Analysis of clinical manifestations and imaging features of facial nerve schwannomas
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摘要: 目的 探讨面神经鞘膜瘤的临床表现和影像学特点, 明确不同影像学技术在本疾病诊断中的应用价值。方法 回顾性分析2020年9月至2022年9月空军军医大学第一附属医院耳鼻喉科经手术及病理证实为面神经鞘膜瘤的患者资料23例, 其中男8例, 女15例, 年龄18~66岁。对患者临床症状、专科检查及影像学表现进行总结与分析。结果 本组患者临床表现为面神经麻痹15例(HB Ⅳ级2例、HB Ⅴ级6例、HB Ⅵ级7例), 听力下降14例(传导性聋5例、混合性聋2例、极重度感音神经性聋7例), 耳鸣8例, 耳痛7例, 头晕4例, 头痛4例, 耳流脓2例, 6例腮腺区肿瘤表现为局部包块。耳内镜检查见外耳道肿物8例、鼓室内肿物3例。结合颞骨HRCT、MRI平扫、增强及面神经(管)CPR等多种影像学技术, 观察病变局限于面神经内听道段1例、鼓室段2例、腮腺区6例; 累及面神经内听道段、迷路段、膝状神经节、鼓室段、乳突段2个或多个节段者共14例。瘤体较大时常累及邻近结构, 其中8例侵及外耳道及鼓室、部分听小骨移位或有骨质破坏, 3例侵及颈静脉孔区, 1例向中颅窝区生长并伴颞叶脑实质受压。结论 面神经鞘膜瘤临床表现多样, 结合多种影像学技术有助于对疾病的定位、定性诊断, 为后续临床治疗方案的制定提供重要依据。Abstract: Objective To explore the clinical manifestations and imaging characteristics, and to clarify the imaging value in the diagnosis of facial nerve schwannomas.Methods Retrospectively analyze the data of 23 patients with facial nerve schwannomas confirmed by surgery and pathology in the Department of Otorhinolaryngology of the First Affiliated Hospital of the Air Force Military Medical University from September 2020 to September 2022, including 8 males and 15 females, aged 18-66 years old. Summarize and analyze their clinical symptoms, specialized examinations, and imaging findings.Results The clinical manifestations were facial nerve paralysis in 15 cases(2 cases of HB Ⅳ, 6 cases of HB Ⅴ, 7 cases of HB Ⅵ), hearing loss in 14 cases(5 cases of conductive deafness, 2 cases of mixed deafness, and 7 cases of severe sensorineural hearing loss), 8 cases tinnitus, 7 cases ear pain, 4 cases dizziness, 4 cases headache, 2 cases ear pus, and parotid gland tumors in 6 cases presenting as local masses. Endoscopic examination revealed 8 cases of external ear canal tumors and 3 cases of intratympanic tumors. Combining temporal bone HRCT, MRI enhanced scanning, and CPR imaging techniques, 1 case involved the internal auditory canal segment, 2 cases in the tympanic segment, 6 cases in the parotid gland area. A total of 14 cases involved two or more segments of the internal auditory canal segment, the labyrinthine segment, geniculate ganglion, the tympanic segment, and the mastoid segment. When the tumors were large, adjacent structures were involved. It was found that 8 cases invaded the external auditory canal and tympanic cavity, ossicles were displaced or bony destruction; 3 cases invaded the jugular foramen area, and 1 case grew to the middle cranial fossa region with temporal lobe brain parenchymal compression.Conclusion The clinical manifestations of facial nerve schwannomas are diverse. The combination of various imaging techniques will be conducive to topical and qualitative diagnosis and provide an important basis for treatment strategies.
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表 1 患者一般情况及临床表现特征
序号 性别 年龄/岁 侧别 面神经麻痹持续时间/月 术前面神经功能HB 除面神经麻痹外的其他症状 术前听力/dB HL 患侧耳镜表现 病变范围 1 男 36 L 216 Ⅴ 耳聋、耳鸣 AC：63.75
BC：32.50外耳道深部肿物隆起 内听道段、迷路段、膝状神经节，鼓室段，乳突段、外耳道、中颅窝 2 男 33 L 72 Ⅴ 耳聋 AC：68.75
BC：25.00外耳道见质软、光滑肿物 鼓室段、乳突段、外耳道、颈静脉孔、腮腺 3 男 29 R NA Ⅰ 耳聋、耳鸣 AC：45.00
BC：17.50鼓膜浑浊、紧张部后方膨隆 鼓室段 4 女 27 R 36 Ⅴ 耳聋，头痛 AC：73.75
BC：23.75外耳道见光滑肿物 内听道段、迷路段、膝状神经节、鼓室段、乳突段、外耳道 5 女 47 R 12 Ⅴ 头痛 AC：25.00
BC：10.00外耳道底壁局部膨隆、触之质软 鼓室段、乳突段、外耳道、颈静脉孔 6 女 36 R 120 Ⅵ 耳聋、耳痛、流脓、头晕、视力减退 全聋 外耳道前壁见质软、光滑肿物 鼓室段、乳突段、外耳道 7 女 46 L 4 Ⅵ 眼干 AC：15.00
BC：15.00鼓膜浑浊 乳突段，腮腺 8 女 57 L 3 Ⅵ 耳聋、耳鸣、耳痛 全聋 鼓膜浑浊 内听道段，迷路段，膝状神经节 9 女 48 L 36 Ⅴ 耳聋、耳鸣、耳痛、流脓、头晕、头痛 全聋 外耳道脓性分泌物、见软组织填塞 内听道段，迷路段，鼓室段、乳突段、外耳道 10 男 26 R 1 Ⅵ 耳聋、耳鸣、耳痛、咽痛、头晕 全聋 鼓膜标志清晰 内听道段 11 女 43 L 48 Ⅴ 耳聋、耳鸣 全聋 鼓膜浑浊 内听道段，迷路段，膝状神经节、鼓室段、 12 女 42 R 6 Ⅳ 耳聋、耳鸣 AC：95.00
BC：53.75鼓膜浑浊膨隆，鼓室内可见粉红色新生物 内听道、膝状神经节、鼓室段、乳突段 13 女 37 R 108 Ⅵ 耳聋、耳鸣、耳痛、头晕 AC：33.75
BC：18.75鼓膜浑浊 迷路段，鼓室段、乳突段、腮腺 14 女 31 R NA Ⅰ 耳聋、耳痛、头痛 全聋 鼓膜标志清晰 内听道，迷路段，膝状神经节、鼓室段 15 男 46 R 36 Ⅵ 耳聋 AC：68.75
BC：21.25鼓膜浑浊、膨隆 膝状神经节、鼓室段、乳突段、外耳道 16 男 25 R 7 Ⅳ 耳痛 AC：25.00
BC：22.50鼓膜充血 鼓室段 17 女 44 R 48 Ⅵ 耳聋 全聋 外耳道后壁膨隆，质软、光滑肿物 膝状神经节、鼓室段、乳突段、外耳道、颈静脉孔、腮腺 18 女 66 L NA Ⅰ NA NA NA 腮腺 19 女 18 L NA Ⅰ NA NA NA 腮腺 20 女 59 L NA Ⅰ NA NA NA 腮腺 21 男 43 R NA Ⅰ NA NA NA 腮腺 22 男 41 L NA Ⅰ NA NA NA 腮腺 23 女 35 L NA Ⅰ NA NA NA 腮腺 AC：(500、1 000、2 000、4 000 Hz)纯音气导平均听阈；BC：(500、1 000、2 000、4 000 Hz)纯音骨导平均听阈；NA：未测。 
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