Deep Nicholas L, Graffeo Christopher S, Copeland William R, Link Michael J, Atkinson John L, Neff Brian A, Raghunathan Aditya, Carlson Matthew L
Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Laryngoscope. 2017 Mar;127(3):715-719. doi: 10.1002/lary.26126. Epub 2016 Jun 19.
OBJECTIVES/HYPOTHESIS: To report two patients with a history of microvascular decompression (MVD) for hemifacial spasm who presented with Teflon granulomas (TG) mimicking cerebellopontine angle (CPA) tumors and to perform a systematic review of the English-language literature.
Case series at a single tertiary academic referral center and systematic review.
Retrospective chart review with analysis of clinical, radiological, and histopathological findings. Systematic review using PubMed, Embase, MEDLINE, and Web of Science databases.
Two patients with large skull base TGs mimicking CPA tumors clinically and radiographically were managed at the authors' institution. The first presented 4 years after MVD with asymmetrical sensorineural hearing loss, multiple progressive cranial neuropathies, and brainstem edema due to a growing TG. Reoperation with resection of the granuloma confirmed a foreign-body reaction consisting of multinucleated giant cells containing intracytoplasmic Teflon particles. The second patient presented 11 years after MVD with asymmetrical sensorineural hearing loss and recurrent hemifacial spasm. No growth was noted over 2 years, and the patient has been managed expectantly. Only one prior case of TG after MVD for hemifacial spasm has been reported in the English literature.
TG is a rare complication of MVD for hemifacial spasm. The diagnosis should be suspected in patients presenting with a new-onset enhancing mass of the CPA after MVD, even when performed decades earlier. A thorough clinical and surgical history is critical toward establishing an accurate diagnosis to guide management and prevent unnecessary morbidity. Surgical intervention is not required unless progressive neurologic complications ensue.
4 Laryngoscope, 127:715-719, 2017.
目的/假设：报告两例曾因面肌痉挛接受微血管减压术（MVD）的患者，他们出现了模仿桥小脑角（CPA）肿瘤的聚四氟乙烯肉芽肿（TG），并对英文文献进行系统综述。
单一三级学术转诊中心的病例系列研究及系统综述。
回顾性病历审查，分析临床、放射学和组织病理学检查结果。使用PubMed、Embase、MEDLINE和Web of Science数据库进行系统综述。
作者所在机构诊治了两例临床上和影像学上模仿CPA肿瘤的大型颅底TG患者。第一例在MVD术后4年出现，伴有不对称性感音神经性听力损失、多发性进行性颅神经病变以及因TG生长导致的脑干水肿。再次手术切除肉芽肿证实为异物反应，由含有胞质内聚四氟乙烯颗粒的多核巨细胞组成。第二例患者在MVD术后11年出现不对称性感音神经性听力损失和复发性面肌痉挛。2年内未发现肿物生长，对该患者进行了观察处理。英文文献中仅报道过1例MVD治疗面肌痉挛后出现TG的病例。
TG是MVD治疗面肌痉挛的一种罕见并发症。对于MVD术后CPA出现新发强化肿块的患者，即使手术是在数十年前进行的，也应怀疑该诊断。详尽的临床和手术史对于准确诊断以指导治疗及预防不必要的发病率至关重要。除非出现进行性神经并发症，否则无需手术干预。
4 喉镜，127:715 - 719，2017年。
