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1.
World Neurosurg ; 135: 171-172, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31870821

RESUMO

Benign peripheral nerve sheath tumors are well known to neurosurgeons and a relatively commonly seen pathology. Intraneural ganglion cysts, once thought to be rare and poorly understood, are increasingly recognized in clinical practice and better understood based on the advent of high-resolution imaging. There are few reports of different nerve lesions in the same anatomic location appearing concurrently. Herein we present a patient with 2 distinct pathologies explaining 2 distinct symptom complexes-sensory changes in the superficial peroneal distribution (from a schwannoma of the superficial peroneal nerve) and mild motor weakness in the tibialis anterior (from an intraneural ganglion cyst arising from the superior tibiofibular joint affecting this motor branch). Recognition of the 2 pathologies allowed targeted surgical approaches, which led to resolution of the symptoms.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Idoso , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Imagem por Ressonância Magnética , Neurilemoma/complicações , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/cirurgia , Neuropatias Fibulares/complicações , Neuropatias Fibulares/cirurgia
3.
J Am Podiatr Med Assoc ; 109(4): 322-326, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31762309

RESUMO

A schwannoma is a solitary benign tumor composed of Schwann cells occurring anywhere in the peripheral nervous system. The diagnosis of a schwannoma is often difficult to make by clinical presentation and advanced imaging modalities. We present a case report of a 61-year-old Hispanic woman with a left-foot, third-digit, soft-tissue mass. The diagnosis of a schwannoma of the proper digital nerve was made postsurgically by means of histopathologic and immunohistochemistry parameters. This is a rare location for a schwannoma, and neurogenic tumor should be included in the differential diagnosis of soft-tissue mass, as there have been prior case reports.


Assuntos
Doenças do Pé/patologia , Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Dedos do Pé/inervação , Feminino , Doenças do Pé/diagnóstico por imagem , Doenças do Pé/cirurgia , Humanos , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/cirurgia , Ultrassonografia
4.
BMC Cancer ; 19(1): 888, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488091

RESUMO

BACKGROUND: Glomus tumors in the digital nerve are extremely rare. Multiple intraneural glomus tumors in different digital nerve fascicles have not been previously reported. CASE PRESENTATION: We report the case of a 54-year-old male with a 1-year history of progressive numbness of the middle finger with point tenderness at the level of the middle phalanx. Surgical incision revealed the presence of two glomus tumors within different fascicles of the ulnar digital nerve of the middle finger. One tumor was excised along with surrounding fascicle, the other was removed leaving the fascicle intact. Subsequently, the patient regained function of the finger and no tumors have recurred. CONCLUSIONS: Patients and physicians should be aware of the properties of intraneural glomus tumors so that early diagnosis and treatment can be sought.


Assuntos
Dedos/patologia , Tumor Glômico/cirurgia , Paraganglioma Extrassuprarrenal/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Doenças Raras/cirurgia , Neuropatias Ulnares/cirurgia , Competência Clínica , Tumor Glômico/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraganglioma Extrassuprarrenal/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças Raras/diagnóstico por imagem , Resultado do Tratamento , Nervo Ulnar/patologia , Neuropatias Ulnares/diagnóstico por imagem
5.
World Neurosurg ; 130: 264-266, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323411

RESUMO

A 41-year-old woman presented with a 16-year history of lumbar pain and right leg paresthesia. Twenty-four years previously, she had been diagnosed with neurofibromatosis type 1 syndrome. Magnetic resonance imaging showed a heterogeneous mass extending through widened lumbar neural foramina to the psoas muscles bilaterally, with a dumbbell-like appearance. Biopsy led to the diagnosis of a malignant peripheral nerve sheath tumor, an uncommon soft tissue sarcoma of neural origin that may occur in the context of neurofibromatosis type 1 syndrome. Given the aggressive behavior of these tumors, prompt and accurate diagnosis is critical to improve patient outcomes.


