RESUMO
RATIONALE: One-and-a-half syndrome (OAAH) is characterized as the combination of ipsilateral horizontal gaze palsy and internuclear ophthalmoplegia. OAAH syndrome accompanied with 7th and 8th cranial nerve palsy is called 16-and-a-half syndrome. We aimed to report the case of 16-and-a-half syndrome with metastatic pons tumor. PATIENT CONCERNS: A 57-year-old male diagnosed with nonsmall-cell lung cancer (NSCLC) with brain metastasis occurring 15 months ago was referred to our clinic with the chief complaint of horizontal diplopia and right gaze palsy. DIAGNOSIS: According to the patient symptom, ocular examination, and radiographic findings, he was diagnosed as 16-and-a-half syndrome which was caused by brain tumor metastasis from NSCLC. INTERVENTIONS: We referred him to hemato-oncology department and he was treated with radiation and supportive therapy. OUTCOMES: Unfortunately, the patient passed away 1 month later without improvement of ophthalmoplegia. LESSONS: The clinical findings of our case indicate 16-and-a-half syndrome caused by brain tumor metastasis from NSCLC, which to our knowledge has not been previously reported. The case highlights a rare cause of OAAH spectrum disease and the importance of a systemic work-up including associated neurologic symptoms and brain imaging in patients with horizontal gaze palsy.
Assuntos
Neoplasias Encefálicas/complicações , Doenças do Nervo Facial/etiologia , Transtornos da Motilidade Ocular/etiologia , Oftalmoplegia/etiologia , Ponte , Doenças do Nervo Vestibulococlear/etiologia , Neoplasias Encefálicas/secundário , Humanos , Masculino , Pessoa de Meia-Idade , SíndromeRESUMO
A 58-year-old man with a history of rheumatoid arthritis and stage IV diffuse large B-cell lymphoma, in complete remission with no evidence of residual disease on positron emission tomography/CT after completing six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy, presented with acute onset of dysphagia to solids and liquids. On further evaluation, his dysphagia was attributed to a vagus nerve palsy, and later during his admission, he developed rapidly progressing left facial and vestibulocochlear nerve palsies. Imaging studies displayed pathological enhancement of bilateral seventh and eighth cranial nerves, concerning for leptomeningeal recurrence of lymphoma. Cerebrospinal fluid analysis and flow cytometry were confirmatory, revealing markedly atypical monotypic CD19 positive B cells.
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Doenças dos Nervos Cranianos/patologia , Linfoma Difuso de Grandes Células B/patologia , Neoplasias Meníngeas/patologia , Recidiva Local de Neoplasia/patologia , Protocolos de Quimioterapia Combinada Antineoplásica , Doenças dos Nervos Cranianos/tratamento farmacológico , Doenças dos Nervos Cranianos/radioterapia , Diagnóstico Diferencial , Doenças do Nervo Facial/etiologia , Humanos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/radioterapia , Masculino , Neoplasias Meníngeas/tratamento farmacológico , Neoplasias Meníngeas/radioterapia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/radioterapia , Doenças do Nervo Vestibulococlear/etiologiaRESUMO
PURPOSE OF REVIEW: Auditory neuropathy spectrum disorder (ANSD) is a condition in which auditory testing reveals normal otoacoustic emissions, but auditory brainstem testing is abnormal or absent and speech discrimination is poor. This constellation of findings ostensibly suggests that the cochlea is healthy and an abnormality of conduction or processing of sound occurs along the nerve fibers. As more is learned about this condition, it is becoming clear that ANSD describes heterogeneous, distinct clinical entities that must be taken into account when devising treatment modalities. RECENT FINDINGS: Modern auditory testing, genetic testing, and neuroimaging can allow for an accurate understanding of the location of the lesion causing ANSD in the auditory pathway. Contributing causes can include genetic mutations, absent or deficient cochlear nerve, hypoxia and jaundice among others. Hearing aids can be successful in the management of ANSD. Several studies suggest that cochlear implantation can lead to successful hearing outcomes in a subset of this patient population. SUMMARY: Auditory neuropathy spectrum disorder represents a relatively rare but important diagnosis for clinicians. Treatment for this condition includes hearing aids and FM systems in more mild cases, and cochlear implants in severe cases. Cochlear implantation for many patients can lead to a good hearing outcomes but the outcome can vary greatly depending on the underlying etiology of ANSD.
