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目的:探讨引起面瘫的颞骨肿瘤的临床特点、影像学表现及治疗方法。方法:回顾分析23例引起周围性面瘫的颞骨肿瘤临床资料,包括面神经瘤11例(面神经鞘瘤8例、面神经纤维瘤3例),颞骨恶性肿瘤12例(颞骨鳞状细胞癌9例、软骨肉瘤1例、横纹肌肉瘤2例)。全部患者行CT及MRI检查。手术治疗23例,其中11例行面神经瘤切除术(经乳突径路6例、乳突颅中窝联合径路3例、乳突腮腺联合径路2例,8例肿瘤切除后同期进行面神经移植);12例行颞骨恶性肿瘤切除术(扩大乳突根治术5例、颞骨次全切6例、颞骨全切除术1例),术后均加放疗。结果:影像学上肿瘤是否沿面神经走向分布是面神经源性及非面神经源性肿瘤的主要鉴别方法。随访3～8年,10例面神经瘤全部切除无复发,1例面神瘤残留。12例颞骨恶性肿瘤(Stell分期:T2期5例,T3期7例)复发率为41.7%(5/12),5年生存率66.7%(8/12)。结论:引发面瘫的颞骨肿瘤中面神经源性肿瘤多为良性,非面神经源性肿瘤以恶性肿瘤多见。CT及MRI对诊断有重要价值。手术为主要治疗手段,手术方式根据肿瘤类型及范围而定,面神经源性肿瘤多可同期行面神经移植改善面神经功能。恶性肿瘤需行放疗等综合治疗。
Objective: To explore the clinical features, imaging findings and treatment of sacral tumors causing facial paralysis. Methods: The clinical data of 23 patients with peripheral facial paralysis were retrospectively analyzed. There were 11 cases of facial nerve neoplasm (8 cases of facial schwannoma and 3 cases of facial nerve fibromas), and 12 cases of metatarsal malignancy (9 cases of squamous cell carcinoma of the sacrum, cartilage 1 case of sarcoma and 2 cases of rhabdomyosarcoma. All patients underwent CT and MRI examinations. Surgical treatment was performed in 23 cases, including 11 cases of facial nerve tumor resection (6 cases of papillary pathway, 3 cases of mastoid cranial fossa combined pathway, 2 cases of mastoid parotid joint pathway, and 8 cases of facial nerve transplantation after tumor resection). Twelve patients underwent excision of malignant tumors of the sacrum (5 cases of radical mastoidectomy, 6 cases of sacral subtotal excision, and 1 case of complete sacral excision). Radiotherapy was performed after surgery. RESULTS: Imaging imaging whether the tumors were distributed along the facial nerve was the main method for identifying facial nerve-derived and non-facial neurogenic tumors. Followed up for 3 to 8 years, 10 cases of all resection of facial nerve tumors without recurrence, 1 case of facial tumor remaining. The recurrence rate was 41.7% (5/12) in 12 malignant tumors of the sacrum (Stell’s stage: 5 cases in T2 stage and 7 cases in T3 stage). The 5-year survival rate was 66.7% (8/12). CONCLUSIONS: Facial nerve-derived neoplasms are mostly benign tumors caused by facial paralysis. Non-facial neurogenic neoplasms are more common with malignant neoplasms. CT and MRI have important diagnostic value. Surgery is the main treatment method. The surgical method depends on the type and scope of the tumor. Facial nerve-derived tumors can be used for facial nerve transplantation to improve facial nerve function. Malignant tumors require radiotherapy and other comprehensive treatments.