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6.
World Neurosurg ; 134: 128-132, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31689568

RESUMO

BACKGROUND: Facial nerve schwannomas (FNSs) are rare benign tumors that arise from Schwann cells of the facial nerve. FNSs are similar to vestibular schwannomas in many aspects, yet their infiltrative nature into the facial nerve fascicles warrants a more conservative management approach. In the last decade, stereotactic radiosurgery (SRS) has shown promise in stabilizing or shrinking FNSs. CASE DESCRIPTION: A 71-year-old woman presented with mild facial paresis. Tumor growth after a period of watchful waiting warranted treatment with SRS, which was complicated by an acute posterior fossa hemorrhage and brainstem compression, necessitating microsurgical hematoma evacuation, tumor resection, and facial nerve substitution. CONCLUSIONS: SRS has led to better facial nerve function and outcomes and is currently considered a reasonable alternative to microsurgical resection in patients with FNSs. This is the first report to our knowledge of an acute, life-threatening hemorrhage after SRS in a patient with FNS.


Assuntos
Neoplasias dos Nervos Cranianos/radioterapia , Doenças do Nervo Facial/radioterapia , Hemorragias Intracranianas/etiologia , Neurilemoma/radioterapia , Radiocirurgia/efeitos adversos , Idoso , Feminino , Humanos
7.
World Neurosurg ; 135: 112, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31838238

RESUMO

Trochlear schwannoma in the absence of neurofibromatosis is a rare entity.1 These schwannomas originate usually from the intradural cisternal part of the nerve and expand in the ambient and interpeduncular cisterns as well as inferiorly in the upper part of the cerebellopontine cistern.2 This case involves a rare pontomesencephalic lesion removed successfully via the simple retrosigmoid suboccipital route (Video 1). A 49-year-old woman presented to our institute with decreased sensation on the left side of her body for 2 months. Neurologic examination revealed left hemihypoesthesia. Cranial magnetic resonance imaging revealed a lobulated, heterogeneously enhanced cystic tumor within the right ambient cistern compressing the adjacent midbrain and extending to the cerebellopontine angle. After obtaining consent for surgery, the patient underwent a right suboccipital retrosigmoid approach for exploration and resection of the lesion. During the operation, it was determined that the tumor originated from the trochlear nerve. Nerve-sparing surgery was performed with intraoperative neuromonitoring including cranial nerve V, VII, X, XI, and XII electromyography and muscle motor evoked potentials. Gross total resection of the tumor was achieved. In the early postoperative period, the patient's eye movements were normal in all directions. The patient did not have any visual problems and experienced improvement in hemihypoesthesia. She was discharged on the third postoperative day. Pathologic examination confirmed diagnosis of schwannoma. At 2 months after surgery, the patient's eye movements were intact, and trochlear nerve palsy did not occur. The patient gave written informed consent for surgery and publication of this case report.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Doenças do Nervo Troclear/cirurgia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Doenças do Nervo Troclear/diagnóstico por imagem
8.
World Neurosurg ; 135: 205-208, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31821912

RESUMO

BACKGROUND: Hypoglossal schwannomas are rare, benign intracranial neoplasms; they represent 5% of all nonvestibular schwannomas. CASE DESCRIPTION: A 22-year-old male patient had presented 4 months before admission with left-sided hearing loss, an increase in the base of support with lateralization to the left, and dysphagia to solids. Physical examination on admission showed hypotrophy of the tongue and deviation to the left. Magnetic resonance imaging showed evidence of an extraaxial lesion compressing the medulla oblongata and pons, which protruded through the hypoglossal canal. The patient was prepared for surgical treatment in 2 stages: in the first surgery, a left retrosigmoidal approach with total resection of the intracranial lesion was performed. The biopsy reported a schwannoma, and correlating the signs, symptoms, and imaging, the diagnosis of a hypoglossal nerve schwannoma was established. In the second surgery, a lateral cervical approach was performed, with subtotal resection of the lesion, leaving a remnant adhered to the nerve in the hypoglossal canal. CONCLUSIONS: Hypoglossal schwannomas are a rare entity, in which surgery is the most viable option with high cure rates. However, its complete resection, without leaving permanent neurologic sequels, is a challenge.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Doenças do Nervo Hipoglosso/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/complicações , Neoplasias dos Nervos Cranianos/cirurgia , Transtornos de Deglutição/etiologia , Perda Auditiva Unilateral/etiologia , Humanos , Doenças do Nervo Hipoglosso/complicações , Doenças do Nervo Hipoglosso/cirurgia , Imagem por Ressonância Magnética , Masculino , Neurilemoma/complicações , Neurilemoma/cirurgia , Adulto Jovem
9.
Pediatr Blood Cancer ; 67(2): e28080, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31736243

