There is no specific treatment at present. Surgical resection is the only effective treatment for this disease. Some patients can be treated with radiotherapy, and the authors of epilepsy can be treated with antiepileptic drugs. The remaining measures are mainly symptomatic treatment.
1. Surgical resection is the only treatment, and the purpose of surgical resection is to relieve symptoms and reduce tumor volume. Intracranial and intraspinal tumors such as acoustic neuroma and optic neuroma can be treated surgically. Intracapsular resection is not as easy as schwannoma, because its capsule is unclear and easy to recur, while resection of the outer edge of the capsule has a low recurrence rate, while extensive resection is affirmative treatment and the recurrence rate is very low. For those who do not grow on the trunk of the great nerve, extensive or marginal resection can be performed. For those who grow on the trunk of the great nerve, such resection will damage the nerve and bring disease and waste. In this case, intracapsular resection is still performed, although there may be recurrence and nerve involvement, and it is very difficult to perform intracapsular resection again. Generally do not do radiotherapy, because it can damage the nerves.
if it is small and limited, it should be completely removed at one time. Large, extensive or multiple patients are usually difficult to completely remove and cannot be cured. Staged resection can be considered. First of all, selective resection is performed on the parts that damage the appearance, or hinder the function, or are suspected of malignant transformation. The amount of resection should be estimated when it is removed by stages. If the excision is too much and the wound edge is too tight after suture, it may lead to complications such as wound edge necrosis and wound dehiscence. Most tumor resection can cause soft tissue defects, which should be repaired by transplantation of large myocutaneous flap combined with microsurgery.
2. Skin flap transplantation, that is, pedicled skin flap transplantation, requires that the skin flap be pedicled with 1 ~ 2 blood vessels (including arteries and veins) to ensure the survival of the skin flap. There are two types of skin flap transplantation: flat skin flap transplantation and tubular skin flap (skin tube) transplantation. The latter is mainly used in surgical plastic surgery and will not be introduced here.
(1) Making of flat flap: Flat flap is also called simple flap or open flap. This seed flap is transplanted in a flat form, usually with only one pedicle, and sometimes with two pedicles. The ratio of length to width of the flap is generally less than 1.5∶1, but the ratio of length to width can reach 3 ~ 4 ∶ 1 in the head and face with rich blood supply. In the leg with poor blood supply, the ratio of length to width can only be 1∶1, otherwise blood supply disorder may occur and the survival of the flap may be affected. The size of the flap can be designed according to the direction of the blood vessels, the pedicle should point to the proximal end of the blood vessels, and the wounds in the donor area can be directly sutured or repaired with medium-thick skin graft.
(2) flap transplantation method:
① local rotation method: it is to make a flap from some normal skin tissues around the defect, and transfer the flap to the defect by local rotation at a certain angle to repair the wound. The design of rotating skin flap requires that the length and diameter should be larger than that of the wound surface, so as to avoid too tight transplantation, and too much tension after suture will split the incision and affect the blood supply of the skin flap. After the flap is rotated, it is often near the defect side of the pedicle, and folds of different degrees appear due to different rotation angles. The bigger the angle, the more obvious it is. However, this fold can not be removed immediately, otherwise the blood supply disorder will be necrotic due to the narrowing of the pedicle of the flap. After skin flap transplantation, some donor sites can be directly sutured, while others need skin graft to repair. ② Local pushing method: A skin flap is formed on the skin around the wound by using the extensibility of the skin, and the skin flap is pushed vertically to the wound to repair the wound. The wound surface of the donor site can be slightly separated from the two sides of the V-shaped incision and then pulled together to make a Y-shaped suture. Y-shaped incision and V-shaped suture can also be used to repair the wound.
③ local lateral displacement method: a tension-reducing incision was made at a proper distance outside the wide wound surface that could not be directly sutured, and the incision was separated from the wound surface subcutaneously to form a double pedicle flat flap, so as to repair the wound surface by lateral displacement. It is often used to repair the longitudinal spindle-shaped skin defect and the wound with exposed bone tissue in the anterior tibial region of the leg. The ratio between the length and width of the flap is generally 1.5∶1, and the donor site is repaired with thick skin graft.
④ Distal transfer method: The donor site of the flap is located in the remote part of the defect area, such as the wound in the anterior tibial area of the calf, which can be repaired by the contralateral calf flap. Finger wounds can be repaired with contralateral chest wall flap.
3. Precautions
(1) Patients with neurofibroma sometimes have poor tolerance to surgery and should pay attention.
(2) Huge tumors on limbs can often rupture, leading to infection and suppuration, which is the indication of final amputation.
(3) After the skin flap transplantation, it should be properly bandaged and fixed, so as to minimize the deformation of the recipient tissue to ensure that the transplanted skin flap is closely attached to the wound surface.
4. TCM treatment principles: the method should be to neutralize qi and blood, dredge channels and activate collaterals, soften the hard and eliminate internal heat.
prescription: salvia miltiorrhiza 15g, Spatholobus suberectus 3g, Paeonia lactiflora 15g, Carthamus tinctorius 15g, Magnolia officinalis 1g, Exocarpium Citri Grandis 1g, Semen Sinapis Albae 1g, Fructus Citri Reticulatae 1g, towel gourd 1g, Bombyx Batryticatus 1g and Bulbus Fritillariae Thunbergii 1g.
(II) Prognosis
Patients with good prognosis and less malignant transformation, accompanied by intracranial meningiomas and gliomas, peripheral neurosarcomas and other malignant tumors have poor prognosis. The development of this disease is generally slow, but it can be accelerated in adolescence or pregnancy, and the incidence of malignant transformation is about 7%. Patients with intracranial meningioma, glioma, peripheral neurosarcoma and other malignant tumors have poor prognosis.