Assuntos
Implantes Cocleares , Perda Auditiva Central/terapia , Criança , Implante Coclear , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Perda Auditiva Central/diagnóstico , Perda Auditiva Central/etiologia , Humanos , Percepção da Fala , Doenças do Nervo Vestibulococlear/diagnóstico , Doenças do Nervo Vestibulococlear/etiologia , Doenças do Nervo Vestibulococlear/terapiaRESUMO
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/diagnósticoRESUMO
OBJECTIVE Malignant peripheral nerve sheath tumors (MPNSTs) of the eighth cranial nerve (CN) are exceedingly rare. To date the literature has focused on MPNSTs occurring after radiation therapy for presumed benign vestibular schwannomas (VSs), while MPNSTs arising without prior irradiation have received little attention. The objectives of the current study are to characterize the epidemiology, clinical presentation, disease course, and outcome using a large national cancer registry database and a systematic review of the English literature. Additionally, a previously unreported case is presented. METHODS The authors conducted an analysis of the Surveillance, Epidemiology, and End Results (SEER) database, a systematic review of the literature, and present a case report. Data from all patients identified in the SEER database with a diagnosis of MPNST involving the eighth CN, without a history of prior radiation, were analyzed. Additionally, all cases reported in the English literature between January 1980 and March 2015 were reviewed. Finally, 1 previously unreported case is presented. RESULTS The SEER registries identified 30 cases between 1992 and 2012. The average incidence was 0.017 per 1 million persons per year (range 0.000-0.0687 per year). The median age at diagnosis was 55 years, and 16 (53%) were women. Thirteen cases were diagnosed upon autopsy. Of the 17 cases diagnosed while alive, the median follow-up was 118 days, with 3 deaths (18%) observed. When compared with the incidence of benign VS, 1041 VSs present for every 1 MPNST arising from the eighth CN. Including a previously unreported case from the authors' center, a systematic review of the English literature yielded 24 reports. The median age at diagnosis was 44 years, 50% were women, and the median tumor size at diagnosis was 3 cm. Eleven patients (46%) reported isolated audiovestibular complaints typical for VS while 13 (54%) exhibited facial paresis or other signs of a more aggressive process. Treatment included microsurgery alone, microsurgery with adjuvant radiation, or microsurgery with chemoradiation. Sixty-one percent of patients receiving treatment experienced recurrence, 22% of which were diagnosed with drop metastases to the spine. Ultimately, 13 patients (54%) died of progressive disease at a median of 3 months following diagnosis. The ability to achieve gross-total resection was the only feature that was associated with improved disease-specific survival. CONCLUSIONS MPNSTs of the eighth CN are extremely rare and portend a poor prognosis. Nearly half of patients initially present with findings consistent with a benign VS, often making an early diagnosis challenging. In light of these data, early radiological and clinical follow-up should be considered in those who elect nonoperative treatment, particularly in patients with a short duration of symptoms or atypical presentation. These data also provide a baseline rate of malignancy that should be considered when estimating the risk of malignant transformation following stereotactic radiosurgery for VS.
Assuntos
Neoplasias dos Nervos Cranianos , Neoplasias de Bainha Neural , Doenças do Nervo Vestibulococlear , Nervo Vestibulococlear , Adulto , Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias dos Nervos Cranianos/epidemiologia , Neoplasias dos Nervos Cranianos/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias de Bainha Neural/diagnóstico , Neoplasias de Bainha Neural/epidemiologia , Neoplasias de Bainha Neural/etiologia , Doenças do Nervo Vestibulococlear/diagnóstico , Doenças do Nervo Vestibulococlear/epidemiologia , Doenças do Nervo Vestibulococlear/etiologiaRESUMO
INTRODUCTION: Hereditary gelsolin amyloidosis (GA) is a rare condition caused by the gelsolin gene mutation. The diagnostic triad includes corneal lattice dystrophy (type 2), progressive bilateral facial paralysis, and cutis laxa. Detailed information on facial paralysis in GA and the extent of cranial nerve injury is lacking. METHODS: 29 GA patients undergoing facial corrective surgery were interviewed, examined, and studied electroneurophysiologically. RESULTS: All showed dysfunction of facial (VII) and trigeminal (V) nerves, two-thirds of oculomotor (III) and hypoglossal (XII) nerves, and half of vestibulocochlear (acoustic) (VIII) nerve. Clinical involvement of frontal, zygomatic, and buccal facial nerve branches was seen in 97%, 83%, and 52% of patients, respectively. Electromyography showed marked motor unit potential loss in facial musculature. CONCLUSIONS: Cranial nerve involvement in GA is more widespread than previously described, and correlates with age, severity of facial paralysis, and electromyographic findings. We describe a grading method for bilateral facial paralysis in GA, which is essential for evaluation of disease progression and the need for treatment.
