The inflammatory pseudotumor presenting periodic acid-Schiff-positive inclusions with acute unilateral facial nerve palsy.
The inflammatory pseudotumor presenting periodic acid-Schiff-positive inclusions with acute unilateral facial nerve palsy.
复制标题
炎性假瘤呈现高碘酸希夫阳性包涵体并伴有急性单侧面神经麻痹。
DOI：
10.1016/j.anl.2018.06.009
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Murakami S.
中科院分区：
文献类型：
--
作者：
Inagaki A;Motegi M;Sato Y;Hattori H;Murakami S.
虽然大多数急性周围性面瘫可归因于贝尔氏麻痹，但其他因素，如感染，创伤和肿瘤，也可导致面瘫。其中，面神经肿瘤是罕见的，但应考虑在鉴别诊断面瘫。由于面神经肿瘤引起的麻痹通常表现为缓慢发作，但偶尔表现为急性发作。在这种情况下，面神经减压术是治疗的选择，允许肿瘤的空间生长，而不会压迫神经或其血液供应。我们描述一个严重的急性面神经麻痹的病例，表现为面神经管乳突部的梭形骨质侵蚀。虽然手术前怀疑是面神经瘤，但紧急减压手术发现是一种不寻常的炎性假瘤。术后组织学分析显示神经纤维广泛破坏，泡沫状巨噬细胞广泛浸润，其中含有特征性的、抗胰蛋白酶的、过碘酸希夫（PAS）阳性包涵体，这是罕见细菌感染的标志。这是一个面神经麻痹的情况下，一个不寻常的病因。该病例显示了减压手术的益处，不仅可以治疗麻痹，还可以作为面神经肿瘤的探查手术。
Although most acute peripheral facial palsies can be attributed to Bell’s palsy, other factors, such as infection, trauma, and neoplasm, can cause facial palsy as well. Among these, facial nerve tumors are rare but should be considered in the differential diagnosis of facial palsy. Palsies due to facial nerve tumors usually present with slow onset but occasionally present as acute episodes. In such cases, facial nerve decompression is the treatment of choice to allow the tumor room to grow without compressing the nerve or its blood supply. We describe a case of severe, acute facial palsy presenting with a spindle-shaped bone erosion on the mastoid portion of the facial canal. Although facial neuroma was suspected preoperatively, emergency decompression surgery revealed that an unusual inflammatory pseudotumor was responsible for the finding. Postoperative histological analysis revealed extensive destruction of the nerve fibers, with extensive infiltration of foamy macrophages containing characteristic, diastase-resistant, periodic acid-Schiff (PAS)-positive inclusions, which are hallmark of the uncommon bacterial infections. This was a case of facial palsy with an unusual etiology. The case shows the benefit of decompression surgery not only as treatment for the palsy but also as exploratory surgery in cases of facial nerve tumor.