Background:Naso-ethmoidal schwannoma is a rare slow-growing tumor arising from the Schwann cells of the sinonasal tract. This study discusses the evolution of surgical approaches to naso-ethmoidal schwannomas with respect to tumor growth and recent advances in minimally invasive techniques.Materials and Methods:A comprehensive literature review on Embase online electronic database on benign naso-ethmoidal schwannoma was performed. Demographic, clinical, neuroradiological, pathological, and surgical factors were analyzed and discussed.Results:Twenty-five cases met the inclusion criteria. No predilection for gender was evident. The mean age at diagnosis was 40.2 years old. Nasal obstruction was the most common presenting symptom (64%), followed by headache (60%), hypo-anosmia (24%), and visual impairment (24%). Skull base and orbital involvement were registered in 64% and 16% of cases, respectively. Surgery is the unique curative treatment, with the endoscopic endonasal approach which plays the leading role (44%). Gross total resection was possible in all cases and was associated with no recurrence. The perioperative complication rate was 32% and mainly consisted of cerebrospinal fluid leakage. The mean time for treatment was 21 months. All patients were alive at last follow up.Conclusion:Surgery is the only curative treatment for naso-ethmoidal schwannomas, with the main goal to relief clinical manifestations. The endoscopic endonasal route represents the master approach for lesions confined to the midline. Transcranial and transorbital approaches play a complementary role when large intracranial extension and orbital involvement occur, respectively.
背景：鼻筛区神经鞘瘤是一种罕见的、生长缓慢的肿瘤，起源于鼻窦道的施万细胞。本研究探讨了针对鼻筛区神经鞘瘤手术入路的演变，重点关注肿瘤生长特点及微创技术的最新进展。 材料与方法：在Embase在线电子数据库中对良性鼻筛区神经鞘瘤进行了全面的文献综述。对人口统计学、临床表现、神经影像学、病理学及手术相关因素进行了分析与讨论。 结果：共纳入25例符合标准的病例。未见明显的性别倾向性。诊断时的平均年龄为40.2岁。鼻塞是最常见的就诊症状（64%），其次为头痛（60%）、嗅觉减退或丧失（24%）和视力障碍（24%）。颅底受累和眼眶受累的比例分别为64%和16%。手术是唯一的根治性治疗方法，其中内镜经鼻入路占主导地位（44%）。所有病例均实现了大体全切除，且无复发。围手术期并发症发生率为32%，主要为脑脊液漏。平均治疗时间为21个月。末次随访时所有患者均存活。 结论：手术是鼻筛区神经鞘瘤的唯一根治性治疗手段，其主要目标是缓解临床症状。对于局限于中线的病变，内镜经鼻入路是主要的手术方式。当肿瘤向颅内广泛扩展或侵犯眼眶时，经颅入路和经眶入路分别发挥补充作用。
Naso-Ethmoidal Schwannoma: From Pathology to Surgical Strategies
肿瘤(癌症)患者之家