RESUMO

PURPOSE: Despite the dosimetric advantages of proton therapy, little data exist on patients who receive proton therapy for Ewing sarcoma of the cranium and skull base. This study reports local disease control and toxicity in such patients. MATERIALS/METHODS: We reviewed 25 patients (≤21 years old) with nonmetastatic Ewing sarcoma of the cranium and skull base treated between 2008 and 2018. Treatment toxicity was graded per the Common Terminology Criteria for Adverse Events v4.0. The Kaplan-Meier product limit method provided estimates of disease control and survival. RESULTS: Median patient age was 5.9 years (range, 1-21.7). Tumor subsites included the skull base (48%), non-skull-base calvarial bones (28%), paranasal sinuses (20%), and nasal cavity (4%). All patients underwent multiagent alkylator- and anthracycline-based chemotherapy; 16% underwent gross total resection (GTR) before radiation. Clinical target volume (CTV) 1 received 45 GyRBE and CTV2 received 50.4 GyRBE following GTR or 54-55.8 GyRBE following biopsy or subtotal resection. Median follow-up was 3.7 years (range, 0.26-8.3); no patients were lost. The 4-year local control, disease-free survival, and overall survival rates were 96%, 86%, and 92%, respectively. Two patients experienced in-field recurrences. One patient experienced bilateral conductive hearing loss requiring aids, two patients developed intracranial vasculopathy, and 6 patients required hormone replacement therapy for neuroendocrine deficits. None developed a secondary malignancy. CONCLUSION: Proton therapy is associated with a favorable therapeutic ratio in children with large Ewing tumors of the cranium and skull base. Despite its high conformality, we observed excellent local control and no marginal recurrences. Treatment dosimetry predicts limited long-term neurocognitive and neuroendocrine side effects.


Assuntos
Neoplasias Ósseas/mortalidade , Neoplasias dos Nervos Cranianos/mortalidade , Recidiva Local de Neoplasia/mortalidade , Terapia com Prótons/mortalidade , Sarcoma de Ewing/mortalidade , Neoplasias da Base do Crânio/mortalidade , Adolescente , Adulto , Neoplasias Ósseas/patologia , Neoplasias Ósseas/radioterapia , Criança , Pré-Escolar , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/radioterapia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Prognóstico , Estudos Prospectivos , Dosagem Radioterapêutica , Sarcoma de Ewing/patologia , Sarcoma de Ewing/radioterapia , Neoplasias da Base do Crânio/patologia , Neoplasias da Base do Crânio/radioterapia , Taxa de Sobrevida , Adulto Jovem
10.
Artigo em Russo | MEDLINE | ID: mdl-31825375

RESUMO

Hypoglossal schwannoma is a rare tumor this frequency approximately less than 5% all non-vestibular schwannomas. Also, it may be sign of neurofibromatosis type 2. Usually, the tong deviation in side of the tumor is the first symptom of the disease. When the tumor size is increased, bulbar disorders and cervico-occipital pain are develop. MRI is the main method of diagnostic. Until the 1970s, mortality after surgical removal reached 50% and was due to bulbar and respiratory dysfunctions. Nowadays, the cause of death remains the same. After introduction stereotactic radiotherapy into clinical practice total removal is not necessary. The purpose of surgery stay is removal of intracranial part of the tumor and decompression of the brainstem (subtotal removal). Radiotherapy or radiosurgery is performed on the intracanal fragment of the tumor. The case of successful surgical treatment of a patient with hypoglossal schwannoma is presented in this article. Subtotal removal was performed via median suboccipital approach. Radiosurgery is planned for residual part of the tumor, located in the hypoglossal nerve channel.


