What Is a Nerve Sheath?

This disease, also known as Schwann cell tumor, is a tumor formed by the Schwann sheath of the peripheral nerve (ie, the nerve sheath). It is also called a neuroma and is a benign tumor. When it occurs in the vestibular or cochlear nerve, it is also called an acoustic neuroma. The patients were mostly middle-aged people aged 30 to 40 years, with no significant gender differences. It usually grows in the posterior root of the spinal nerve. If the tumor is large, 2 to 3 nerve roots can be adhered or buried in the tumor. The nerve roots are thick and may occur in several spinal nerve roots. A small number of patients may be accompanied by multiple neurofibromatosis, and it can be seen that there are coffee pigmentation spots and multiple small nodular tumors on the skin. Spinal schwannomas are usually 2 to 3 cm in size.

Basic Information

Also known as

"Xu Wang cell tumor, neuroma"

English name

neurilemmoma; schwannoma

Visiting department

neurosurgery

Multiple groups

Middle-aged 30 to 40 years old

Common locations

Spinal nerve root

Causes of Schwannomas

It is generally believed that this tumor originates from a tumor of the nerve sheath, but whether it originated from Schwann cells or from fibroblasts derived from the nerve sheath is controversial. It can occur naturally or as a result of trauma or other irritation. The disease can also be associated with multiple neurofibromas.

Clinical manifestations of schwannoma

It can occur at any age and gender. Occurs in cranial nerves more often than peripheral nerves. Usually single shot, sometimes multiple shots. They vary in size, up to a few centimeters. Skin damage often occurs in the limbs, especially where the larger flexor nerve is located. Others such as neck, face, scalp, eyes and orbit can also occur. It is also found in the tongue, bone, and posterior mediastinum.

Tumors are scattered soft masses, usually without symptoms, but sometimes accompanied by pain and tenderness. If tumors involve nerve tissue, sensory disturbances can occur, especially pain and numbness at the corresponding site. Dyskinesias are rarely seen, and at most they show weak strength in the affected area.

The affected neural stem approached a round or oval parenchymal mass. The mass was tough, the surface of the mass was smooth, the boundaries were clear, and there was no adhesion with surrounding tissues. It can move in a direction perpendicular to the neural trunk, but the longitudinal movement is small, and the Tinel sign is positive. There are varying degrees of sensory motor abnormalities in the innervated innervation zone.

Schwannomas originating from the auditory nerve can cause symptoms such as tinnitus, hearing loss, facial numbness or pain, and larger lesions can also cause symptoms such as facial paralysis, drinking cough, difficulty swallowing, and hydrocephalus.

Schwannomas examination

Patients in the neck, brachial plexus, lumbar plexus, and intracranial and spinal canals were examined by MRI before surgery.

Schwannomas diagnosis

Schwannomas lesions can often cause pain, especially paroxysmal pain, so painful masses are often suspected of the disease, but a biopsy is needed to confirm the diagnosis.

Differential diagnosis of schwannoma

It should be distinguished from fibroids, neurofibromas, lipomas, epidermal cysts or dermoid cysts. The disease is even similar to a hemangioma or an organised hematoma, which can be distinguished by pathological examination.

Schwannomas treatment

Surgical treatment

Because its capsule is intact, it can be peeled off from the capsule without removing adjacent normal tissue.

2. Drug treatment

For prophylactic anti-infection in general surgery, sulfa drugs (such as compound sinomethoxin) or drugs mainly acting on Gram-positive bacteria (such as erythromycin and cyanin) are used; the scope of the operation is large, and the tumor site In general, a combination of drugs is used, such as: drugs that act on Gram-positive bacteria (such as penicillin) + drugs that act on Gram-negative bacteria (such as gentamicin) + drugs that act on anaerobic bacteria (such as exterminator Di Ling); before and after surgery, the infection is serious or the surgical wound is large, and those with complicated repair methods can choose effective antibiotics according to clinical and drug sensitivity tests.