Ogiwara Toshihiro, Horiuchi Tetsuyoshi, Sekiguchi Nodoka, Kakizawa Yukinari, Hongo Kazuhiro
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
World Neurosurg. 2015 Aug;84(2):592.e3-7. doi: 10.1016/j.wneu.2015.03.019. Epub 2015 Mar 19.
Primary lymphomas of the cranial nerves are extremely rare except for optic nerve lymphoma, and it is difficult to make a correct diagnosis in the initial stage. Here, we report a case of primary malignant lymphoma of the left trigeminal nerve that presented as trigeminal nerve disorder.
A 47-year-old man presented with aggravating left facial pain and hypesthesia within all three divisions of the trigeminal nerve. Magnetic resonance imaging (MRI) revealed a swollen left trigeminal nerve with gadolinium homogenous enhancement. An open biopsy had to be taken from two different locations of the tumor via the lateral suboccipital approach followed by subtemporal approach because adequate specimen volume was not obtained for definitive diagnosis at the first surgery. Histopathological examinations with flow cytometric analysis revealed diffuse large B cell lymphoma. Chemotherapy followed by whole-brain radiation therapy was effective. No recurrence was observed during a 15-month follow-up period.
This is a rare clinical presentation of malignant lymphoma of the trigeminal nerve. It is difficult to establish a correct diagnosis of trigeminal nerve lesions during the initial stages without biopsy. Therefore it is important that a sufficient specimen should be taken for biopsy without hesitation in order to diagnose and treat rapidly. The most suitable operative approach must be selected in trigeminal nerve lesions considering functional preservation, operative difficulty, preference of each surgeon, and quantity of specimen to be removed.
除视神经淋巴瘤外，原发性颅神经淋巴瘤极为罕见，且在疾病初期难以做出正确诊断。在此，我们报告一例以三叉神经病变为表现的左侧原发性恶性三叉神经淋巴瘤病例。
一名47岁男性，出现左侧面部疼痛加重以及三叉神经所有三支区域感觉减退。磁共振成像（MRI）显示左侧三叉神经肿胀，钆剂均匀强化。由于首次手术未能获取足够的标本进行明确诊断，因此不得不通过枕下外侧入路，随后采用颞下入路，从肿瘤的两个不同部位进行开放活检。组织病理学检查及流式细胞术分析显示为弥漫性大B细胞淋巴瘤。化疗后行全脑放射治疗，效果良好。在15个月的随访期内未观察到复发。
这是一例罕见的三叉神经恶性淋巴瘤临床表现。在未进行活检的初始阶段，很难对三叉神经病变做出正确诊断。因此，为了快速诊断和治疗，毫不犹豫地获取足够的标本进行活检非常重要。对于三叉神经病变，必须综合考虑功能保留、手术难度、每位外科医生的偏好以及待切除标本的数量等因素，选择最合适的手术入路。