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Neuropatias Amiloides Familiares/fisiopatologia , Amiloidose/fisiopatologia , Distrofias Hereditárias da Córnea/fisiopatologia , Doenças dos Nervos Cranianos/fisiopatologia , Músculos Faciais/fisiopatologia , Paralisia Facial/fisiopatologia , Condução Nervosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Neuropatias Amiloides Familiares/complicações , Amiloidose/complicações , Distrofias Hereditárias da Córnea/complicações , Doenças dos Nervos Cranianos/etiologia , Cútis Laxa/etiologia , Eletromiografia , Doenças do Nervo Facial/etiologia , Doenças do Nervo Facial/fisiopatologia , Paralisia Facial/etiologia , Feminino , Humanos , Doenças do Nervo Hipoglosso/etiologia , Doenças do Nervo Hipoglosso/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/etiologia , Doenças do Nervo Oculomotor/fisiopatologia , Doenças do Nervo Trigêmeo/etiologia , Doenças do Nervo Trigêmeo/fisiopatologia , Doenças do Nervo Vestibulococlear/etiologia , Doenças do Nervo Vestibulococlear/fisiopatologiaRESUMO
The present review of the current literature concerning pathogenesis, formation of neurovascular conflict of the vestibulocochlear nerve, its epidemiology, clinical manifestations, diagnostics, and the methods for the surgical and conservative treatment is focused on the indications for decompression of the vestibulocochlear nerve and its effectiveness in the patients presenting with the neurovascular conflict of the vestibulocochlear nerve.
Assuntos
Cirurgia de Descompressão Microvascular/métodos , Doenças do Nervo Vestibulococlear/cirurgia , Humanos , Doenças do Nervo Vestibulococlear/diagnóstico , Doenças do Nervo Vestibulococlear/etiologiaRESUMO
TITLE: Espasmo hemifacial provocado por un granuloma de colesterol del hueso temporal.
Assuntos
Colesterol/análise , Doenças do Nervo Facial/etiologia , Granuloma de Corpo Estranho/complicações , Espasmo Hemifacial/etiologia , Síndromes de Compressão Nervosa/etiologia , Osso Petroso/patologia , Descompressão Cirúrgica , Feminino , Granuloma de Corpo Estranho/metabolismo , Granuloma de Corpo Estranho/cirurgia , Perda Auditiva Unilateral/etiologia , Humanos , Hiperlipidemias/complicações , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/cirurgia , Osso Petroso/cirurgia , Doenças do Nervo Vestibulococlear/etiologiaRESUMO
Painful tic convulsif is referred to as the concurrent trigeminal neuralgia and hemifacial spasm. However, painful tic convulsif after ipsilateral Bell palsy has never been reported before. We report a case of a 77-year-old woman with coexistent trigeminal neuralgia and hemifacial spasm who had experienced Bell palsy half a year ago. The patient underwent microvascular decompression. Intraoperatively, the vertebrobasilar artery was found to deviate to the symptomatic side and a severe adhesion was observed in the cerebellopontine angle. Meanwhile, an ectatic anterior inferior cerebellar artery and 2 branches of the superior cerebellar artery were identified to compress the caudal root entry zone (REZ) of the VII nerve and the rostroventral cisternal portion of the V nerve, respectively. Postoperatively, the symptoms of spasm ceased immediately and the pain disappeared within 3 months. In this article, the pathogenesis of the patient's illness was discussed and it was assumed that the adhesions developed from inflammatory reactions after Bell palsy and the anatomic features of the patient were the factors that generated the disorder. Microvascular decompression surgery is the suggested treatment of the disease, and the dissection should be started from the caudal cranial nerves while performing the operation.
