Goel Atul, Jadhav Neha, Shah Abhidha, Rai Survendra, Vutha Ravikiran, Dandpat Saswat
Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, India; Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, India.
Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, India.
World Neurosurg. 2021 Jan;145:e291-e297. doi: 10.1016/j.wneu.2020.10.039. Epub 2020 Oct 14.
The pattern of recurrence of large trigeminal neurinomas is analyzed on the basis of experience with 7 cases.
This is a report of 7 cases of large trigeminal neurinomas that were operated on an average of 11 years earlier. After being relatively asymptomatic over the years, these patients worsened relatively suddenly in their neurologic symptoms and were reoperated.
Imaging showed massive recurrence with tumor having cystic and solid components with sizes ranging from 4.5-11 cm. In 4 cases, the cysts at the time of initial presentation and at the time of recurrence showed a well-defined fluid level within the fluid content of the cyst. During operation it was seen that the tumor contained "hemorrhagic" fluid that was under significant pressure. The solid component in the circumferential periphery of the cyst fluid was soft, necrotic, and vascular. The entire recurrence in the middle and posterior cranial fossa and in the extracranial compartment was "interdural" or within the dural confines. Radical tumor resection within the dural confines by deploying relatively small surgical exposure resulted in "unusually" rapid recovery in the symptoms. Histological examination of the tumor did not reveal any malignant transformation.
The cases add further insight to the growth pattern and characteristics of large trigeminal neurinomas.
基于7例大型三叉神经鞘瘤的治疗经验，分析其复发模式。
本文报告7例大型三叉神经鞘瘤患者，平均在11年前接受手术治疗。这些患者多年来相对无症状，但神经症状突然恶化并接受再次手术。
影像学显示肿瘤大量复发，有囊性和实性成分，大小在4.5至11厘米之间。4例患者初次就诊时及复发时，囊肿内的液体成分均显示出清晰的液平面。手术中发现肿瘤含有“出血性”液体，压力较大。囊肿液体周边的实性成分质地柔软、坏死且有血管。中后颅窝及颅外间隙的整个复发病灶均位于“硬膜内”或硬膜范围内。通过相对较小的手术暴露在硬膜范围内进行肿瘤根治性切除，症状“异常”迅速缓解。肿瘤组织学检查未发现任何恶性转化。
这些病例进一步深入了解了大型三叉神经鞘瘤的生长模式和特征。
