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累及中颅窝和后颅窝的三叉神经恶性外周神经鞘瘤

Malignant Peripheral Nerve Sheath Tumor of the Trigeminal Nerve Involving the Middle and Posterior Cranial Fossa.

作者信息

Liang Aijun, Xi Bin, Zhou Chaoyang, Yang Yu, Zhang Jianzhong, Gui Shaogao, Xu Fanghua, Wan Dengfeng

机构信息

Department of Neurosurgery, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China.

Department of Medical Imaging, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China.

出版信息

World Neurosurg. 2018 Apr;112:221-226. doi: 10.1016/j.wneu.2018.01.179. Epub 2018 Feb 3.

Abstract

BACKGROUND

Although benign trigeminal schwannomas are uncommon, malignant peripheral nerve sheath tumors (MPNSTs) of the trigeminal nerve are extraordinarily rare.

CASE DESCRIPTION

A 56-year-old female presented with a 2-month-long history of numbness of the right face and progressive weakness of the left limbs. Preoperative neuroimages indicated a giant tumor involving the middle and posterior cranial fossa with similar radiologic characteristics to benign trigeminal schwannomas. However, histopathologic and immunochemical examinations confirmed the tumor to be an MPNST. A nearly gross total resection was obtained with a combined frontotemporal extradural and subtemporal anterior petrosal approach. The postoperative course was uneventful, and the patient received adjuvant radiotherapy subsequently. There was no recurrence of the tumor with a 6-month-long follow-up.

CONCLUSION

MPNSTs of the trigeminal nerve are exceedingly rare. This study described the 21st case of MPNSTs of the trigeminal nerve. MPNSTs of the trigeminal nerve showed similar radiologic characteristics to benign trigeminal schwannomas, and accurate diagnosis depended on pathologic and immunochemical examinations. Gross total resection followed by radiotherapy is the usual treatment.

摘要

背景

尽管良性三叉神经鞘瘤并不常见,但三叉神经恶性外周神经鞘膜瘤(MPNST)极为罕见。

病例描述

一名56岁女性,有2个月的右脸麻木和左肢进行性无力病史。术前神经影像学检查显示一个巨大肿瘤累及中颅窝和后颅窝,其放射学特征与良性三叉神经鞘瘤相似。然而,组织病理学和免疫化学检查证实该肿瘤为MPNST。采用额颞硬膜外联合颞下前岩骨入路实现了近全切除。术后过程顺利,患者随后接受了辅助放疗。随访6个月,肿瘤无复发。

结论

三叉神经MPNST极为罕见。本研究描述了第21例三叉神经MPNST。三叉神经MPNST的放射学特征与良性三叉神经鞘瘤相似,准确诊断依赖于病理和免疫化学检查。全切除后放疗是常用的治疗方法。

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