RESUMEN
Hemifacial spasm (HFS) is commonly caused by a vascular loop compressing the Root Exit Zone (REZ) of the facial nerve. We report a case of HFS caused by a vascular loop that was abnormally displaced by a neuroglial cyst not seen in Magnetic Resonance Imaging (MRI). Microvascular decompression (MVD) was planned and the patient underwent a key-hole retromastoid posterior fossa exposure. A cystic lesion was found in the cerebellopontine angle (CPA), located around the seventh and eighth cranial nerves extending from the porous acousticus to the brainstem REZ of the facial nerve. The cyst wall was partially excised revealing the region of the neurovascular conflict. MVD of the facial nerve was performed with immediate postoperative complete resolution of the patient's symptoms.
Asunto(s)
Quistes del Sistema Nervioso Central/cirugía , Enfermedades Cerebelosas/cirugía , Ángulo Pontocerebeloso/cirugía , Espasmo Hemifacial/etiología , Neuroglía , Adulto , Quistes del Sistema Nervioso Central/diagnóstico , Quistes del Sistema Nervioso Central/patología , Enfermedades Cerebelosas/diagnóstico , Enfermedades Cerebelosas/patología , Ángulo Pontocerebeloso/patología , Craneotomía , Diagnóstico Diferencial , Enfermedades del Nervio Facial/diagnóstico , Enfermedades del Nervio Facial/patología , Enfermedades del Nervio Facial/cirugía , Humanos , Angiografía por Resonancia Magnética , Masculino , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/patología , Síndromes de Compresión Nerviosa/cirugíaRESUMEN
A new technique is reported for the treatment of isolated lumbar nerve root foraminal stenosis. Nerve root decompression is performed via a 5-mm drill hole in the lamina immediately below the superior facet. This technique preserves spinal stability even if done at multiple levels. It also provides early mobility of the patient and subsequently shortens the hospital stay. The technical details are described.
Asunto(s)
Síndromes de Compresión Nerviosa/cirugía , Procedimientos Neuroquirúrgicos/métodos , Raíces Nerviosas Espinales/cirugía , Estenosis Espinal/cirugía , Humanos , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Estenosis Espinal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodosRESUMEN
A case of cerebellopontine angle epithelial cyst is described. Lesions in this region usually present with hearing loss, tinnitus, dysequilibrium, headaches, facial numbness and occasionally trigeminal neuralgia. Our patient presented with the unusual phenomenon of episodic facial palsy. The literature reporting this lesion as well as this mode of presentation has been reviewed.
Asunto(s)
Enfermedades Cerebelosas/complicaciones , Ángulo Pontocerebeloso , Quistes/complicaciones , Parálisis Facial/etiología , Adulto , Enfermedades Cerebelosas/diagnóstico , Ángulo Pontocerebeloso/patología , Quistes/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
Trochlear nerve schwannoma is an extremely rare intracranial tumour. It is a benign tumour often presenting late with the involvement of neighbouring structures and potentially life threatening complications. We report a case of this condition, which is the first to be treated by surgery via a presigmoid 'combined petrosal approach' with follow-up by magnetic resonance imaging (MRI) for 6 years. The advantages of the presigmoid combined petrosal approach for this type of tumour are described. Early investigation of patients with unexplained trochlear nerve palsy by MRI will facilitate the management of these rare tumours.