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1.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(2): 93-97, mar.-abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-190377

RESUMO

Los schwannomas del nervio glosofaríngeo son tumores de la fosa posterior extraordinariamente raros. En una revisión de 100 años se encontró un total de 42 casos entre 1908-2008. Los datos clínicos más comunes se encuentran asociados a su localización, siendo los más comunes síntomas vestíbulo cocleares y síntomas de afectación de la función del nervio glosofaríngeo. Su diagnóstico actualmente se ha facilitado con el uso de la resonancia magnética; sin embargo, es muy complicado definir en ocasiones preoperatoriamente si el tumor se origina del ix, x u xi nervios craneales. Presentamos el caso de una paciente de 42 años con síndrome del ángulo pontocerebeloso, síndrome del agujero rasgado posterior (yugular) + condileo anterior (Collet-Sicard). El tratamiento empleado fue quirúrgico con abordaje extremo lateral transcondilar, con monitorización de pares craneales y potenciales evocados transoperatorios


Schwannomas of the glossopharyngeal nerve are extremely rare tumors of the posterior fossa. In a 100-year review, a total of 42 cases were found between 1908-2008. The most common clinical data are associated with its location, the most common being cochlear vestibule symptoms and symptoms of glossopharyngeal nerve function. its diagnosis has now been facilitated by the use of magnetic resonance, however, it is very complicated to define preoperatively if the tumor originates from the ix, x or xi NC. We present the case of a 42-year-old patient with a syndrome of angulopentocerebellar syndrome, posterior torn (jugular) hole syndrome + anterior condyle (Collet-Sicard). The treatment used was surgical with transcondylar lateral extreme approach, with monitoring of cranial nerves and trans-operative evoked potentials


Assuntos
Humanos , Feminino , Adulto , Neurilemoma/cirurgia , Nervo Glossofaríngeo/cirurgia , Neoplasias dos Nervos Cranianos/cirurgia , Nervos Cranianos/cirurgia , Hipestesia/diagnóstico por imagem , Paresia/diagnóstico por imagem , Audiometria , Potenciais Evocados , Nervo Glossofaríngeo/diagnóstico por imagem , Nervo Glossofaríngeo/patologia
2.
World Neurosurg ; 137: 218-225, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32059963

RESUMO

BACKGROUND: This report presents the third case of trochlear schwannoma arising from the pineal region and the first case to be resected using a paramedian infratentorial supracerebellar approach. Schwannomas of cranial nerves have traditionally been thought to arise from the transitional point where the axonal envelopment switches from glial cells to Schwann cells; however, recent temporal bone histopathologic evidence from vestibular schwannomas challenges this view. Of the 38 cases of pathology-confirmed trochlear schwannoma in the literature, there are only 2 cases arising from the pineal region, where the nerve sheath transition zone is located. Here, we discuss an unusual case of trochlear schwannoma arising from this transition zone. CASE DESCRIPTION: A 65-year-old man was admitted to our institute after a traffic accident. He complained of headache and dizziness, and a computed tomography scan revealed an isodense mass in the pineal region with obstructive hydrocephalus. Magnetic resonance imaging with contrast showed an enhancing mass in the pineal region. The tumor was subtotally resected using a paramedian infratentorial supracerebellar approach, and pathology confirmed the diagnosis of trochlear schwannoma. CONCLUSIONS: Trochlear schwannoma should be considered when a mass is identified in the pineal region. This diagnosis should still be entertained for mass lesions along the free tentorial edge because the tumor may arise distant from the glial-Schwann transition zone located by the dorsal midbrain. We propose a treatment algorithm for this rare tumor that seeks to maximize functional outcome.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos , Glândula Pineal , Doenças do Nervo Troclear/cirurgia , Idoso , Angiografia Cerebral , Neoplasias dos Nervos Cranianos/complicações , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/patologia , Tontura/etiologia , Cefaleia/etiologia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Masculino , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Tomografia Computadorizada por Raios X , Doenças do Nervo Troclear/complicações , Doenças do Nervo Troclear/diagnóstico por imagem , Doenças do Nervo Troclear/patologia
3.
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
4.
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
5.
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
6.
World Neurosurg ; 132: e40-e52, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520759