Assuntos
Neoplasias da Bainha Neural/patologia , Neoplasias da Bainha Neural/terapia , Neurofibroma/patologia , Neurofibroma/cirurgia , Adulto , Feminino , Humanos , Região Lombossacral/patologia , Neoplasias da Bainha Neural/diagnóstico , Neurilemoma/diagnóstico , Neurilemoma/patologia , Neurofibroma/diagnóstico , Neurofibromatose 1/diagnóstico , Neurofibromatose 1/patologia , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Neoplasias do Sistema Nervoso Periférico/patologia , Neoplasias do Sistema Nervoso Periférico/cirurgia
6.
Muscle Nerve ; 60(5): 544-548, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31361339

RESUMO

INTRODUCTION: Ultrasound (US) evaluation of peripheral nerves is a noninvasive, cost-effective approach to diagnosing focal mononeuropathies and guiding surgical management. We used the intranerve ratio to evaluate for possible cut-off values in diagnosis of fibular mononeuropathies (FNs). METHODS: A retrospective analysis of FN confirmed by electrodiagnosis (EDx) was performed to identify intranerve ratio values between affected and unaffected limbs at the fibular head and popliteal fossa. RESULTS: The optimal fibular head/popliteal fossa intranerve ratio to discriminate between limbs with and without disease was 1.25 (sensitivity, 51%; specificity, 71%). There was no statistically significant difference between affected vs unaffected limbs (ratio, 1.13; P = .15) nor in subgroup analyses. However, 25% of patients had structural lesions amenable to surgery. DISCUSSION: The utility of US in diagnosis of FN is limited using intranerve ratio data, but US has a distinct advantage over EDx for identifying treatable structural lesions.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Neoplasias da Bainha Neural/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Fibular/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Eletrodiagnóstico , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Joelho , Masculino , Pessoa de Meia-Idade , Neoplasias da Bainha Neural/complicações , Neoplasias da Bainha Neural/cirurgia , Condução Nervosa , Tamanho do Órgão , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/patologia , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/cirurgia , Estudos Retrospectivos
7.
World Neurosurg ; 130: 459-466, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31349078

RESUMO

BACKGROUND: Malignant peripheral nerve sheath tumor (MPNST), which refers to any malignant tumor that originates from peripheral nerve sheath cells, is rarely found in the spine. Primary intraosseous spinal MPNSTs are extremely uncommon; in fact, such an occurrence has been reported in a very limited number of cases hitherto. We report here one case of low-grade intraosseous MPNST in the lumbar vertebrae and review clinical research related to this rare tumor and modus operandi to its treatment. CASE DESCRIPTION: A 51-year-old man suffering from lower back pain was initially diagnosed with lumbar tuberculosis. The intraoperative histopathologic examination, however, revealed that the occupying lesion was synovial sarcoma when surgeons intended to perform a debridement surgery of what was thought to be tuberculosis. The operation was therefore suspended. Two months later, the patient was referred to our institution. The pathologic sections were reexamined. Its results refuted the earlier thought of being synovial sarcoma, and a final diagnosis of MPNST was made. In addition, preoperative examination revealed that the tumor had advanced rapidly to the adjacent inferior vena cava and pedicle, which ruled out the possibility of performing a total en bloc spondylectomy. Therefore, a marginal resection for 2-level consecutive lumbar vertebrae was performed successfully via an anterior-posterior combined approach. No serious complications were detected at 18-month follow-up. CONCLUSIONS: Preoperative biopsy is of great importance for the diagnosis of spinal tumors. Marginal resection of a complicated intraosseous spine MPNST via an anterior-posterior combined approach, despite being technically challenging, resulted in good survival and functional outcomes.


Assuntos
Vértebras Lombares/cirurgia , Neoplasias da Bainha Neural/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Bainha Neural/diagnóstico , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Nervos Espinhais/cirurgia
8.
Tech Hand Up Extrem Surg ; 23(4): 152-154, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31157733

RESUMO

Painful neuromas are not uncommon following nerve injury, and are especially bothersome in the hand, with severe cases resulting in significant disability. Outcomes of neuroma surgery are unpredictable regardless of technique. It is recognized that optimal soft tissue environment influences nerve healing more than the specific nerve graft technique, and it is in this context, we present a novel technique of transferring a posterior interosseous nerve graft along with vascularized synovial and fat tissue based on a branch of the posterior interosseous artery to provide healthy soft tissue for nerve healing of neuroma in continuity about the hand and digits.


