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題名 | 頸-腮腺腫瘤切除術切除顱內侵犯之咽旁間隙許旺氏細胞瘤--病例報告=Excision of Parapharyngeal Space Schwannoma with Intra-cranial Invasion through Cervical Parotid Approach--A Case Report |
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作者 | 蔡宗佑; 林群皓; 莊啟政; 張凱評; | 書刊名 | 臺灣耳鼻喉頭頸外科雜誌 |
卷期 | 52:2 2017.04-06[民106.04-06] |
頁次 | 頁79-82 |
分類號 | 416.89 |
關鍵詞 | 咽旁間隙; 許旺氏細胞瘤; 頸-腮腺腫瘤切除; 顱內; Parapharyngeal space; Schwannoma; Cervical-parotid approach; Intra-cranial; |
語文 | 中文(Chinese) |
中文摘要 | 咽旁間隙腫瘤相當罕見,占頭頸腫瘤中大約0.5%。此空間解剖構造複雜,無論在臨床檢查、術前評估或是手術術式選擇對於醫師都是一項挑戰。本例病患為一50歲男性,臨床表現為持續1個月吞嚥時有觸電感,理學檢查發現口腔內左側扁桃體窩有一表面黏膜正常的腫塊。電腦斷層掃描顯示左側咽旁間隙有一低密度腫塊並有顱底卵圓孔擴大及顱內侵犯。隨即安排核磁共振掃描,推測為神經源性腫瘤,經粗針切片初步診斷為許旺氏細胞瘤。在完成完整術前評估後,透過頸–腮腺途徑,暴露並分離顏面神經,移除部分淺層腮腺並由此進入咽旁間隙將腫瘤分離。由於腫瘤擴及顱內,因此同時會同神經外科,經由左側顳骨切開途徑,將腫瘤與三叉神經(V3)分離並切除腫瘤,病理報告證實為許旺氏細胞瘤。術後追蹤半年,傷口癒合狀況良好、無後遺症,且電腦斷層無腫瘤復發跡象。我們提出本案例,以探討臨床表現、常見的術式選擇以及可能的併發症,做為臨床醫師選擇的參考。 |
英文摘要 | Parapharyngeal space tumors are rather rare, accounting for only 0.5% of all head and neck tumors. Herein we report a 50-year-old male who complained about dysphagia for 1 month. He came to our outpatient department and a left tonsil fossa bulging mass with smooth mucosal lining was noted on physical examination, and there was no neurologic deficit observed when performing neurologic examination. Computed tomography done in local medical department revealed a hypo-density mass in the left parapharyngeal space with intracranial invasion, accompanied with the expansion of foramen ovale. Magnetic resonance imaging was arranged, suggesting a tumor with neurogenic origin. CT-guided core needle biopsy indicated a Schwannoma on pathology. We performed tumor excision with cervical-parotid approach. Beginning with pre-auricular incision, we approached the parapharyngeal space after dissecting the facial nerve and performing partial superficial parotidectomy. Meanwhile, because the tumor invaded intracranially, our neurosurgeon performed temporal craniotomy and excised tumor after dividing the tumor from trigeminal nerve (V3). The diagnosis of Schwannoma was confirmed by the pathologic report. There were no related complication or neurologic deficit on 6-month follow up, and no evidence of local tumor recurrence was noted during follow up period. |
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