RESUMO
Intracranial chordomas are locally infiltrative tumours that usually present with deficits of the cranial nerves. Because of their location in the skull base they are difficult to cure and pose complex problems in management. We report an unusual case of a chordoma that presented as a swelling of the medial canthus. Diagnosis of chordoma might not be considered in this site, which is unfortunate because its superficial location offers the possibility of complete excision and cure.
Assuntos
Cordoma/diagnóstico , Doenças Palpebrais/diagnóstico , Neoplasias da Base do Crânio/diagnóstico , Fossa Craniana Anterior/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Invasividade Neoplásica , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
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.
Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Doenças Cerebelares/cirurgia , Ângulo Cerebelopontino/cirurgia , Espasmo Hemifacial/etiologia , Neuroglia , Adulto , Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/patologia , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/patologia , Ângulo Cerebelopontino/patologia , Craniotomia , Diagnóstico Diferencial , Doenças do Nervo Facial/diagnóstico , Doenças do Nervo Facial/patologia , Doenças do Nervo Facial/cirurgia , Humanos , Angiografia por Ressonância Magnética , Masculino , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/cirurgiaRESUMO
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.
Assuntos
Síndromes de Compressão Nervosa/cirurgia , Procedimentos Neurocirúrgicos/métodos , Raízes Nervosas Espinhais/cirurgia , Estenose Espinal/cirurgia , Humanos , Síndromes de Compressão Nervosa/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
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.
Assuntos
Doenças Cerebelares/complicações , Ângulo Cerebelopontino , Cistos/complicações , Paralisia Facial/etiologia , Adulto , Doenças Cerebelares/diagnóstico , Ângulo Cerebelopontino/patologia , Cistos/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
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.
