Amano Toshiyuki, Sangatsuda Yuhei, Hata Nobuhiro, Inoue Daisuke, Mori Megumu, Nakamizo Akira, Yoshimoto Koji, Mizoguchi Masahiro, Sasaki Tomio
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka 812-8582, Japan.
Neurol Med Chir (Tokyo). 2013;53(4):242-4. doi: 10.2176/nmc.53.242.
A 74-year-old female suffered hearing disturbance in the right ear persisting for several years, followed by sudden onset of right facial nerve palsy. Her symptoms gradually worsened and neuroradiological imaging revealed a 4-cm cerebellopontine angle (CPA) tumor. Intraoperatively, the tumor was found to originate from the facial nerve. Total removal of the tumor was achieved, followed by a split hypoglossal-facial nerve anastomosis. Facial nerve schwannomas are rare and extremely difficult to preoperatively distinguish from vestibular schwannomas, especially if arising from the CPA and the internal auditory canal. However, preoperative diagnosis of facial nerve schwannomas is important because functional preservation of the facial nerve is more challenging than for vestibular schwannomas. Facial nerve palsy is one of the most unique symptoms in patients with facial nerve schwannomas, but is rare with vestibular schwannomas. Facial nerve schwannomas should be included in the differential diagnosis of CPA tumors with atypical clinical manifestations, and patients should be informed before surgery of the possibility of facial nerve dysfunction and the consequent need for facial nerve graft or reconstruction.
一名74岁女性右耳听力障碍持续数年，随后突然出现右侧面神经麻痹。其症状逐渐加重，神经影像学检查显示桥小脑角（CPA）有一个4厘米的肿瘤。术中发现肿瘤起源于面神经。肿瘤被完全切除，随后进行了舌下-面神经吻合术。面神经鞘瘤罕见，术前极难与前庭神经鞘瘤区分，尤其是起源于CPA和内耳道的情况。然而，面神经鞘瘤的术前诊断很重要，因为保留面神经功能比前庭神经鞘瘤更具挑战性。面神经麻痹是面神经鞘瘤患者最独特的症状之一，但在前庭神经鞘瘤中很少见。面神经鞘瘤应纳入具有非典型临床表现的CPA肿瘤的鉴别诊断中，术前应告知患者面神经功能障碍的可能性以及随之而来的面神经移植或重建的必要性。
