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題名 | The Prognosis and Recurrence of Head and Neck Schwannomas: An 8-Year Retrospective Study=臺中榮總頭頸部神經鞘瘤預後及復發分析:8年回溯性研究 |
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作者 | 蔡佩晏; 陳萬宜; 陳淑賢; 林知瑩; 陳柏秀; | 書刊名 | 臺灣口腔顎面外科學會雜誌 |
卷期 | 22:3 2011.09[民100.09] |
頁次 | 頁165-174 |
分類號 | 416.8 |
關鍵詞 | 頭頸部神經鞘瘤; 復發率; Head and neck schwannomas; Nerve of origin; Recurrence rate; |
語文 | 英文(English) |
中文摘要 | 緒論:本研究針對八年來中部某醫學中心所發生頭頸部神經鞘瘤(稱之史旺氏瘤等)之病患所產生部位、癥狀、所在神經叢、術後復元情形以及復發率加以研究。 材料與方法:本文在於探討台中榮民總醫院自2003年1月至2010年12月間回顧其診療紀錄完整之69名頭頸部神經鞘瘤患者。作者利用統計特性分析及比較分析法針對其腫瘤所在位置、不同的病癥、神經鞘瘤神經元起始來源,進而對於術後觀察神經受損情形至痊癒經歷期間以及腫瘤割除再復發之可能。旨在提供頭頸部神經鞘瘤病患及醫護相關人員參考與建議。 結果:本研究發現男性病患約佔45%,相較於女性55%略少,而年齡層由12歲至83歲分布甚廣,平均年齡為47.84歲。在69位患者中53位診斷腫瘤部位有5位在口腔,32位在小腦橋腦角,2位在眼部以及3位在頭皮部位,此外16位患者則腫瘤長在頸部,其中最常見者為聽覺神經鞘瘤。術後治療率約略達59.4%。此外,在6例顱內神經鞘瘤中有4例為小腦橋腦角,基於這些顱內神經鞘瘤復發率佔8.6%,維護腫瘤所在的神經功能,一些腫瘤無法切除乾淨,因此研究中發現顱內神經鞘瘤復發率為7.2%高於顱外復發率1.4%。 討論:本篇研究中發現術後治療率達59.4%,顱內神經鞘瘤復發率高於顱外復發率。神經鞘瘤成長緩慢,不僅包膜完整且邊界清楚,由於此類腫瘤成長不明顯導致病患就醫亦不積極。一般而言,依照其腫瘤所在位置選擇治療方式,在無妨礙神經功能之虞,通常選擇完整切除,當牽涉神經叢所在之腫瘤則以部份切除,搭配珈瑪刀(光子刀)為最佳治療方式之選擇。 |
英文摘要 | Introduction: We studied a series of head and neck schwannoma (also known as neurilemmoma, neurinoma, neurolemmoma, and Schwann cell tumor) treated during an eight-year period. Focus was given to analyzing location, symptoms, nerve of origin, postoperative resolution, and recurrence. The objective of this article is to provide the patient and relative healthcares some reference suggestions. Materials and Methods: Clinical records of 69 head and neck schwannoma patients treated in Taichung Veterans General Hospital since January 2003 to December 2010 were retrospectively examined. We surveyed the tumor location, the symptoms, nerve of origin, postoperative nerve injury symptoms, resolution, and recurrence after resection of head and neck schwannomas with characteristics statistics and comparison analysis. Results: In this study, patients' gender was approximately 55% female and 45% male. They ranged from 12 to 83 years of age with the mean age of diagnosis at 47.84 years. In this study, lesions were diagnosed in the head region of 53 patients (including 5 oral cavities, 32 brain cerebellopontine angles, 11 brain other than cerebellopontine angles, 2 eyes, and 3 scalps), as well as lesions in the neck area of 16 additional patients. The most common observation was found along the acoustic nerve and diagnosed as cerebellopontine angle (C-P angle) syndrome. Resolution rates were 59.4% after resection of schwannomas. According to protect the function of origin nerve, we would not remove those tumors completely. Among these was one case of neurofibromatosis type 2—an inherited disease. For recurrent intracranial schwannomas, 4 of 6 cases were C-P angle schwannomas. Intracranial schwannomas showed a recurrence rate of 7.2% which was higher than the extracranial schwannomas recurrence rate of 1.4%. Discussion: Schwannoma is a slow-growing tumor, its involucrum is complete, the boundary is clear, and the delayed appearance of symptoms may result in late diagnosis and treatment. In general, the choice of surgical approaches often depends upon location, but the best outcomes normally resulted from surgical intervention. Nevertheless, once intracranial schwannomas recur, then successive treatments of Gamma Knife radiosurgeries were performed in our hospital. |
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