Petruzzi Gerardo, Costantino Andrea, Arosio Alberto Daniele, De Virgilio Armando, Pichi Barbara, Zocchi Jacopo, Mercante Giuseppe, Spriano Giuseppe, Pellini Raul
Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome.
Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI).
J Craniofac Surg. 2020 Jun;31(4):e411-e413. doi: 10.1097/SCS.0000000000006417.
Schwannomas are the most common benign tumors arising from the peripheral nerve sheath, and the intraoral location is very atypical, representing less than 1% of all cases. Surgical excision is the treatment of choice, and a variety of surgical approaches have been described. The authors report the first described case of tongue base schwannoma treated with transoral robotic surgery (TORS). A 47-years-old female patient complaining mild dysphagia and snoring, presented a submucosal swelling at the right side of the tongue base. MRI showed a large well-circumscribed solid mass, homogeneously isointense in T1WI and hyperintense on T2WI, with no lymph node metastasis. According to size, location and radiological characteristic of the mass a TORS approach was chosen. An extracapsular dissection was performed, and the lesion was completely removed with no intraoperative complications. The final diagnosis based on histopathological examination and IHC analysis (S-100 positive) was a schwannoma of the tongue base. The post-operative course was uneventful, and no recurrence was observed after 6 months of follow-up. This study demonstrates the feasibility of TORS in the treatment of a tongue base schwannoma. This is a valid alternative to the common transoral approach in order to avoid more invasive external approaches, and further studies are recommended in order to clarify if this approach could be proposed as the first line treatment in selected cases.
神经鞘瘤是起源于周围神经鞘的最常见良性肿瘤，而口腔内发生的情况非常不典型，占所有病例的比例不到1%。手术切除是首选治疗方法，已有多种手术方式被描述。作者报告了首例经口机器人手术（TORS）治疗舌根神经鞘瘤的病例。一名47岁女性患者，主诉轻度吞咽困难和打鼾，在舌根右侧出现黏膜下肿胀。MRI显示一个边界清晰的大实性肿块，在T1WI上呈均匀等信号，在T2WI上呈高信号，无淋巴结转移。根据肿块的大小、位置和影像学特征，选择了TORS手术方式。进行了囊外剥离，病变被完全切除，术中无并发症。基于组织病理学检查和免疫组化分析（S-100阳性）的最终诊断为舌根神经鞘瘤。术后过程顺利，随访6个月未观察到复发。本研究证明了TORS治疗舌根神经鞘瘤的可行性。这是一种有效的替代常规经口手术的方法，以避免更具侵入性的外部手术方式，建议进一步开展研究以明确该方法是否可作为某些特定病例的一线治疗方法。