Assuntos
Paralisia de Bell/complicações , Descompressão Cirúrgica/métodos , Espasmo Hemifacial/cirurgia , Microcirurgia/métodos , Neuralgia do Trigêmeo/cirurgia , Idoso , Artéria Basilar/anormalidades , Artéria Basilar/cirurgia , Doenças Cerebelares/etiologia , Doenças Cerebelares/cirurgia , Ângulo Cerebelopontino/patologia , Cerebelo/irrigação sanguínea , Doenças do Nervo Facial/etiologia , Doenças do Nervo Facial/cirurgia , Feminino , Seguimentos , Espasmo Hemifacial/etiologia , Humanos , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/cirurgia , Telangiectasia/complicações , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Doenças do Nervo Trigêmeo/etiologia , Doenças do Nervo Trigêmeo/cirurgia , Neuralgia do Trigêmeo/etiologia , Artéria Vertebral/anormalidades , Artéria Vertebral/cirurgia , Doenças do Nervo Vestibulococlear/etiologia , Doenças do Nervo Vestibulococlear/cirurgiaRESUMO
Vestibulopathy is a condition characterized by the onset of vertigo, nausea and vomiting, in the absence of hearing loss or tinnitus. The differential diagnosis includes peripheral otologic disorders and central disorders such as vascular insufficiency. Modified Blalock-Taussig (B-T) shunt, a polytetrafluoroethylene graft from the subclavian artery to the pulmonary artery, has become the palliative procedure of choice in cyanotic congenital heart disease patients. This palliative surgery creates a similar vascular haemodynamic to that seen in the subclavian steal syndrome and when associated with aplasia, hypoplasia or stenosis of the contralateral carotid, vertebral or posterior communicating arteries it may predispose to vascular hypoperfusion and peripheral hypofunctioning of the vestibular system. We report the case of a cyanotic congenital heart disease patient with vertigo and dizziness who underwent a modified B-T fistula on childhood and developed, many years later, a vertiginous syndrome probably of vascular origin.
Assuntos
Procedimento de Blalock-Taussig , Comunicação Interventricular/cirurgia , Síndrome do Roubo Subclávio/diagnóstico , Doenças do Nervo Vestibulococlear/etiologia , Adulto , Procedimento de Blalock-Taussig/efeitos adversos , Procedimento de Blalock-Taussig/métodos , Transposição das Grandes Artérias Corrigida Congenitamente , Humanos , Masculino , Radiografia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Transposição dos Grandes Vasos , Insuficiência Vertebrobasilar/complicaçõesAssuntos
Neoplasias Encefálicas/patologia , Neoplasias Cerebelares/secundário , Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino/cirurgia , Doenças do Nervo Facial/etiologia , Neuroblastoma/patologia , Neuroblastoma/cirurgia , Radiocirurgia/efeitos adversos , Doenças do Nervo Vestibulococlear/etiologia , Audiometria de Tons Puros , Neoplasias Encefálicas/cirurgia , Pré-Escolar , Terapia Combinada , Doenças do Nervo Facial/terapia , Humanos , Masculino , Neuroblastoma/terapia , Recuperação de Função Fisiológica , Tomografia Computadorizada por Raios X , Potenciais Evocados Miogênicos Vestibulares , Doenças do Nervo Vestibulococlear/terapiaRESUMO
We report two patients with biopsy-proven audiovestibular sarcoidosis who presented with hearing loss, vertigo and gait ataxia. Oto-neurological investigations confirmed the presence of sensorineural hearing loss, vestibular hypofunction and abnormal auditory brainstem responses. MRI scans of the brain revealed enhancement of the vestibulo-cochlear nerves. Both patients responded to high dose oral corticosteroid treatment, although one patient has required multiple trials of immunosuppressant drug therapy because of relapsing disease.