Assuntos
Neoplasias dos Nervos Cranianos , Doenças do Nervo Hipoglosso , Neurilemoma , Humanos , Procedimentos Neurocirúrgicos , Radiocirurgia , Resultado do Tratamento
11.
J Int Adv Otol ; 15(3): 415-419, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31846922

RESUMO

OBJECTIVES: The aim of this study was to evaluate the preoperative and postoperative facial nerve (FN) function in patients with FN schwannoma (FNS) and analyze the duration of preoperative facial palsy according to the preoperative and postoperative facial function. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 29 patients with FNS who underwent surgery. We evaluated the FN function according to the type of FN manipulation and location of the anastomoses in the cable nerve graft, and we also analyzed the duration of facial palsy according to the facial function before and after surgery. RESULTS: All 4 patients who underwent nerve-stripping surgery had the House-Brackmann (H-B) Grade III, 12 of 21 who underwent a cable nerve graft had the H-B Grade III or better postoperatively, and all 4 who underwent a hypoglossal facial crossover had the H-B Grade IV. Patients who underwent cable nerve grafting were more likely to have better FN function when the proximal anastomosis site was located in the internal auditory canal, geniculate ganglion, tympanic segment of FN, and distal end in the mastoid segment of FN. The duration of preoperative facial palsy was statistically shorter in patients with better postoperative facial function. CONCLUSION: Surgery can be considered in patients with FNS who have the H-B Grade III or worse. A shorter duration of facial palsy prior to surgery resulted in better postoperative facial function.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Neurilemoma/cirurgia , Adulto , Neoplasias dos Nervos Cranianos/complicações , Neoplasias dos Nervos Cranianos/fisiopatologia , Nervo Facial/fisiopatologia , Paralisia Facial/etiologia , Paralisia Facial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/complicações , Neurilemoma/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento
12.
Kyobu Geka ; 72(13): 1123-1125, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879392

RESUMO

Schwannomatosis with mediastinal vagal schwannoma is rare. A 71-year-old man presented with multiple mediastinal tumors by a regular check-up. A chest computed tomography showed well-defined round tumors along with the 3rd intercostal nerve and in the left upper mediastinal area. A percutaneous biopsy specimen of the tumor suggested benign tumor, however surgical excision was performed for a definitive diagnosis and treatment. The histological diagnosis was schwannoma. Since the tumor originated from the mediastinal vagal nerve proximal to the recurrent laryngeal nerve and was suggested to be benign, it was not resected to preserve the function of the recurrent laryngeal nerve.


Assuntos
Neoplasias dos Nervos Cranianos , Neurilemoma , Neurofibromatoses , Neoplasias Cutâneas , Idoso , Humanos , Nervos Intercostais , Masculino
16.
Pain Res Manag ; 2019: 5392945, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31662812

RESUMO

Background: Recurrent painful ophthalmoplegic neuropathy (RPON), previously known as ophthalmoplegic migraine (OM), is an uncommon disorder with repeated episodes of ocular cranial nerve neuropathy associated with ipsilateral headache. The age of presentation is most often during childhood or adolescence. MRI has a central role in the assessment of the RPON, especially to distinguish orbital, parasellar, or posterior fossa lesions that mimic symptoms of RPON. Actually, oculomotor nerve tumors may be masquerade as RPON so that MRI follow-ups are required to detect the possibility of tumor etiology. Case presentation: We report a 16-year-old boy with a 7-year follow-up and multiple brain MRI data, previously diagnosed as OM. The last brain MRI, performed during an acute phase of oculomotor paresis with ipsilateral headache, showed a nodular lesion described as schwannoma of III cranial nerve. Then, we reviewed the literature on OM and RPON in pediatric age with a focus on brain MRI findings. Conclusions: This review highlights the important role of serial brain MRIs in the long-term follow-up of RPON, especially in the cases with childhood onset, in order to not delay the diagnosis of a possible oculomotor nerve schwannoma.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Doenças do Nervo Oculomotor/diagnóstico por imagem , Enxaqueca Oftalmoplégica/etiologia , Adolescente , Neoplasias dos Nervos Cranianos/complicações , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Neurilemoma/complicações , Doenças do Nervo Oculomotor/complicações
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