Assuntos
Dedos/cirurgia , Neuroma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Radial/transplante , Tecido Adiposo/irrigação sanguínea , Tecido Adiposo/transplante , Contraindicações de Procedimentos , Humanos , Nervo Radial/anatomia & histologia
9.
BMC Cancer ; 19(1): 594, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208357

RESUMO

BACKGROUND: Secondary central nervous system involvement of non-Hodgkin's lymphoma (NHL) is rare and with poor prognosis, the most common pathological type is diffuse large B cell lymphoma (DLBCL). Although it can occur in any part of central nervous system, it rarely directly infiltrates the spinal cord or cauda equina. CASE PRESENTATION: We present the case of 64-year-old immunocompetent man with a worsening pain of waist and left lower extremity, accompanied by numbness and paresis of bilateral lower extremity for 20 days. His previous medical history included a resection of painless mass in the left groin in another hospital 7 months ago, and the pathological diagnosis was non-Hodgkin small B cell lymphoma. Gd-enhanced MRI and F-18 FDG PET-CT scan demonstrated multiple infiltrations in the cauda equina. During the operation, we removed as many as 11 subdural-extramedullary bean-size lesions involving multiple nerve roots. The paralysis of his left leg recovered rapidly after the operation. During the follow-up period of more than one year, he underwent standard R-CHOP chemical therapy, no evidence of recurrence was noted until the 13th month, the patient died because of intracranial relapse. CONCLUSIONS: Imaging examination is important in the diagnosis of multiple secondary cauda equina non-Hodgkin's lymphoma, and we highlight the significance of gadolinium-enhanced MRI and F-18 FDG-PET/CT in preoperative diagnosis as well as the previous history.


Assuntos
Cauda Equina/patologia , Linfoma de Células B/patologia , Neoplasias do Sistema Nervoso Periférico/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cauda Equina/diagnóstico por imagem , Meios de Contraste , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Encefalocele/mortalidade , Evolução Fatal , Seguimentos , Gadolínio/química , Humanos , Linfoma de Células B/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/tratamento farmacológico , Neoplasias do Sistema Nervoso Periférico/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Recusa do Paciente ao Tratamento , Vincristina/uso terapêutico
10.
World Neurosurg ; 129: 210-215, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31203077

RESUMO

BACKGROUND: Sacral schwannomas are very rare nerve sheath tumors. Patients usually present with a variety of nonspecific symptoms, which often lead to a delay in diagnosis. Although most schwannomas are benign, they present surgical challenges owing to their proximity to neurologic and other anatomic structures. CASE DESCRIPTION: This 58-year-old female presented with a 2-month old history of left-sided perineal and radicular pain secondary to a right S2 sacral nerve root schwannoma. The sacral mass demonstrated homogenous enhancement with cystic changes in a T2-weighted magnetic resonance imaging sequence. The patient underwent S1-S3 laminectomy and tumor excision through a posterior surgical approach. Intraoperative monitoring was used to distinguish nonfunctional tissue during tumor resection. The patient had an unremarkable postoperative course. CONCLUSIONS: Sacral schwannomas can present with a variety of nonspecific symptoms. They pose unique challenges given their location, size, and involvement of surrounding structures. Complete surgical resection is the main goal of sacral schwannoma treatment. A combined anterior-posterior surgical approach and a multidisciplinary surgical team are associated with improved outcomes.


Assuntos
Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Raízes Nervosas Espinhais/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neuralgia/etiologia , Neurilemoma/complicações , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Região Sacrococcígea , Raízes Nervosas Espinhais/cirurgia
11.
Neurol Sci ; 40(9): 1985-1989, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147856

RESUMO

INTRODUCTION: Neuroblastoma ranks third among pediatric malignancies. CASE REPORT: The case of a 3-year-old child is presented, who suddenly had frequent, unproductive, emetic cough; fever; and weight loss. Lung X-ray showed an opacity situated in the posterior superior mediastinum. Thoracic ultrasound revealed a slightly inhomogeneous, hypoechoic mass located in the posterior superior mediastinum. Computed tomography evidenced a tumor mass with homogeneous appearance in the costo-vertebral groove. Histological examination confirmed the diagnosis of ganglioneuroblastoma. CONCLUSION: Although history and clinical examination provided few elements, diagnosis was made based on imaging and histopathological examination.


