Acupuncture for rehabilitation after surgery for cerebellopontine angle meningioma: A case report.

RATIONALE: In some cases, surgery of cerebellopontine angle meningioma (CPAM) might result in multiple cranial nerve injury, which could bring serious impact on the patients, especially when it affects the function of facial muscles and eyeballs. This report describes a successful application of acupuncture for rehabilitation in a patient after surgery for CPAM. PATIENT CONCERNS: A 27-year-old patient presented with limitation of left eye abduction, accompanied with frontal and facial sensory disturbance on the left after resection of the pontocerebellar angle tumor. The patient also suffered from significant anxiety and depression as concomitant symptoms. DIAGNOSES: Based on medical history, clinical symptoms, and magnetic resonance imaging results, the patient was diagnosed with the fourth, fifth, sixth, and seventh cranial nerve injury after surgery for CPAM. INTERVENTIONS: Acupuncture treatment was applied for this patient. One acupuncture session was given every 2 days in 35 days, and the needles were retained for 30 minutes per session. OUTCOMES: After acupuncture treatment, the limitation of left eye abduction had totally recovered. The superficial sensory disturbance in the frontal and facial region was significantly relived. Besides, the scores of Hamilton Anxiety and Depression Scale showed a significant reduction. However, the superficial sensory of the alar and nasolabial groove on the left side still decreased mildly when compared with the right side. CONCLUSION: Acupuncture might be an option for rehabilitation after surgery for CPAM.

Síndrome constitucional como presentación de meningioma pontocerebeloso / Constitutional syndrome as a presentation of a cerebellopontine meningioma

Los meningiomas son tumoraciones eminentemente benignas procedentes de las meninges, correspondiendo al 15-25% de las tumoraciones intracraneales en el adulto, cuya expresividad clínica viene representada por la compresión de estructuras vecinas quedando representada predominantemente por cefalea, alteraciones del comportamiento, y déficit neurológicos. Presentamos un caso donde el cuadro constitucional constituye la primera y principal manifestación de un meningioma intracraneal pontocerebeloso (AU)

Meningiomas are basically benign tumours arising in the meninges and account for 15-25% of intracranial tumours in adults. It is clinically signs are due to compression of the neighbouring structures, with the main symptoms being migraine, behavioural changes, and neurological deficits. We present a case where constitutional syndrome was the first and principal manifestation of an intracranial cerebellopontine meningioma (AU)

Motor cortex stimulation in a three-year-old child with trigeminal neuropathic pain caused by a malignant glioma in the cerebellopontine angle: case report.

BACKGROUND AND IMPORTANCE: Motor cortex stimulation (MCS) is an accepted treatment in neuropathic pain syndromes. Use of MCS for trigeminal neuropathic pain (TNP) caused by a malignant glioma or in a child has not previously been reported in the literature. CLINICAL PRESENTATION: A 3-year-old boy presented to our department with a right temporal tumor with extension into the cavernous sinus and along the root of the trigeminal nerve up to the protuberance. Six weeks after removal of the temporal part of the tumor, the patient developed medically refractory trigeminal pain associated with tumor progression into the posterior fossa. We decided to remove the tumor from the cerebellopontine angle and residual tumor in the pericavernous area and then gave postoperative radio- and chemotherapy. Five months later, the patient developed unbearable refractory neuropathic pain characterized by a burning sensation in the first and second trigeminal areas. After a multidisciplinary discussion, MCS was recommended. We performed subdural MCS after localization of the central sulcus via anatomic landmarks, neuronavigation, peroperative sensory evoked potentials, and motor evoked potentials. The mother estimated a 75% reduction in the child's pain at 48 hours postoperatively, which continued until the child was pain-free. CONCLUSION: MCS is a minimally invasive surgical technique that seems to be a potential treatment for carefully selected children experiencing very severe and medically refractory neuropathic pain, even in the context of a neoplasm.

A case of cerebellopontine angle meningioma presenting with neck and upper extremity pain.

OBJECTIVE: The purpose of this case report is to describe and discuss the clinical presentation, diagnosis, and management of a patient with a cerebellopontine angle meningioma. CLINICAL FEATURES: A 29-year-old man presented to a chiropractor with diffuse musculoskeletal pain in the neck and right upper extremity. The findings of the clinical examination included a unilateral lower cranial nerve motor deficit. INTERVENTION AND OUTCOME: Magnetic resonance imaging studies of the neck and brain revealed a posterior fossa tumor, which was eventually diagnosed as a benign meningioma. Partial surgical removal of the tumor mass was followed by radiation therapy. Postoperative morbidity was fairly low. Lower cranial nerve function normalized after surgery. CONCLUSION: Patients with brain lesions may present to chiropractic practices with predominantly musculoskeletal symptoms. Chiropractors can aid in the multidisciplinary and integrated management of such conditions through careful interviewing and appropriate neurological examination.

[Usefulness of hyperbaric oxygen in the treatment of radionecrosis and symptomatic brain edema after LINAC radiosurgery]. / Eficacia del oxígeno hiperbárico en el tratamiento de la radionecrosis y el edemacerebral sintomáticos tras radiocirugía con acelerador lineal.

