目的：通过对鼻-翼腭窝区域神经鞘瘤的临床病例回顾，探讨该部位神经鞘瘤的临床诊断及治疗策略。方法回顾性分析5个鼻-翼腭窝区域神经鞘瘤的临床病例资料，并列举其主要的临床表现、辅助检查、治疗方法和预后情况。结果5例神经鞘瘤分别位于上颌窦（1例）、蝶窦（1例），鼻腔（1例）、鼻中隔（1例）及翼腭窝（1例）。临床表现多由肿物的局部压迫所引起，包括眼眶深部隐痛、鼻塞、清水涕、嗅觉减退、额顶部头昏和头痛等。查体可见鼻腔神经鞘瘤呈灰白色，质软，表面光滑。神经鞘瘤在CT上主要表现为软组织密度影，并且伴有不同程度的周围骨质破坏，在MRI上的的特点主要是T1WI呈等信号，T2WI呈不均匀稍高信号。5个病例均行手术切除治疗。5个病例的术后病理中HE染色的特点主要为梭形细胞肿瘤。术后随访中无1例患者出现复发，总体预后良好。结论鼻-翼腭窝神经鞘瘤临床表现较为隐蔽，影像学表现与其他类型肿瘤不易区分，因此直接诊断困难，需结合术后病理。手术为其主要治疗方式，并且总体预后良好。%Objective To investigate the diagnosis and treatment strategy of schwannoma in the nasal cavity, paranasal sinus and pterygopalatine fossa region. Methods A retrospective study of 5 schwannoma cases in above region was conducted. The clinical data and follow-up information were summarized. Results The 5 cases of schwannoma located at maxillary sinus, sphenoid sinus, nasal septum, nasal cavity and pterygopalatine fossa, respectively. Their clinical symptoms included headache, nasal obstruction, rhinorrhea and hyposmia. 1 schwannoma appeared as a gray, smooth and soft mass in physical examination while the other 4 were convert. In computed tomography (CT), all the 5 schwannomas manifested as soft tissue masses, and 1 schwannoma showed iso-signal intensity in T1WI and heterogeneous slightly-high-signal intensity in T2WI in magnetic resonance imaging (MRI). Surgical excision was conducted in all the 5 cases, and they all achieved good recovery without any recurrence according to recent follow-up. Conclusion Schwannoma in the nasal cavity, paranasal sinus and pterygopalatine fossa region should be diagnosed on the basis of clinical symptoms, physical examination, radiological images, and especially pathology. Surgery is of first priority in the treatment of schwannoma in above region, and the outcome of which is usually good.
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