Assuntos
Gânglios Simpáticos/patologia , Ganglioneuroblastoma/diagnóstico , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Pré-Escolar , Ganglioneuroblastoma/patologia , Ganglioneuroblastoma/cirurgia , Humanos , Masculino , Neoplasias do Sistema Nervoso Periférico/patologia , Neoplasias do Sistema Nervoso Periférico/cirurgia
12.
Neurol India ; 67(2): 481-484, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31085864

RESUMO

Brachial plexus neuropathies are uncommon and are rarely caused by a tumor. The clinical presentation of a brachial plexus neuropathy caused by a tumor depends on the degree of malignancy of the tumor and its localization. We report an illustrative case of a 27-year old female subject with a progressively increasing mass lesion causing brachial plexus compression, ipsilateral shoulder pain, C8 dermatomal paresthesia, and impairment of motor power. The patient underwent surgical resection of the mass and neurolysis of the nerves in the vicinity. Following the surgical procedure, the patient had improvement in the pain and paresthesia that he was suffering from. The histopathological diagnosis revealed a hibernoma, an extremely rare tumor described only once previously in this location. A systematic review of the literature was performed utilizing the PubMed database to access articles published before March 2018, using: A - the term 'hibernoma' in the title/abstract associated with the following MeSH terms: brachial plexus neuropathies OR brachial plexus neuropathy OR nerve compression syndrome, OR brachial plexus; B - the MeSH term 'brachial plexus' associated with the term 'non neural sheath nerve tumor' or 'peripheral non-neural sheath nerve tumor'. The origin of the hibernoma, as well as its metabolic influence, pathology, and treatment have been discussed.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Lipoma/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Neoplasias da Bainha Neural/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Adulto , Neuropatias do Plexo Braquial/diagnóstico , Feminino , Humanos , Lipoma/diagnóstico , Síndromes de Compressão Nervosa/diagnóstico , Neoplasias da Bainha Neural/diagnóstico , Neoplasias da Bainha Neural/patologia , Procedimentos Neurocirúrgicos/métodos , Neoplasias do Sistema Nervoso Periférico/diagnóstico
13.
Hautarzt ; 70(8): 638-640, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31076816

RESUMO

The case of segmental neurofibromatosis (NF) with a monstrous plexiform neurofibroma in a 53-year-old female patient is described. Segmental NF is a rare form of NF, which is caused by a postzygotic mutation in the NF1 gene. In this mosaic form the typical cutaneous symptoms of NF are limited to certain unilateral dermatomes. Plexiform neurofibromas are clinically and histologically in contrast to locally delimited neurofibromas. They involve the catchment area of a peripheral nerve, affect many fascicles and nerve branches, do not respect growth limits and spread in a reticulated fashion. Plexiform neurofibromas can become malignant. In the presented case large parts of the monstrous plexiform cutaneous neurofibroma were excised and the patient did not wish any further measures to be carried out for the time being.


Assuntos
Neurofibroma Plexiforme/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Mosaicismo , Neurofibroma Plexiforme/cirurgia , Neurofibromatoses , Neurofibromatose 1 , Neoplasias do Sistema Nervoso Periférico/cirurgia
14.
World Neurosurg ; 128: 55-61, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054349

RESUMO

BACKGROUND: Presacral schwannomas are rare benign tumors that may reach large size before becoming symptomatic. Total surgical removal has been considered the best treatment option. Tumors arising from the presacral area are commonly managed through anterior approaches, whereas posterior approaches are used for pure intrasacral tumors or large lesions with both intrasacral and presacral extension, alone or in combination with anterior approaches. METHODS: We describe a quick and minimally invasive navigation-guided posterolateral approach to a right presacral L5 schwannoma. The lesion was microsurgically removed through high-speed drilling of the upper portion of the right sacral ala, under intraoperative neurophysiologic monitoring. RESULTS: The postoperative course was unremarkable, and the patient experienced improvement in his sensory disturbance. Postoperative magnetic resonance imaging and computed tomography scan showed the complete excision of the lesion and the removal of the upper sacral ala with preservation of the right L5-S1 articular complex. The histologic examination confirmed a schwannoma (World Health Organization grade I). CONCLUSIONS: The posterolateral transsacral ala approach may represent a minimally invasive option in the surgical management of presacral well-circumscribed benign tumors. Spinal navigation could be properly used to facilitate lesion exposure and to minimize the bone removal. The intraoperative neurophysiologic monitoring is an essential tool for the preservation of the lumbosacral nerve roots.


