Schwannome des N. facialis im inneren Gehörgang und am Ganglion geniculi
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Zusammenfassung
Schwannome des N. facialis im inneren Gehörgang sind seltene Tumoren. Anhand einer retrospektiven Studie sollte die Klinik dieser gutartigen Tumoren analysiert werden. Von 1975 bis 2001 wurde 17-mal ein Schwannom des N. facialis im inneren Gehörgang diagnostiziert. Der Zugang erfolgte in 16 Fällen über die mittlere Schädelgrube, einmal translabyrinthär. Bei 11 Patienten blieb die Kontinuität des N. facialis erhalten; in 6 Fällen war ein Nervinterponat erforderlich. In zehn Fällen resultierte eine zufriedenstellende postoperative Funktion. Zu Beginn des Analysezeitraumes überwogen periphere Fazialisparesen, später Hörstörungen und Tinnitus. Die Kernspintomographie ermöglicht es im Einzelfall, Schwannome des N. facialis von anderen Tumoren des inneren Gehörganges zu differenzieren. Auch die elektrophysiologische Diagnostik kann Hinweise auf ein Schwannom des N. facialis geben. Dadurch kann die Therapie mit den Patienten differenziert besprochen werden.
Schlüsselwörter
Schwannome Innerer Gehörgang Transtemporale Chirurgie N. facialis Kernspintomographie Felsenbein Ganglion geniculiAbstract
Background
Schwannoma of the vestibular nerve is the most common tumor found in the inner auditory canal. If a schwannoma of the facial nerve is found unexpectedly during surgery, the original surgical plan may have to be changed. In our series, we describe the symptoms, diagnostic procedures and therapy of this infrequent, benign tumor. In particular, we want to analyse the influence of diagnostic techniques, such as magnetic resonance tomography and electrophysiology, on the diagnosis of these tumors.
Patients
Between 1975 and 2001, we diagnosed 17 cases of facial nerve schwannoma in the inner auditory canal or the geniculate ganglion. All patients were treated surgically. In 16 cases, we used the enlarged middle fossa approach and in the remaining patient the translabyrinthine approach was used.
Results
In 11 cases, the facial nerve could be saved but in six the nerve had to be rebuilt with a transplant. During the first years of our study, palsy of the facial nerve was a frequent finding. In the later years, a hearing impairment and tinnitus became the most frequent symptoms.
Conclusions
Advances in magnetic resonance imaging have, in many cases, facilitated the differentiation between schwannomas of the facial nerve and the vestibular nerve over the last years. Signal enhancement at the geniculate ganglion is important for the diagnosis of facial nerve schwannoma. In individual cases, we found significant findings using electrophysiological procedures. In three cases, the temporal delay was elongated. Based on these findings, the therapeutic procedures can be discussed together with the patients.
Keywords
Internal auditory canal Schwannoma Facial nerve Middle fossa surgery Cerebellopontine angle Geniculate ganglionLiteratur
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