Assuntos
Doenças do Sistema Nervoso Central/patologia , Perda Auditiva Neurossensorial/diagnóstico , Sarcoidose/patologia , Doenças do Nervo Vestibulococlear/diagnóstico , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/tratamento farmacológico , Feminino , Perda Auditiva Neurossensorial/etiologia , Humanos , Pessoa de Meia-Idade , Sarcoidose/complicações , Sarcoidose/tratamento farmacológico , Resultado do Tratamento , Doenças do Nervo Vestibulococlear/etiologiaRESUMO
Exostoses and osteomas are benign bony lesions of the auditory canal. Although common in the external auditory canal, they are rare and difficult to distinguish in the internal auditory canal (IAC). In this literature review and case presentation, we define radiologic and histologic criteria to differentiate exostoses from osteomas of the IAC. Two patients with exostoses and 1 patient with an osteoma of the IAC are described here. Patient 1 presented with disabling vertigo and was found to have bilateral exostoses with nerve impingement on the right. After removal of the right-sided exostoses via retrosigmoid craniotomy, the patient had complete resolution of her symptoms over 1 year. Patient 2 presented with bilateral pulsatile tinnitus and vertigo and was found to have bilateral IAC exostoses. Patient 3 presented with hearing loss and tinnitus, and a unilateral IAC osteoma was ultimately discovered. Because of the mild nature of their symptoms, patients 2 and 3 were managed without surgery. We show that IAC osteomas can be differentiated from exostoses by radiographic evidence of bone marrow in high-resolution computed tomography scans, or by the presence of fibrovascular channels on histologic analysis. Management of these rare entities is customized on the basis of patient symptoms.
Assuntos
Neoplasias Ósseas/diagnóstico , Orelha Interna/patologia , Exostose/diagnóstico , Osteoma/diagnóstico , Idoso , Neoplasias Ósseas/cirurgia , Craniotomia/métodos , Exostose/cirurgia , Feminino , Perda Auditiva Neurossensorial/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Osteoma/cirurgia , Osso Temporal/patologia , Zumbido/etiologia , Tomografia Computadorizada por Raios X , Vertigem/etiologia , Doenças do Nervo Vestibulococlear/etiologiaRESUMO
UNLABELLED: Destruction of the inner ear in rats for medical research has been performed since 1936. Nevertheless, descriptions of the technique used and clinical analysis are poor and often involve coagulation of the stapedial artery. We suggest a description of a surgical ventrolateral approach to labyrinthectomy in rats, with preservation of the stapedial artery. METHODS: Twenty-five Wistar rats were operated on via a right ventrolateral approach to the bulla, followed by labyrinthectomy with preservation of the stapedial artery. Clinical observation and tests were carried out from the time of the surgery until day one. Twenty-four hours after the surgery on the right side, the same surgery was performed on the left side, followed by clinical observation. Twenty-five other rats were used as controls, with sham surgery. Histologic analysis of the vestibular nerve with silver staining was performed in six rats 3 or 7 days after the labyrinthectomy. RESULTS: The ventrolateral approach made it possible to reach the middle- and inner-ear with preservation of nervous and vascular elements such as the facial nerve and stapedial artery. Unilateral labyrinthectomy induced ocular skew deviation, head torsion and limb asymmetry. Dynamic signs were first rolling, then rotation, which increased considerably during tail suspension. Bilateral labyrinthectomy produces instability with major body oscillation. Animals show head and neck dorsiflexion with limb extension, sometimes followed by fast backward walking. CONCLUSION: The ventrolateral approach is an efficient technique for surgical labyrinthectomy with stapedial artery preservation. Clinical analysis shows a wide range of signs to evaluate the functional destruction of the vestibular organ.
Assuntos
Orelha Interna/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Animais , Orelha Interna/anatomia & histologia , Masculino , Nistagmo Patológico/etiologia , Postura , Ratos , Ratos Wistar , Nervo Vestibulococlear/patologia , Doenças do Nervo Vestibulococlear/etiologia , Doenças do Nervo Vestibulococlear/patologiaRESUMO
A 49-year-old man presented with a rare case of cerebellar hemangioblastoma manifesting as only hearing disturbance. He had suffered from hearing difficulty in the right ear for a few months. Magnetic resonance imaging revealed a cystic mass lesion with an internal fluid level and surrounding flow voids in the right cerebellopontine (CP) angle. Cerebral angiography disclosed a vascular-rich tumor fed by both the superior cerebellar and anterior inferior cerebellar arteries. En bloc resection of the tumor was planned under a preoperative diagnosis of cerebellar hemangioblastoma. The tumor protruded into the CP cistern and compressed cranial nerve VIII. The feeding arteries were meticulously coagulated and the tumor was successfully removed. The histological diagnosis was hemangioblastoma. After the operation, the patient's hearing acuity improved dramatically. Cerebellar hemangioblastoma should be considered in the differential diagnosis of CP angle tumors associated with hearing disturbance.