Assuntos
Microcirurgia/métodos , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias do Sistema Nervoso Periférico/cirurgia , Raízes Nervosas Espinhais/cirurgia , Adulto , Humanos , Monitorização Neurofisiológica Intraoperatória , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Sacro , Raízes Nervosas Espinhais/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
World Neurosurg ; 128: e970-e974, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31100516

RESUMO

OBJECTIVE: Tumors of the greater sciatic foramen remain difficult to treat. They often have both intrapelvic and extrapelvic components that may limit visualization and make safe resection of the tumor difficult. Therefore the goal of the present anatomic study was to quantitate how much additional surgical working space could be gained by transection of the sacrospinous and sacrotuberous ligaments. METHODS: Sixteen sides from 9 fresh-frozen Caucasian cadaveric torsos underwent transgluteal dissection and exposure of the greater sciatic foramen and associated liagments. With the piriformis in place, the vertical and horizontal diameters of the greater sciatic foramen were measured. Next, the sacrotuberous and sacrospinous ligaments were cut at their ischial attachments. The vertical diameter of the now confluent greater and lesser sciatic foramina (V2) was measured. RESULTS: The mean vertical diameter of the greater sciatic foramen (V1) was 54.8 ± 9.7 mm. The horizontal diameter of the greater sciatic foramen had a mean of 44.3 ± 6.1 mm with a range of 30-52 mm. After transection of the sacrotuberous and sacrospinous ligaments, the vertical distance of the greater and lesser sciatic foramina (V2) had a mean of 74.8 ± 6.8 mm with a range of 60.1-90 mm. The mean ratio of V2 to V1 was 1.40. CONCLUSIONS: The vertical length of the greater sciatic foramen increased, on average, 40% after resection of the sacrotuberous and sacrospinous ligaments. The results of this study support an alternative technique for resecting large intrapelvic tumors via a transgluteal approach.


Assuntos
Ligamentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Isquiático/anatomia & histologia , Nervo Isquiático/cirurgia , Neuropatia Ciática/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Lipossarcoma Mixoide/diagnóstico por imagem , Lipossarcoma Mixoide/patologia , Lipossarcoma Mixoide/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Neuropatia Ciática/diagnóstico por imagem , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(10): e14605, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855444

RESUMO

RATIONALE: Benign schwannoma is the most common tumor of peripheral nerves while plexiform multiple schwannomas are rare conditions. This manuscript reported a case of multiple Schwannomas characterized by unusual location. PATIENT CONCERNS: We report a 34-year-old workman presented with multiple nodules in his forefinger, middle finger and palm respectively for 5 years. He felt pain combined with paraesthesias in fingers and palm. The symptoms could be eased through rest and drugs medication. DIAGNOSIS: Three Schwannomas were found in surgery respectively. Histologic findings confirmed the diagnosis of schwannomas. INTERVENTIONS: We removed all of the 3 schwannomas completely without damaging the continuity of the nerve. OUTCOMES: Six months after the surgery, the patient had had not experienced any symptom recurrence. LESSONS: Successful treatment of multiple schwannomas depends upon accurate diagnosis. Early surgery can improve the treatment outcome of multiple schwannomas.


Assuntos
Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/cirurgia , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Neoplasias do Sistema Nervoso Periférico/cirurgia , Adulto , Diagnóstico Diferencial , Mãos , Humanos , Masculino , Neoplasias Primárias Múltiplas/patologia , Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia
17.
Neurodiagn J ; 59(1): 34-44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30916637

