原文題目(出處)： Schwannoma in Head and Neck: Preoperative Image Study and Intracapsular Enucleation for Functional Nerve
Preservation. Yonsei Med J 2010;51:938-42 原文作者姓名： Si Hong Kim, Na Hyun Kim, Kyung Rok Kim,
Ja Hyun Lee, and Hong-Shik Choi
通訊作者學校： Department of Otorhinolaryngology, Institute of Logopedics
& Phoniatrics, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
報告者姓名(組別)： 陳威齊(Intern F 組)
報告日期： 2011.01.10
內文：
Introduction
1. Schwannoma
Benign neural sheath tumor (slowly-growing)
Occur as a single enity in many cases
Occur in overall body
Head and neck: 25%~40%
Vagus nerve
Sympathetic nervous system
2. surgical resection (before) → intracapsular enucleation (recently)
preservation of the neurological functions 3. in this study
preoperative imaging studies in distinguishing the neurological origin of the Schwannomas of head and neck
efficacy of intracapsular enucleation in preserving the nerve function
Materials and Methods
1. 7 patients who were suspectef with schwannoma at Department of Otorhinolaryngology Gangnam Severance Hospital from March 2003 to September 2009
3 men / 4 women
Ages ranged between 46~71
All patient complained of a neck mass as a major symptom
6 patients had normal nerve function
1 patient complained ptosis 2. CT and MRI were performed
To examine the location of the tumor
Correlation with the carotid artery and the internal jugular vein 3. all patients underwent intracapsular enucleation
expose the tumor in the carotid sheath
a vertical incision on capsule parallel to the direction of nerve
confirm the nerve fibers surrounded the tumor
intracapsular enucleation
the tumor was carefully dissected from the capsule without any damages to the nerve fibers
4. vagus nerve and the sympathetic nerve was evaluated preoperatively and postoperatively
vocal cord mobility with laryngoscope
symptoms of Hornor’s syndrome Result
Fig.1 Fig.2 1. preoperative imaging
6 cases(Fig.1) : tumor located between the carotid artery and the internal jugular vein
1 case(Fig.2) : tumor located posteriorly displaying the carotid artery and the internal jugular vein anteriorly
2. at the time of operation, we confirmed
schwannoma originated from the vagus nerve on the first 6 cases
schwannoma originated from the sympathetic nervous system on the last case
3.
Operative findings and specimen of a vagal schwannoma patient
Operative findings and specimen of a sympathetic schwannoma patient
4.
6 vagal schwannoma
5 cases maintained normal postoperative neurological function
1 sympathetic schwannoma
No aggravated neurological deficits except for the ptosis which was observed preoperative
Discussion
1. schwannoma in head and neck
mostly from vagus nerve and sympathetic nervous system
vagal schwannoma : sympathetic schwannoma = 2~3 : 1
tumor size gradually increased
compress the maternal nerve fibers which go over the tumor capsule
nerve paralysis may occur preoperative
vagal schwannoma : dysphagia and hoarseness
sympathetic schwannoma : Horner’s syndrome
however, there are no symptoms in most cases
2. in making differential diagnosis of intracranial tumors, imaging studies play a key role. Particular in case in which schwannoma was suspected.
CT and MRI offer great help in identifying the tumor and its correlations with surrounding vascular structure, muscles, and nerves
3. in 1996, Furukawa, et al. performed imaging studies on 9 schwannoma patients, and suggested their neurological origin prior to surgery
accurate diagnostic rate of 100%
4. in 2007, Saito et al. made an accurate diagnostic at rate of 83% prior to surgery in 12 schwannoma patients
5. in this study, with the criteria proposed by Furukawa, et al. imaging studies were performed on all 7 cases
accurate diagnostic rate of 100%
6. schwannoma
previously, to prevent recurrence, radical dissection was performed
most are encapsulated, nerve fibers surrounded the surface of tumor
intracapsular enucleation can be performed to preserve the nerve fibers
7. Valetino, et al.
Intracpasular enucleation while preserve the nerve fibers preserved its function by more than 30% when compared to tumor resection
8. previous studies reported the preservation rate of the neurological functions following the intracapsular enucleation to be 30~80%
9. in this study, the neurological function was preserved in 6 out of 7 cases
in the case of patient #2, intracapsular enucleation was performed routinely, however, multiple schwannomas directly connected to the nerve fiber were observed intraoperative
10. many controversies exist regarding the recurrence rate between the
total tumor resection including nerve fibers and the intracapsular enucleation
Zbären, et al., there was no significant difference in recurrence rate
In cases where partial remove of tumor was performed, the recurrence rate has been reported to rise
In this study, the mean follow-up period after sugery was 3.42 years, and no recurrence
However, further long-term regular follow-up imaging studies are needed
題號 題目
1 Which is wrong about schwannoma?
(A) a benign neural neoplasm (B) slow-growing
(C) usually is asymptomatic
(D) hard palate is the most common location for oral schwannoma 答案
(D)
出處：Oral & Maxillofacial PATHOLOGY second edition P.456~P.457
題號 題目
2 Which is not histopathologic feature of schwannoma?
(A) Antini A (B) Antoni B (C) Starry sky (D) Verocay body 答案
(C)
出處：Oral & Maxillofacial PATHOLOGY second edition P.456~P.457
