and other lesions mimicking them, and discuss operative strategy for these rare tumors emphasizing oculomotor nerve preservation.
The clinical records of our patients and all those reported in the literature focusing on oculomotor schwannomas were reviewed and analyzed. The clinical presentations, operative approaches, complications, and results were studied.
Between 1983 and 2010, six patients with primary oculomotor nerve lesions were treated. Three of them had schwannomas. Two others had pathologies that mimicked an oculomotor schwannoma and one was suspected as schwannoma. In the literature there were 55 previous cases of oculomotor schwannomas reported (surgical treated, 41 cases; observed, 9; gamma knife surgery treated, 2; autopsy, 3). Patients presented most commonly with diplopia, followed by headache and ptosis as initial symptoms. Out of 55 patients including the present 3 cases (3 autopsy cases were excluded), 30 patients (54.5%) finally developed oculomotor nerve palsy. Fifteen of 44 patients (34.1%) who underwent surgery developed persistent postoperative oculomotor palsy. Among them, 6 patients developed total palsy after surgery. Five of 12 patients (41.7%) who did not undergo surgery also developed oculomotor palsy. Oculomotor schwannomas most often grow its cisternal segment (48.3%) followed by intracavernous (39.6%) and cisternocavernous segments (12.1%).
The microsurgical resection of oculomotor schwannomas carries a risk of worsening preoperative oculomotor nerve function; however, this is often transient. Considerable technical training and microanatomical knowledge of the region is required to optimize outcome.
起源于动眼神经的神经鞘瘤极为罕见。我们报告了我们在动眼神经神经鞘瘤及其他类似病变的治疗经验，并讨论了这些罕见肿瘤的手术策略，重点是动眼神经的保留。
回顾并分析了我们的患者和所有文献中聚焦于动眼神经鞘瘤的患者的临床记录，研究了临床表现、手术方法、并发症和结果。
1983 年至 2010 年间，治疗了 6 例原发性动眼神经病变患者。其中 3 例患有神经鞘瘤。另外 2 例有类似动眼神经鞘瘤的病变，1 例疑似神经鞘瘤。文献中报道了 55 例动眼神经鞘瘤病例（手术治疗 41 例；观察 9 例；伽玛刀治疗 2 例；尸检 3 例）。患者最常见的表现是复视，其次是头痛和上睑下垂作为首发症状。在包括本研究 3 例患者在内的 55 例患者中（排除 3 例尸检病例），最终有 30 例（54.5%）患者发生动眼神经麻痹。44 例接受手术治疗的患者中有 15 例（34.1%）出现持续性术后动眼神经麻痹。其中，6 例患者术后完全麻痹。12 例未接受手术的患者中有 5 例（41.7%）也发生了动眼神经麻痹。动眼神经鞘瘤最常生长在其脑池段（48.3%），其次是在海绵窦内段（39.6%）和脑池海绵窦段（12.1%）。
动眼神经鞘瘤的显微切除术有加重术前动眼神经功能的风险；然而，这种情况往往是暂时的。需要相当的技术培训和对该区域的显微解剖知识，以优化结果。