RESUMO

BACKGROUND: Schwannomas encompassing the superior parapharyngeal space are challenging lesions because of the anatomical complexity of this region and the frequent involvement of the neurovascular structures of the jugular foramen. The purpose of this study is to report the technical aspects and the advantages of the anterolateral approach, here proposed for schwannomas of this complex area. METHODS: The main steps of the anterolateral approach are described in detail, along with the results of a consecutive series of 38 patients with a retrostyloid superior parapharyngeal schwannoma involving the jugular foramen operated on by means of this route between 1999 and 2019. RESULTS: The supine position is generally preferred. The medial border of the sternocleidomastoid muscle, mastoid tip, and superior nuchal line are the landmarks for the hockey-stick skin incision. The accessory nerve is retrieved and mobilized cranially. Detachment of the sternocleidomastoid, digastric, and nuchal muscles allows for a 180° exposure of the extracranial side of the jugular foramen. Three working corridors, namely the pre-carotid, pre-jugular, and retro-jugular, allow access to the deeper part of the jugular foramen area and the superior parapharyngeal space. In the present series, a gross total resection was achieved in 89.4% of the patients. Three recurrences occurred after an average follow-up of 80.5 ± 51 months. CONCLUSIONS: The anterolateral approach is highly effective in the treatment of retrostyloid superior parapharyngeal space schwannomas involving the jugular foramen. Its simplicity of execution, versatility, and very low morbidity are among its main strengths.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Forâmen Jugular/cirurgia , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Espaço Parafaríngeo/cirurgia , Faringe/cirurgia , Adulto , Idoso , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/epidemiologia , Músculos Faríngeos/anatomia & histologia , Músculos Faríngeos/cirurgia , Faringe/diagnóstico por imagem , Decúbito Dorsal , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
Cir Cir ; 87(4): 377-384, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264987

RESUMO

Objective: To describe the clinical presentation of the facial nerve schwannomas according to the anatomical site of origin. Method: A retrospective study in which the clinical presentation, diagnostic protocol and treatment of facial nerve tumors in adults was evaluated. Results: We found 6 cases, 4 cases of tympanic-mastoid location at the spectrum of its possible clinical presentation: from symptomatic cases with facial paralysis, to an asymptomatic case in the tympanic portion found as intraoperative finding; and also found two cases located at the parotid gland, one with complete facial paralysis and one without facial palsy. Conclusions: For the diagnosis of intratemporal and parotid schwannomas of the facial nerve, a high clinical suspicion is required given its heterogeneous presentation; its clinical course depends on the segment of origin and expansion: more frequently asymptomatic at the tympanic horizontal portion and symptomatic at the mastoid vertical portion. These tumors must be assessed with imaging studies, incisional biopsy is not recommended. The treatment is surgical resection in symptomatic patients with facial paralysis greater than grade III of House-Brackmann, with immediate reconstruction of the nerve.


Assuntos
Neoplasias dos Nervos Cranianos/complicações , Doenças do Nervo Facial/complicações , Processo Mastoide/inervação , Neurilemoma/complicações , Neoplasias Parotídeas/complicações , Membrana Timpânica/inervação , Adulto , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Doenças do Nervo Facial/patologia , Doenças do Nervo Facial/cirurgia , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Feminino , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Neurilemoma/patologia , Neurilemoma/cirurgia , Glândula Parótida/inervação , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Estudos Retrospectivos , Zumbido/etiologia , Adulto Jovem
8.
World Neurosurg ; 129: 72-80, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150851

