背景:颅内颈动脉交感神经丛神经鞘瘤(CSPS)极为罕见;因此,鉴别诊断标准,最佳手术策略,甚至缺乏精确的定义。在这里,我们描述了CSPS的案例,并为以前报告的案例提出了定义和分类。
方法:一名54岁男子表现为下张神经麻痹和外展神经麻痹。放射学检查显示,右内侧颞基的肿块增强,岩尖侵蚀和完整的病灶周围皮质骨。术前发现,如自发改善复视,没有干眼症或面部麻痹,和横向移位的颈内动脉(ICA),提示了岩尖神经鞘瘤的非典型起源。使用颞下硬膜外入路暴露肿瘤并完全切除。完整的卵圆孔,肿瘤外膜内岩浅神经的rostlateral移位,侵蚀的岩尖和颈动脉管,外外侧流离失所的ICA,并且对任何可疑神经都没有明显的肿瘤附着,这表明肿瘤起源于岩性ICA的颈动脉交感神经丛。患者完全康复,无神经系统并发症。
结论:岩尖神经鞘瘤的术前诊断困难:特征性表现,如复视,hypacusis,和横向流离失所的ICA可能会有所帮助。此外,评估肿瘤与海绵窦之间的关系可能有助于确定手术入路。使用Dolenc\'s入路(A型)和中窝硬膜外入路(B型)治疗海绵体内和海绵体外CSPS,可以预期具有良好临床效果的完整切除。分别。
BACKGROUND: Intracranial carotid sympathetic plexus schwannoma (CSPS) is extremely rare; thus differential diagnostic criteria, optimal surgical strategies, and even a precise definition are lacking. Here we describe a case of CSPS and propose a definition and classification for previously reported cases.
METHODS: A 54-year-old man presented with hypacusis and abducens nerve palsy. Radiologic examinations revealed a well-enhanced mass at the right medial temporal base with erosion of the petrous apex and intact perilesional cortical bone. Preoperative findings, such as spontaneous improvement of diplopia, absence of xerophthalmia or facial palsy, and laterally displaced internal carotid artery (ICA), suggested the atypical origins of the petrous apex schwannoma. The tumor was exposed using the subtemporal extradural approach and completely resected. Intact foramen ovale, rostrolateral displacement of the greater superficial petrosal nerve within the outer membrane of the tumor, eroded petrous apex and carotid canal, superolaterally displaced ICA, and lack of an obvious tumor attachment to any of the suspected nerves suggested that the tumor originated from the carotid sympathetic plexus of the petrous ICA. The patient fully recovered without neurological complications.
CONCLUSIONS: Preoperative diagnosis of petrous apex schwannoma is difficult: characteristic findings such as diplopia, hypacusis, and laterally displaced ICA may help. In addition, assessment of the relationship between the tumor and cavernous sinus could be useful in the determination of the surgical approach. Complete resection with good clinical outcome could be expected using Dolenc\'s approach (type A) and by the middle fossa extradural approach (type B) for intracavernous and extracavernous CSPS, respectively.