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颈段迷走神经鞘瘤:病例报告

Cervical vagal schwannoma: single case report.

作者信息

Bracale Umberto, Sodo Maurizio, Strazzullo Tommasina, Scotto Bruno, Spera Emanuele, Di Salvo Enrico

机构信息

Dipartimento di Scienze Chirurgiche, Anestesiologiche-Rianimatorie e dell' Emergenza.

出版信息

Ann Ital Chir. 2013 May 28;84(ePub):S2239253X13021130.

Abstract

Schwannomas of the cervical vagal nerve are rare neoplasms, usually occurring between the third and the sixth decade of life. They don't demonstrate any sex predilection, and they often present as slow-growing, palpable neck masses, leftright sided, without early neurological symptoms, and they are often confused with enlarged lymphnodes or lipomas. Several differential diagnosis should be considered. Imaging techniques are largely used to define their etiology. If they are considered primary to evaluate their relationship with surrounding structures (i.e. omolateral neck vessels and nerves, oesophagus, trachea), they don't always result decisive for a correct differential diagnosis. Surgical excision is the treatment of choice: when technically possible, nerve sparing technique has to be preferred to en-bloc resection, because of the possibility of neurological outcomes such as dysphonia, dysphagia, hoarseness, vocal cord paralysis after surgical therapy. We report our case about a 34 years-old male, evaluating differential diagnosis course, choosing the correct therapy in relation with literature cases, and including new techniques for post-operative outcomes, such as injectable soft-tissue bulking agent performed in the last years to ameliorate dysphonia after nerve trunk injury.

摘要

颈迷走神经鞘瘤是一种罕见的肿瘤,通常发生在30至60岁之间。它们没有明显的性别倾向,常表现为生长缓慢、可触及的颈部肿块,左右侧均可出现,早期无神经症状,常被误诊为肿大的淋巴结或脂肪瘤。应考虑多种鉴别诊断。影像学技术在很大程度上用于确定其病因。如果将其视为原发性肿瘤以评估其与周围结构(即同侧颈部血管和神经、食管、气管)的关系,它们并不总是对正确的鉴别诊断起决定性作用。手术切除是首选的治疗方法:在技术可行的情况下,由于手术治疗后可能出现诸如发音困难、吞咽困难、声音嘶哑、声带麻痹等神经学后果,保留神经的技术应优于整块切除。我们报告了一例34岁男性病例,评估了鉴别诊断过程,根据文献病例选择了正确的治疗方法,并介绍了改善术后预后的新技术,如近年来用于改善神经干损伤后发音困难的可注射软组织填充剂。

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