Endoscopy-assisted transoral resection of a parapharyngeal space schwannoma without mandibular dissection.
Endoscopy-assisted transoral resection of a parapharyngeal space schwannoma without mandibular dissection.
复制标题
内窥镜辅助经口切除咽旁间隙神经鞘瘤，无需进行下颌解剖。
DOI：
10.1016/j.anl.2020.04.012
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Kenichi Takano
中科院分区：
文献类型：
--
作者：
Keisuke Yamamoto;Makoto Kurose;Risa Yadomura;Ryoto Yajima;Tsuyoshi Okuni;Kenichi Takano
发生于咽旁间隙的神经鞘瘤中，高颈区的神经鞘瘤侵袭性特别强，需要对下颌骨进行切除。由于这些肿瘤是良性的，但是，过度的手术侵入和术后神经系统并发症应避免。术后脱落症状可通过囊内摘除术避免，包括神经完整性监测（NIM）和窄带成像（NBI）。据报道，视频喉镜手术是有用的经口切除咽和喉肿瘤。本文报告一位74岁的男性患者，在不进行下颌骨解剖的情况下，使用手术支撑装置经口切除了位于高颈区的巨大神经鞘瘤，肿瘤位于右侧咽壁，从上口咽延伸到下咽部，同时压迫会厌到颅底。颈内静脉和颈内动脉之间未观察到分离。根据空芯针活检（CNB）的组织学，肿瘤被诊断为无恶性的神经鞘瘤，并使用NIM和NBI在内窥镜下完全安全地切除，无需外部切口或下颌骨解剖。本病例说明即使是位于颈高位咽旁间隙的巨大交感神经鞘瘤，也可以使用电视喉镜手术（TOVS）经口切除，而无需下颌骨解剖。
Of the schwannomas that arise from the parapharyngeal space, those in the high cervical region are particularly invasive, requiring mandibular dissection. Because these tumors are benign, however, excessive surgical invasion and postoperative neurological complications should be avoided. Postoperative dropout symptoms may be avoided by intracapsular extraction, including nerve integrity monitoring (NIM) and narrow-band imaging (NBI). Video laryngoscopy surgery is reported to be useful for transoral resection of pharyngeal and laryngeal tumors. This report describes the transoral removal of a giant schwannoma located in the high cervical region from a 74-years-old man using a surgical support device without mandibular dissection.The tumor was located on the right lateral pharyngeal wall and extended from the upper oropharynx to the hypopharynx while compressing the epiglottis to the skull base. No separation was observed between the internal jugular vein and the internal carotid artery. The tumor was diagnosed as a schwannoma with no malignancy on the basis of the histology of a core needle biopsy (CNB), and was completely and safely removed endoscopically using NIM and NBI, with no need for an external incision or mandibular dissection. This case illustrates that even a huge sympathetic schwannoma located in the parapharyngeal space at a high cervical position can be excised transorally using video-laryngoscopic surgery (TOVS) without mandibular dissection.
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