联合半球间入路与内镜下经鼻入路切除一例罕见嗅神经鞘瘤并保留嗅觉功能

文献信息

中文摘要

引言： 嗅沟神经鞘瘤（OGSs）是极为罕见的颅内肿瘤，报道病例不足80例。其影像学特征常类似脑膜瘤或嗅神经母细胞瘤，使术前诊断复杂化。由于嗅神经中缺乏施万细胞，其起源仍存在争议。
研究问题： 描述一例罕见的伴筛窦延伸的嗅沟神经鞘瘤，通过联合半球间入路与内镜下经鼻入路成功治疗，并结合当前文献讨论其诊断和手术意义。此外，测量手术前后的各自嗅觉功能。
材料和方法： 一名52岁男性表现为短暂性视觉障碍、头痛、词汇提取困难、轻度执行功能障碍伴抑制受损，以及顺行性言语记忆障碍。他无嗅觉主诉，但嗅觉测试显示单侧左侧嗅觉丧失。术前MRI显示左侧嗅沟大型肿块，伴实性-囊性成分、骨侵蚀和下方筛窦延伸。采用联合经颅半球间入路与内镜下经鼻入路以实现全切除并确保颅底重建。
结果： 实现肿瘤大体全切除。组织病理学检查证实为WHO I级神经鞘瘤。术后恢复顺利，神经心理和左侧嗅觉功能改善。随访MRI未见残留病灶。
讨论和结论： OGS应纳入伴有囊性或鼻窦延伸的前颅底肿瘤的鉴别诊断。在选定病例中，联合颅-内镜入路可实现安全且根治性切除，同时最小化并发症。准确的病理组织学评估对于明确诊断仍至关重要，因为仅凭影像学特征可能误导。应系统测量嗅觉功能，因为嗅觉功能的保留甚至改善是可能的。这支持肿瘤的非嗅觉起源，提示为继发性压迫而非嗅觉系统的原发性受累。

英文摘要

INTRODUCTION: Olfactory groove schwannomas (OGSs) are exceptionally rare intracranial tumors, with fewer than 80 cases reported. Their imaging features often mimic meningiomas or esthesioneuroblastomas, complicating preoperative diagnosis. Their origin remains debated due to the absence of Schwann cells in the olfactory nerve.
RESEARCH QUESTION: To describe a rare case of olfactory groove schwannoma with ethmoidal extension, successfully treated through a combined interhemispheric and endoscopic endonasal approach, and to discuss its diagnostic and surgical implications in light of the current literature. Furthermore, to measure the respective olfactory function before and after surgery.
MATERIAL AND METHODS: A 52-year-old man presented with transient visual disturbances, headache, lexical access difficulties, slight executive dysfunction with impaired inhibition, and anterograde verbal memory impairment. He had no olfactory complaints but olfactory testing revealed unilateral, left-sided anosmia. Preoperative MRI demonstrated a large left olfactory groove mass with solid-cystic components, bone erosion, and inferior ethmoidal extension. A combined transcranial interhemispheric and endoscopic endonasal approach was performed to achieve total resection and ensure skull base reconstruction.
RESULTS: Gross total tumor removal was achieved. Histopathological examination confirmed a WHO grade I schwannoma. Postoperative recovery was uneventful, with improvement in neuropsychological and left-sided olfactory function. There was no residual lesion on follow-up MRI.
DISCUSSION AND CONCLUSIONS: OGS should be included in the differential diagnosis of anterior skull base tumors with cystic or sinonasal extension. In selected cases, a combined cranio-endoscopic approach allows safe and radical resection while minimizing morbidity. Accurate histopathological evaluation remains essential for definitive diagnosis, as radiological features alone may be misleading. Olfactory function should be systematically measured since preservation and even improvement of olfactory function are possible. This supports a non-olfactory origin of the tumor, suggesting secondary compression rather than primary involvement of the olfactory system.