RESUMO

BACKGROUND: We report the first case of oculomotor nerve (ON) schwannoma treatment through an endonasal endoscopic approach. We also review the literature to determine prognosis factors of ON function after treatment. METHODS: A complete MEDLINE search was undertaken for all articles reporting data for oculomotor schwannoma. We divided the patient population into 2 groups; Group I: patients who conserved or recovered good ON function and Group II: patients with either new, worsening, or unchanged third-nerve palsy at the last available follow-up. We conducted a comparative statistical analysis of data between the 2 groups. RESULTS: We identified 55 reported cases of ON schwannoma, all of whom were treated with open transcranial surgery, stereotactic radiosurgery, or observation. There were 22 patients in group I and 33 in group II. At admission, 29 patients had complete oculomotor nerve palsy (34.7% in group I and 67.7% in group II; P = 0.02). Surgical treatment was performed in 36 cases. Radiosurgery was performed in 3 cases. Among patients with good preoperative ON function, 34.6% worsened at last follow-up (26.6% after surgery and 50% with observation; P = 0.03). In total, 31% of patients with total or near-total palsy at admission had an improvement of their ON function (all after surgical resection; P = 0.05). CONCLUSIONS: ON function at admission and surgical resection of schwannoma appears to be a predictive factor of favorable prognosis regardless of location and tumor size. The endonasal endoscopic approach can be used to biopsy tumors in cases in which open surgery is considered too risky, such as cavernous sinus schwannomas.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Neuroendoscopia/métodos , Doenças do Nervo Oculomotor/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento
9.
Laryngoscope ; 129(12): E434-E436, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31211430

RESUMO

Vagal schwannomas are rare, benign tumors. Intermittent intraoperative neuromonitoring via selective stimulation of splayed motor fibers running on the schwannoma surface to elicit a compound muscle action potential has been previously reported as a method of preserving vagal motor fibers. In this case report, vagal sensory fibers are mapped and continuously monitored intraoperatively during high vagus schwannoma resection using the laryngeal adductor reflex (LAR). Mapping of nerve fibers on the schwannoma surface enabled identification of sensory fibers. Continuous LAR monitoring during schwannoma subcapsular microsurgical dissection enabled sensory (and motor) vagal fibers to be monitored in real time with excellent postoperative functional outcomes. Laryngoscope, 129:E434-E436, 2019.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Monitorização Intraoperatória/métodos , Neurilemoma/cirurgia , Doenças do Nervo Vago/cirurgia , Nervo Vago , Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias dos Nervos Cranianos/fisiopatologia , Feminino , Humanos , Laringoscopia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Neurilemoma/fisiopatologia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Doenças do Nervo Vago/diagnóstico , Doenças do Nervo Vago/fisiopatologia
10.
Arch Argent Pediatr ; 117(3): e301-e304, 2019 06 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31063322

RESUMO

Schwannomas are benign tumors which arise from Schwann cells and take place along peripheral nerves. Extra-temporal facial nerve schwannomas are infrequent and present as painless masses in the parotid region, slow-growing and involvement of the facial nerve. Although rare, they should be taken into account as a differential diagnosis in parotid masses in children. Surgical strategies include superficial parotidectomy and surgical tumor resection with electrical nerve stimulation and nerve preservation. The following case describes a paediatric patient treated with the previously mentioned nerve sparing surgical technique.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico , Nervo Facial/patologia , Neurilemoma/diagnóstico , Neoplasias Parotídeas/diagnóstico , Adolescente , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Diagnóstico Diferencial , Nervo Facial/cirurgia , Feminino , Humanos , Neurilemoma/patologia , Neurilemoma/cirurgia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia
11.
Medicine (Baltimore) ; 98(19): e15657, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083267

RESUMO

RATIONALE: Granular cell tumor (GCT) is a relatively uncommon, usually benign lesion that often presents as a solitary, painless cutaneous or submucosal nodule. GCTs of the head and neck are not uncommon; however, involvement of the trunk of the facial nerve is rare. PATIENT CONCERNS: A 55-year-old woman presented a lesion at the posterior border of the left parotid gland. Doppler ultrasound revealed a hypoechoic mass and magnetic resonance imaging disclosed an irregularly shaped lesion with unsharp borders in the posterior aspect of the left parotid gland that was hyperintense on T2-weighted images and enhancing with contrast on T1-weighted images. The remainder of the parotid gland was normal. DIAGNOSIS: Following excision of the mass, diagnosis of a GCT was established and confirmed by immunohistochemistry. INTERVENTIONS: The patient underwent surgical excision of the lesion. OUTCOMES: The patient is currently asymptomatic and without recurrence after 10 months follow-up. LESSONS: GCT involvement of the trunk of the facial nerve is rare. Immunohistochemical staining is helpful for its diagnosis.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico , Doenças do Nervo Facial/diagnóstico , Tumor de Células Granulares/diagnóstico , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Diagnóstico Diferencial , Nervo Facial/diagnóstico por imagem , Nervo Facial/patologia , Nervo Facial/cirurgia , Doenças do Nervo Facial/patologia , Doenças do Nervo Facial/cirurgia , Feminino , Tumor de Células Granulares/patologia , Tumor de Células Granulares/cirurgia , Humanos , Pessoa de Meia-Idade
12.
World Neurosurg ; 127: e534-e541, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30928581

