Nkaoui Mustafa, Sasbou Youness
Service de Chirurgie Orthopédique et de Traumatologie, CHU Ibn Sina, Université Mohammed V, Souissi, Rabat, Maroc.
Pan Afr Med J. 2017 Oct 19;28:161. doi: 10.11604/pamj.2017.28.161.12439. eCollection 2017.
We report the case of a 61-year old patient with no particular previous history who complained of pain with paraesthesias at the level of the anterolateral compartment of the left leg irradiating to the dorsal side of the ankle and the foot which lasted over six months. These pains were made worse by effort. Clinical examination showed partial sensitivity deficit and positive Tinel's sign in the territory of the superficial peroneal nerve (A). Electromyography (EMG) confirmed peroneal nerve involvement with decreased amplitude of sensory potentials. X-ray ruled out the presence of an underlying osteo articular cause (B). Ultrasound objectified well-defined homogeneous tissue formation (C) while MRI showed fusiform mass centered on the nerve with contrast-enhanced T1-weighted hyposignal and T2-weighted hypersignal (D). Conservative surgical resection with sparing of nerve fascicles (E,F) and anatomopathological examination confirmed the diagnosis of benign schwannoma (G). At 1-month follow-up, symptoms had disappeared with sensitivity conservation in the territory of this nerve. The diagnosis of schwannoma is difficult due to the absence of swelling and because schwannoma may mimic entrapment neuropathy, as in the case of our patient. Schwannomas are resectable peripheral nerve tumors. Their prognosis is excellent after adapted surgical treatment with sparing of nerve fascicles.
我们报告一例61岁患者,既往无特殊病史,主诉左小腿前外侧区疼痛伴感觉异常,放射至踝关节背侧和足部,持续6个月以上。用力时这些疼痛会加重。临床检查显示在腓浅神经分布区域存在部分感觉减退和阳性Tinel征(A)。肌电图(EMG)证实腓神经受累,感觉电位幅度降低。X线排除了潜在的骨关节病因(B)。超声显示边界清晰的均匀组织形成(C),而MRI显示以神经为中心的梭形肿块,T1加权像呈低信号,T2加权像呈高信号且有强化(D)。保留神经束的保守性手术切除(E、F)及解剖病理学检查确诊为良性神经鞘瘤(G)。在1个月的随访中,症状消失,该神经分布区域感觉保留。由于无肿胀且神经鞘瘤可能类似卡压性神经病变,如我们的患者病例,神经鞘瘤的诊断较为困难。神经鞘瘤是可切除的周围神经肿瘤。经过保留神经束的适当手术治疗后,其预后极佳。