RESUMO
We report a case of a 16-year-old female patient harboring neurofibromatosis type 2 who presented with bilateral hearing impairment, which was on the left side, as well as facial paresis (House-Brackmann grade III) and ataxic gait. A magnetic resonance imaging (MRI) exam evidenced bilateral lesions in the cerebellopontine angles (CPAs) with extension into the internal acoustic meatus, and an additional lesion in the right CPA with radiological characteristics of an epidermoid cyst. The patient was submitted to microsurgical resection, confirming a collision of a vestibular schwannoma and an epidermoid cyst in the right CPA. In the present case report, we describe the first case reported in the literature with preoperative diagnostic work-up, intraoperative findings, postoperative course of the patient, as well as a detailed literature review of these specific coinciding pathologies, denoting the importance of further genomic studies regarding multiple central nervous system (CNS) lesions.
Relatamos o caso de uma paciente de 16 anos de idade com neurofibromatose tipo II com deficiência auditiva bilateral, pior no ouvido esquerdo, assim como paresia facial (HouseBrackmann grau III) e ataxia. Estudo de ressonância magnética comprovou lesão bilateral nos ângulos cerebelopontinos (ACPs) com extensão ao meato acústico interno, e uma lesão adicional no ACP direito com características radiológicas de um cisto epidermoide. A paciente foi submetida a ressecção microcirúrgica, confirmando a colisão de um schwannoma vestibular com um cisto epidermoide no ACP direito. No presente estudo, descrevemos o primeiro caso relatado na literatura com trabalho diagnóstico pré-operatório, resultados intraoperatórios, evolução da paciente no pós-operatório, assim como revisão detalhada da literatura específica sobre essas patologias, demonstrando a importância de mais estudos genômicos sobre as múltiplas lesões do sistema nervoso central (SNC).
Assuntos
Humanos , Feminino , Adolescente , Neuroma Acústico , Neurofibromatose 2 , Cisto Epidérmico , Ângulo Cerebelopontino/lesõesRESUMO
BACKGROUND: Surgical procedures in the cerebello-pontine angle (CPA), e. g. for vestibular schwannoma, have an increased risk for damage to the cochlear nerve. Consequently, hearing deterioration up to complete deafness may result with severe impact on quality of life. Methods for intraoperative monitoring of function may minimize such risks. OBJECTIVE: Review of current methods for intraoperative monitoring of the cochelar nerve and summary of new developments. MATERIALS AND METHODS: Analysis and summary of literature, discussion of new methods. RESULTS: Early auditory evoked potentials using click stimuli remain the standard method for intraoperative monitoring of cochlear nerve function. Amplitude and latency changes indicate a risk of postoperative hearing deterioration; however demonstrate only limited further differentiation of hearing quality. As novel methods, near-field recordings may allow faster feedback and auditory steady state responses potentially enable frequency specific testing. CONCLUSIONS: Intraoperative monitoring of the cochlear nerve is an integral component of CPA surgery. It enables detection of potential nerve damage and thus contributes to avoiding postoperative functional deficits. Development and implementation of novel and additional approaches may further improve its clinical value.
Assuntos
Ângulo Cerebelopontino/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Doenças do Nervo Vestibulococlear/etiologia , Doenças do Nervo Vestibulococlear/prevenção & controle , Ângulo Cerebelopontino/lesões , Medicina Baseada em Evidências , Humanos , Neuroma Acústico/diagnóstico , Resultado do Tratamento , Doenças do Nervo Vestibulococlear/diagnósticoAssuntos
Doenças Cerebelares/terapia , Ângulo Cerebelopontino/lesões , Osteopatia/métodos , Acidentes de Trânsito , Doenças Cerebelares/etiologia , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Gadolinium-enhanced magnetic resonance imaging (MRI) is currently the gold standard for diagnosis of an acoustic neuroma. Its status is diagnosis of a recurrent or residual neuroma is not nearly as clear. A pilot study of 36 postoperative cases showed enhancement in 100% of the patients at the operative site. To examine the role of surgical trauma and biodegradable packing on enhanced MRI, an animal study was designed. Cats and monkeys that underwent posterior fossa surgical procedures had preoperative and postoperative MRI and histologic correlation of any enhanced area. Areas of postoperative enhancement should not be considered as diagnostic of tumor. Further studies are necessary to develop a criteria for recurrent tumor diagnosis with enhanced MRI.