RESUMO

OBJECTIVE: The objectives of this study were to report 4 cases diagnosed with trigeminal schwannomas (TS), among whom tumor in epidural space of middle fossa broke through dura mater into subdural space, and to analyze the potential reason for recurrence of TS in middle fossa after surgical removal by endoscopic endonasal approach (EEA) or interdural approach. METHODS: The information of 4 patients diagnosed with TS who were surgically treated was retrospectively analyzed and the selection of approaches, surgical strategies, and potential reason for recurrence after middle fossa TS removal by EEA and interdural approach were discussed. RESULTS: During last 10 years, 43 patients with TS received surgical treatment at Xuan Wu Hospital of Capital Medical University, among whom 1 patient with TS extending from middle fossa to infratemporal fossa was first treated by EEA, then the tumor recurred and the patient underwent a second operation via a frontotemporal subdural approach. During the second operation, we found part of tumor had broken through the dura mater into subdural space. Moreover, this phenomenon was detected in another 3 patients with middle-posterior fossa TS. CONCLUSIONS: TS in middle fossa has been widely believed to be totally located at epidural space, whereas we found that it could occasionally breach into subdural space and accept blood supply from the pial artery. We believe this could be the potential reason for recurrence after tumor resection by EEA and interdural approach.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neurilemoma/cirurgia , Espaço Subdural/cirurgia , Adulto , Idoso , Dura-Máter/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/cirurgia , Espaço Subdural/patologia , Adulto Jovem
13.
World Neurosurg ; 127: e509-e516, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30928584

RESUMO

OBJECTIVE: Imaging to visualize nerves around tumors preoperatively could help the surgeon to plan the surgery and excise the tumor with preservation or improvement in patients' quality of life. In the present prospective study, we attempted to correlate the preoperative cranial nerves (i.e., trigeminal, abducens, facial, and vestibulocochlear diffusion tensor tractography and anatomic magnetic resonance imaging [MRI] findings) with intraoperative findings during cerebellopontine angle (CPA) tumor surgery. METHODS: The 40 enrolled patients had CPA tumors (31 vestibular schwannomas, 5 epidermoid tumors, 2 meningiomas, 2 trigeminal schwannomas). All the patients were undergoing microsurgery for the first time. They underwent preoperative MRI for anatomic and diffusion tensor imaging (DTI) data. The imaging series were postprocessed, and 3-dimensional images were obtained. The location of the involved nerves around the tumors was recorded during surgery by the senior surgeon, who was kept unaware of the results of the fiber tracking, and a correlation was performed. RESULTS: We evaluated the correlation between the DTI and intraoperative findings for the nerve location in relation to the tumor in the CPA. The correlation between the DTI and intraoperative findings for the facial, trigeminal, and vestibulocochlear nerves was 85% (34 of 40), 85% (34 of 40), and 75% (12 of 16), respectively. CONCLUSIONS: The modified technical parameters proposed could lead to better preservation of cranial nerve function, especially for patients with large tumors. To the best of our knowledge, the present study is the first systematic study of relevant cranial nerves in 40 patients with demonstration of the vestibulocochlear bundle by preoperative MRI in the most common CPA tumors using advanced MRI sequences such as diffusion tensor tractography and capturing the data in a multiplanar format.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Nervos Cranianos/cirurgia , Nervo Facial/cirurgia , Neuroma Acústico/cirurgia , Adolescente , Adulto , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/cirurgia , Cuidados Pré-Operatórios/métodos , Qualidade de Vida , Nervo Vestibulococlear/cirurgia , Adulto Jovem
14.
World Neurosurg ; 127: 525-529, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31004855

