Bacciu Andrea, Medina Marimar, Ben Ammar Mehdi, D'Orazio Flavia, Di Lella Filippo, Russo Alessandra, Magnan Jacques, Sanna Mario
Department of Clinical and Experimental Medicine, Otolaryngology Unit, University-Hospital of Parma, Parma, Italy
Gruppo Otologico Piacenza, Rome, Italy University of Chieti, Chieti, Italy.
Ann Otol Rhinol Laryngol. 2014 Sep;123(9):647-53. doi: 10.1177/0003489414528673. Epub 2014 Apr 4.
This study aimed to report our experience in the management of patients with intraoperatively diagnosed intracranial facial nerve schwannomas (FNSs) and propose a decision-making strategy.
Twenty-three patients with FNS of the internal auditory canal and/or cerebellopontine angle operated on between 1992 and 2012 were identified.
Preoperatively, all cases have been radiographically diagnosed as vestibular schwannomas. Operative procedures consisted of total tumor resection with grafting in 43.4% of patients, near-total resection leaving behind the tumor capsule overlying the facial nerve in 21.7%, total tumor resection with preservation of anatomic continuity of the facial nerve in 13%, and subtotal resection in 4.3%. Four patients (17.4%) underwent bony decompression with no tumor removal.
Management of FNS diagnosed at surgery represents a significant clinical challenge. We considered total tumor resection with grafting when patients presented with preoperative facial nerve palsy (≥ grade III). Both subtotal and near-total tumor removal can be performed in patients with preoperative good facial function and/or large tumors with brainstem compression. Patients with small tumors who were selected for hearing preservation surgery can be considered for bony decompression. Fascicle preservation surgery may be an option when a clear cleavage plane between the tumor and the facial nerve is found.
本研究旨在报告我们在术中诊断为颅内面神经鞘瘤（FNSs）患者管理方面的经验，并提出一种决策策略。
确定了1992年至2012年间接受手术治疗的23例内耳道和/或桥小脑角FNS患者。
术前，所有病例经影像学诊断为前庭神经鞘瘤。手术方式包括43.4%的患者进行肿瘤全切并移植，21.7%的患者进行次全切除，保留面神经表面的肿瘤包膜，13%的患者进行肿瘤全切并保留面神经的解剖连续性，4.3%的患者进行次全切除。4例患者（17.4%）接受了骨减压但未切除肿瘤。
手术中诊断的FNS的管理是一项重大的临床挑战。当患者术前出现面神经麻痹（≥Ⅲ级）时，我们考虑进行肿瘤全切并移植。对于术前面神经功能良好和/或肿瘤较大且压迫脑干的患者，可以进行次全和近全肿瘤切除。选择保留听力手术的小肿瘤患者可考虑进行骨减压。当在肿瘤与面神经之间发现清晰的分离平面时，束状保留手术可能是一种选择。