Assuntos
Neoplasias Cerebelares/complicações , Neoplasias Cerebelares/patologia , Hemangioblastoma/complicações , Hemangioblastoma/patologia , Doenças do Nervo Vestibulococlear/etiologia , Doenças do Nervo Vestibulococlear/patologia , Artéria Basilar/patologia , Artéria Basilar/cirurgia , Neoplasias Cerebelares/irrigação sanguínea , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino/cirurgia , Nervo Coclear/patologia , Nervo Coclear/fisiopatologia , Descompressão Cirúrgica , Perda Auditiva Neurossensorial/etiologia , Hemangioblastoma/irrigação sanguínea , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Resultado do Tratamento , Doenças do Nervo Vestibulococlear/fisiopatologiaAssuntos
Ângulo Cerebelopontino/irrigação sanguínea , Orelha Interna/irrigação sanguínea , Doenças do Nervo Facial/etiologia , Perda Auditiva Neurossensorial/etiologia , Síndromes de Compressão Nervosa/etiologia , Zumbido/etiologia , Artérias , Cerebelo/irrigação sanguínea , Humanos , Fatores de Risco , Doenças do Nervo Vestibulococlear/etiologiaRESUMO
Imaging of the vestibulocochlear nerve has evolved dramatically over the past few decades. The imaging specialist now is involved in the diagnosis of far more diagnostic entities than ever before. With this increased involvement comes the responsibility to increase collective knowledge regarding the pathophysiology of these diagnostic entities. This article is organized in a conventional way and covers congenital deformity of the internal auditory canal, neoplastic and pseudoneoplastic lesions, with special detailed emphasis on schwannoma of the eight cranial nerves (acoustic neuroma), nonneoplastic IAC/CPA pathology, including vascular loops, and numerous additional differential diagnostic entities, with particular emphasis on non-neoplastic meningeal disease. Lesions of the auditory pathway and an overview of cochlear implant surgery are also included in this discussion.
Assuntos
Neoplasias dos Nervos Cranianos/patologia , Imageamento por Ressonância Magnética , Doenças do Nervo Vestibulococlear/patologia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/etiologia , Humanos , Radiografia , Doenças do Nervo Vestibulococlear/diagnóstico por imagem , Doenças do Nervo Vestibulococlear/etiologiaRESUMO
OBJECTIVE OF REVIEW: To determine evidence for a relationship between vascular loops in contact with the vestibulocochlear nerve (CN VIII) and otological symptoms. TYPE OF REVIEW: Systematic review and meta-analysis of observational studies. SEARCH STRATEGY: Comprehensive search of MEDLINE, EMBASE, CINAHL, Cochrane Library, Clinical Evidence and Cochrane Central Register of Trials. Reference lists cross-referenced and authors contacted for missing data. No language restrictions. INCLUDED STUDIES: (1) compared symptoms in subjects with a vascular loop contacting CN VIII to subjects without (inter-subject control); (2) compared the prevalence of vascular loop in contact with CN VIII in symptomatic ears to contra-lateral asymptomatic ears (intra-subject control). Study quality systematically appraised. RESULTS: Five case-control studies included. A statistically significant association was demonstrated for the prevalence of vascular loops in contact with CN VIII, with unilateral sensorineural hearing loss: pooled odds ratio (OR) 2.0 [95% confidence interval (CI): 1.5-2.6]. No association was demonstrated for non-pulsatile tinnitus. A highly significant association with vascular loops was shown in subjects having pulsatile tinnitus, with pooled OR: 78.8 (95% CI: 10.9-821.8). CONCLUSIONS: Vascular loops in contact with CN VIII are a normal variant. Subjects with unilateral hearing loss were twice as likely to have these vascular loops in the symptomatic ear, than in the asymptomatic ear. Subjects with pulsatile tinnitus were 80 times more likely to have a contacting vascular loop than patients with non-pulsatile tinnitus, suggesting in some cases a causal relationship exists for pulsatile tinnitus, where surgical intervention may be occasionally indicated.