Singh Rohin, Spinner Robert J
1Mayo Clinic Alix School of Medicine, Scottsdale, Arizona; and.
2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
J Neurosurg Case Lessons. 2023 Jan 2;5(1). doi: 10.3171/CASE22510.
Delayed facial palsy (DFP) after vestibular schwannoma resection is a well-documented, yet poorly understood condition. The exact pathophysiological mechanisms of DFP are unknown, although diminished intraoperative nerve response has been shown to be a prognostic factor. To date, no such condition has been described in regard to peripheral nerve schwannomas.
Here the authors present the first reported cases of delayed motor weakness (DMW) after peripheral schwannoma resection of the ulnar nerve at the elbow and peroneal nerve in the popliteal fossa. Both patients presented with a mass lesion and radiating paresthesias and had normal motor function preoperatively. Immediately after surgical resection, the patients had full strength. Within 24 hours, both patients exhibited marked weakness that gradually resolved over the course of several weeks.
DMW after peripheral schwannoma resection is a rare condition likely akin to delayed facial nerve palsy after VS resection. The mechanism of this phenomenon remains unknown, although symptoms appear to self-resolve with time. A better understanding of the processes driving this condition may allow for therapies that can expedite and improve long-term outcomes.
前庭神经鞘瘤切除术后迟发性面神经麻痹（DFP）是一种有充分文献记载但了解甚少的病症。DFP的确切病理生理机制尚不清楚，尽管术中神经反应减弱已被证明是一个预后因素。迄今为止，尚未有关于周围神经鞘瘤出现此类病症的描述。
本文作者报告了首例肘部尺神经和腘窝腓总神经周围神经鞘瘤切除术后迟发性运动无力（DMW）的病例。两名患者均表现为肿块病变和放射性感觉异常，术前运动功能正常。手术切除后即刻，患者肌力正常。在24小时内，两名患者均出现明显无力，在数周内逐渐缓解。
周围神经鞘瘤切除术后的DMW是一种罕见病症，可能类似于前庭神经鞘瘤切除术后的迟发性面神经麻痹。尽管症状似乎会随时间自行缓解，但这种现象的机制仍然未知。更好地了解导致这种病症的过程可能会产生能够加速并改善长期预后的治疗方法。