Radionecrosis with brain edema is a complication of radiosurgery. Three female patients harbouring a frontal pole, petrous and parasagital parietoocipital meningiomas respectively who had been treated with LINAC radiosurgery are presented. Those patients developed, between two and eight months later, a severe symptomatic radionecrosis with a huge brain edema resistant to the usual steroid therapy. Only after 40 sessions of hyperbaric oxygen, a good remission of the lesions was obtained. There are few cases reported in the literature with such a good outcome. Consequentely, this therapy must be taken into account to treat this type of radiosurgical complication before considering surgery.

Eficacia del oxígeno hiperbárico en el tratamiento de la radionecrosis y el edemacerebral sintomáticos tras radiocirugía con acelerador lineal / Usefulness of hyperbaric oxygen in the treatment of radionecrosis and symptomatic brain edema after LINAC radiosurgery

La radio necrosis y el edema cerebral son complicaciones asociadas a la radiocirugía. Presentamos los casos de tres pacientes tratadas con radiocirugía mediante acelerador lineal, de un meningioma de polo frontal izquierdo, peñasco y para sagital parietooccipital, respectivamente, que desarrollaron, entre dos y ocho meses más tarde, lesiones de tipo radio necrótico con extenso edema peritumoral que resultaron resistentes al tratamiento con esteroides y que se han resuelto con la administración de 40 sesiones de oxígeno hiperbárico. Son pocos los casos publicados hasta ahora en la literatura con tan excelentes resultados, por lo que consideramos un hecho a tener muy en cuenta ante las posibles complicaciones de este tipo que puedan presentarse en el transcurso de la práctica radioquirúrgica antes de recurrir a la cirugía (AU)

Radionecrosis with brain edema is a complication of radiosurgery. Three female patients harbouring a frontal pole, petrous and parasagital parietoocipital meningiomas respectively who had been treated with LINAC radiosurgery are presented. Those patients developed, between two and eight months later, a severe symptomatic radionecrosis with a huge brain edema resistant to the usual steroid therapy. Only after 40 sessions of hyperbaric oxygen, a good remission of the lesions was obtained. There are few cases reported in the literature with such a good outcome. Consequentely, this therapy must be taken into account to treat this type of radiosurgical complication before considering surgery (AU)

Hearing improvement after resection of cerebellopontine angle meningioma: case study of the preoperative role of transient evoked otoacoustic emissions.

In a retrospective case study of a patient with a right-sided cerebellopontine angle mass lesion, transient evoked otoacoustic emissions were robustly present despite a severe to profound sensorineural hearing loss and abnormal auditory brainstem response. These results were interpreted as suggestive of a neural site of lesion, and the potential for planned, preserved, or improved hearing by a suboccipital surgical craniotomy was considered. A gross total resection was successful. Three years postoperatively, the patient has normal hearing sensitivity and word recognition ability.

Auditory disorder in central nervous system miliary tuberculosis: case report.

We evaluated a 28-year-old female with a unilateral hearing loss of unusual pathogenesis, that of central nervous system miliary tuberculosis. Audiologic and otologic findings were consistent with left retrocochlear disorder, characterized by a profound hearing sensitivity loss, absent acoustic reflexes, normal otoacoustic emissions, and the presence of only wave I of the auditory brainstem response. Imaging studies revealed the presence of multiple punctate lesions, one of which was extra-axial and located at the left cerebellopontine angle. The pattern of audiometric test results, particularly the combination of normal otoacoustic emissions and profound hearing sensitivity loss, contributed importantly to the investigative sequence leading to the final diagnosis.

Usefulness of auditory brainstem responses at high stimulus rates in the diagnosis of acoustic neuroma.

The effects of the stimulus rate on the auditory brainstem responses (ABRs) of acoustic neuroma (AN) patients were studied. Ninety-decibel click stimuli at a normal hearing level were delivered at stimulus rates of 9.5, 20, 40 and 90 Hz, and ABRs were recorded of 40 AN patients (40 ears) at each stimulus rate. Subjects with normal hearing (42 ears) and patients with sensorineural hearing loss (30 ears) were also studied to obtain normative data. The following two parameters were examined: the interpeak latency difference between wave I and wave V (IPL I-V) at each stimulus rate, and the increase in IPL I-V (delta IPL I-V) when the stimulus rate was increased from 9.5 Hz. AN patients showed significantly larger values for both parameters at all stimulus rates compared to those of the control groups. Among 6 AN patients with normal ABRs at 9.5 Hz, 5 showed abnormal IPL I-V or abnormal delta IPL I-V at 90 Hz, when the upper normal limits of both parameters were defined as the mean plus 2 SD of the group with normal hearing. These results suggest that recording ABR at high stimulus rates provides valuable information for detecting AN patients with normal ABRs.

A case of glioblastoma with multiple centers above and below the tentorium.

A case of multicentric glioblastoma with the clinical and histopathological findings is presented in which three lesions are located above and below the tnetorium. Multicentric glioblastomas are those which have no macroscopic or microscopic connection.