RESUMO

Bowel and bladder function are at risk during tumor resection of the conus, cauda equina, and nerve roots. This study demonstrates the ability to acquire transcranial electrical motor evoked potentials (TCeMEPs) from the urethral sphincter muscles (USMEPs) by utilizing a urethral catheter with an embedded electrode. A retrospective analysis of intraoperative neurophysiological monitoring (IONM) data from nine intradural tumors, four tethered cord releases, and two spinal stenosis procedures was performed (n = 15). The cohort included seven females and eight males (median age: 38.91 years). A catheter with embedded urethral electrodes was used for recording TCeMEPs and spontaneous electromyograph (s-EMG) from the external urethral sphincter (EUS). USMEPs were obtained in 14 patients (93%). The reliability of TCeMEP from the external anal sphincter (EAS) was variable across all patients. In patient 7, the TCeMEP recordings from the urethral sphincter were not present before incision; however, following the resection of the tumor, the USMEP recordings were obtained and remained stable for the remainder of the procedure. Patient 7 had subsequent improvement in bladder function postoperatively. Patient 4 exhibited a 50% increase in the amplitude of the USMEP following tumor resection and exhibited improved bladder function as well postoperatively. In this small series, we were able to acquire consistent and reliable MEPs when recorded from the urethral sphincters. More study is needed to establish a better understanding of the value added by this modality. USMEPs can be attempted in surgeries that put the function of the pelvic floor at risk.


Assuntos
Potencial Evocado Motor/fisiologia , Monitorização Neurofisiológica Intraoperatória/métodos , Neoplasias do Sistema Nervoso Periférico/cirurgia , Uretra/fisiologia , Adulto , Idoso , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Turk Neurosurg ; 29(4): 594-597, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30875079

RESUMO

AIM: To describe the ultrasound-guided microsurgical excision technique and to evaluate the surgical outcomes of brachial plexus schwannomas. MATERIAL AND METHODS: Eleven patients who underwent ultrasound-guided microsurgery for small ( < 3 cm) brachial plexus schwannomas between 2013 and 2017 were included in our study. RESULTS: The mean age of the patients was 45 years (range: 30-68 years), with six tumors localized on the right and five on the left side. There were no perioperative or postoperative complications. No postoperative deficits were observed in the patients. CONCLUSION: Surgeons can safely and completely excise most of the benign ( < 3 cm and non-palpable) brachial plexus tumors by the ultrasound-guided microsurgical excision technique.


Assuntos
Plexo Braquial/diagnóstico por imagem , Plexo Braquial/cirurgia , Microcirurgia/métodos , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento
19.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(1): 28-32, ene.-feb. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-181458

RESUMO

Se describe el caso de una paciente de 41 años con cuadro de dorsalgia crónica. Mediante RM se diagnosticó una lesión intradural extramedular bien delimitada con morfología en reloj de arena con gran componente paravertebral izquierdo en D5-D6. El tumor fue embolizado previo a la cirugía, realizándose posteriormente laminotomía D4-D6, costotransversectomía D5-D6 izquierdas y resección de la porción intrarraquídea extradural con sección del nervio D5 izquierdo. A continuación, se realizó una resección en bloque del componente extrarraquídeo por vía posterolateral. El diagnóstico anatomopatológico fue de schwannoma maligno, precisando posteriormente tratamiento radioterápico adyuvante. El schwannoma maligno es un tumor poco frecuente perteneciente al grupo de tumores malignos de la vaina del nervio periférico (MPNST), originado en las células de Schwann. Se asocia frecuentemente con la neurofibromatosis tipo 1. Los MPNST recurren con frecuencia a nivel locorregional y pueden dar metástasis a distancia


We report a case of a 41 years old patient complaining of chronic dorsalgia. MRI showed a well defined intradural extramedular dumbbell-shaped lesion, associated to a left paravertebral tumor at D5-D6 level. The tumor was embolizated prior to surgery. Following she underwent a D4-D6 laminotomy, left D5-D6 costotransversectomy and resection of the intracanal extradural part of the lesion with section of the left D5 nerve. Posteriorly, complete resection of the extracanal portion of the tumor was performed by a postero-lateral approach. The anatomopathologic diagnosis was a malignant schwannoma. After the surgery, the patient required adyuvant radiotherapic treatment. Malignant schwannoma is a very uncommon tumor which belongs to the malignant peripheral nerve sheath tumors (MPNST). It develops from Schwann cells. It is frequently associated with type 1 neurofibromatosis. MPNST usually present local recurrence and can metastatize


Assuntos
Humanos , Feminino , Adulto , Neurofibrossarcoma/diagnóstico por imagem , Neurofibrossarcoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Dor nas Costas/diagnóstico por imagem , Radioterapia Adjuvante/métodos , Radiografia Torácica , Neoplasias do Mediastino/diagnóstico por imagem , Diagnóstico Diferencial
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