立体定向放射手术后伴急性出血的面神经神经鞘瘤。
Facial Nerve Schwannoma Complicated by Acute Hemorrhage After Treatment with Stereotactic Radiosurgery.
机构信息
Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
Department of Neurosurgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA.
出版信息
World Neurosurg. 2020 Feb;134:128-132. doi: 10.1016/j.wneu.2019.10.161. Epub 2019 Nov 2.
BACKGROUND
Facial nerve schwannomas (FNSs) are rare benign tumors that arise from Schwann cells of the facial nerve. FNSs are similar to vestibular schwannomas in many aspects, yet their infiltrative nature into the facial nerve fascicles warrants a more conservative management approach. In the last decade, stereotactic radiosurgery (SRS) has shown promise in stabilizing or shrinking FNSs.
CASE DESCRIPTION
A 71-year-old woman presented with mild facial paresis. Tumor growth after a period of watchful waiting warranted treatment with SRS, which was complicated by an acute posterior fossa hemorrhage and brainstem compression, necessitating microsurgical hematoma evacuation, tumor resection, and facial nerve substitution.
CONCLUSIONS
SRS has led to better facial nerve function and outcomes and is currently considered a reasonable alternative to microsurgical resection in patients with FNSs. This is the first report to our knowledge of an acute, life-threatening hemorrhage after SRS in a patient with FNS.
背景
面神经神经鞘瘤（FNS）是一种罕见的良性肿瘤，起源于面神经的施旺细胞。FNS 在许多方面与前庭神经鞘瘤相似，但由于其对面神经束的浸润性，需要采取更保守的管理方法。在过去的十年中，立体定向放射外科（SRS）已显示出稳定或缩小 FNS 的潜力。
病例描述
一位 71 岁女性因轻度面瘫就诊。在观察等待一段时间后肿瘤生长，需要进行 SRS 治疗，但 SRS 后出现急性后颅窝出血和脑干压迫，需要进行显微手术血肿清除、肿瘤切除和面神经替代。
结论
SRS 可改善面神经功能和预后，目前被认为是 FNS 患者显微手术切除的合理替代方法。据我们所知，这是首例报道 FNS 患者 SRS 后发生急性、危及生命的出血。
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