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目的探讨周围神经鞘瘤的临床特点、手术治疗要点及疗效。方法 2004年1月至2011年1月,采用显微外科技术对8例周围神经鞘瘤进行切除,并行术中神经电生理监测。其中男5例,女3例。年龄20～65岁,平均40.5岁。位于坐骨神经2例,腓总神经1例,胫神经1例,正中神经2例,桡神经1例,尺神经1例。肿瘤最大直径4.5～12.5cm,平均7.5cm。术前均行MRI和肌电图检查,术后所有肿瘤均经病理证实为神经鞘瘤。结果所有病例得到随访,术后7例神经功能未受影响,随访3.5-7年,平均4.5年,无复发。1例巨大正中神经鞘瘤患者出现该神经掌侧分布区感觉迟钝,拇指掌指关节及指间关节屈曲不能,食指和中指远近指间关节屈曲力量减弱,腕关节屈曲力量减弱。术后3周神经支配区域感觉恢复,术后6个月运动功能恢复正常。结论在清楚了解神经鞘瘤解剖与临床特点的前提下,术前仔细评估肿瘤的影像学表现,应用显微外科技术在显微镜下操作,并采用术中神经电生理监测,可最大限度地切除周围神经鞘瘤,减少复发,并保留正常神经功能。
Objective To investigate the clinical features, surgical treatment of peripheral nerve sheath tumor and curative effect. Methods From January 2004 to January 2011, 8 cases of peripheral schwannoma were excised by microsurgical technique and the intraoperative electrophysiological monitoring was performed. There are 5 males and 3 females. Age 20 to 65 years old, average 40.5 years old. Located in 2 cases of sciatic nerve, common peroneal nerve in 1 case, tibial nerve in 1 case, median nerve in 2 cases, radial nerve in 1 case, ulnar nerve in 1 case. The largest tumor diameter 4.5 ~ 12.5cm, an average of 7.5cm. All patients underwent MRI and electromyography before operation. All the tumors were proved to be schwannoma by pathology. Results All cases were followed up. The neurological function was not affected after operation in 7 cases. The patients were followed up for 3.5-7 years with an average of 4.5 years without recurrence. In 1 patient with a huge median schwannoma, the palmar region of the nerve appeared unresponsive and the flexor strength of the metacarpophalangeal and interphalangeal interphalangeal joints of the index finger and middle finger was weakened and the flexor strength of the wrist was weakened. Three weeks after operation, the innervation of the innervation of the innervation of the innervation of the motor function returned to normal after 6 months. Conclusions With a clear understanding of the anatomy and clinical features of schwannoma, the imaging features of the tumor were carefully evaluated preoperatively. Microsurgery was performed using microsurgical techniques and the intraoperative electrophysiological monitoring was used to maximize the excision of the periphery Schwannoma, reduce recurrence, and retain normal nerve function.