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作者报告1例滑车神经鞘瘤。女37岁,1982年8月1日以突然右颞部疼痛及恶心、呕吐发病。怒晨感到复视。头痛等症状2～3日后减轻,复视仍继续存在。8天后眼科检查指出右上斜肌很轻微的瘫痪。数日后复视消失,辐辏也无明显异常。CT 扫描指出右小脑幕切迹区有一小的肿块。腰穿初压110mmH_2O,蛋白32mg%,颅骨 x 线素片和断层片均正常。用增强的 CT 扫描可见肿块的轮廓。血管造影前脉络膜动脉稍位于内上方,小脑上动脉的池部同样位于稍下方,无明显血管异位。9月28日全麻下右颞下经小脑幕入路进行肿瘤切除术。肿瘤呈淡黄色,稍带光泽,位于小脑幕边缘的正下方,与一部分小脑幕紧密粘连,肿瘤被全切除。在肿瘤后外侧发现滑车神经,肿瘤大小为1.0×0.9×0.7cm。动眼神经在桥脑外侧被肿瘤压迫,除此无异常。术后仅遗留滑车神经瘫痪。组织学检查证实为 Antoni A型神经鞘瘤。滑车神经鞘瘤至今报告5例。在颅内发生部位大多在大脑脚侧方或侧前方,滑车神经出脑干后数
The authors report a case of trochlear schwannomas. 37-year-old female, on August 1, 1982 with sudden right cheek pain and nausea and vomiting. Angry morning feel diplopia. Symptoms such as headaches decreased after 2 to 3 days, and diplopia still persisted. After 8 days, the eye examination indicated a very slight spasm of the right oblique muscle. Diplopia disappeared several days later, and there was no obvious abnormality in the convergence. A CT scan indicated a small lump in the right submental notch. The lumbar puncture was 110 mmH2O, protein 32 mg%, skull x-ray film and slice were normal. The outline of the mass can be seen with an enhanced CT scan. Before the angiogram, the choroidal artery was located slightly in the medial aspect, and the cerebellar artery was also located slightly below the stenosis. There was no obvious vascular ectopic position. On September 28, under the anesthesia, tumor resection was performed by the submental approach through the cerebellar window approach. The tumor was pale yellow and slightly lustrous. It was located just below the edge of the tentorium and closely adhered to a portion of the tentorium. The tumor was completely resected. The trochlear nerve was found on the posterior side of the tumor. The tumor size was 1.0×0.9×0.7 cm. The oculomotor nerves are oppressed by the tumor outside the pons, with no exception. Only the trochlear nerve spasm was left after the operation. Histological examination confirmed Antoni A schwannomas. Takin schwannomas have been reported so far in 5 cases. Most of the intracranial sites occur at the lateral side or lateral side of the brain, and the trochlear nerve is out of the brain stem.