RESUMO

BACKGROUND: Primary extracranial meningiomas are uncommon neoplasms. In particular, meningioma involving the hypoglossal canal is extremely rare, with only 4 cases reported in the literature so far. Given that each of these meningiomas originated in the juxtacondyle region with involvement of the hypoglossal canal, to the best of our knowledge, a meningioma that exists only within the hypoglossal canal has yet to be reported. CASE DESCRIPTION: We present a case of primary extracranial meningioma arising solely from the hypoglossal canal. A 62-year-old woman presented with long-term difficulty in tongue movement. Her tongue was deviated to the right, and neurologic examination revealed fasciculation and muscle wasting on the right side of the tongue. Computed tomography revealed a calcification in the right hypoglossal canal. Magnetic resonance imaging further demonstrated a hypointense tumor on both T1-weighted and T2-weighted images, with contrast enhancement in the right condyle. Total tumor removal was performed via a transcondylar approach, and histopathologic examination confirmed the presence of a transitional meningioma. No recurrence was observed at 14 months of follow-up. The patient's tongue atrophy was slightly improved, and the deviation completely disappeared. CONCLUSIONS: In this extremely rare case of hypoglossal canal meningioma, total tumor removal via a transcondylar approach resulted in the recovery of hypoglossal nerve function.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Doenças do Nervo Hipoglosso/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Craniotomia/métodos , Feminino , Humanos , Pessoa de Meia-Idade
15.
World Neurosurg ; 127: 518-524, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009782

RESUMO

BACKGROUND: Trigeminal schwannomas are fifth cranial nerve tumors that originate from the nerve sheath. They rarely occur within the pediatric population and can cause dysfunction of the trigeminal nerve and surrounding structures. When patients become symptomatic, neurosurgeons should consider resection. CASE DESRIPTION: We report the case of a 14-year-old adolescent boy who presented with an isolated sixth nerve palsy manifested by diplopia. The patient was found to have a trigeminal schwannoma involving the ophthalmic and maxillary branches of the trigeminal nerve. A modified mini-pterional craniotomy was performed for an extended middle fossa approach with an anterior petrosectomy to gain access to the inferior aspect of the posterior fossa tumor component. Intraoperatively, the sixth nerve was compressed within Dorello's canal. Postoperatively, the patient's sixth nerve palsy resolved, and magnetic resonance imaging demonstrated near-total resection with residual enhancement along the superior orbital fissure near the oculomotor nerve entry zone and foramen rotundum. CONSLUSIONS: We present a rare case of pediatric trigeminal schwannoma type Mp treated surgically with a near-total resection via a novel mini-pterional approach and use of cranial nerve diffusion tensor imaging.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Doenças do Nervo Trigêmeo/cirurgia , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/cirurgia , Adolescente , Craniotomia/métodos , Humanos , Masculino , Resultado do Tratamento
17.
Surg Radiol Anat ; 41(6): 625-637, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30923840

RESUMO

PURPOSE: The sensory trigeminal nerve in the trigeminal cave of Meckel-which is an individualized lodge-is classically segmented into two parts: the trigeminal ganglion (TG) and the triangular plexus (TP). The TP has been defined as the portion of the trigeminal nerve from the posterior margin of the TG to the path over the upper ridge of the petrous bone. Due to its relatively unrecognized status, its morphological and functional anatomy has been reviewed by the authors through a PRISMA systematic review of the literature. METHODS: The authors have carried out a systematic review of the TP according to the PRISMA model with various bibliographical bases. Before 1947: Medic @ Library (BIU Santé Paris, 2017); Index-Catalog of the Library of the Surgeon-General's Office (US National Library of Medicine, 2017); Gallica (French National Library, 2017). After 1947: PUBMED, PubMed Central and MEDLINE. RESULTS: 56 articles were retained for full-text examination, of which 23 were chosen and included. The TP was described as having a triangular shape (30.2%), a plexual organization (97.4%) with sensory-, motor- and sympathetic-anastomoses (96.7%) that, however, respect the somatotopic trigeminal distribution (93.3%). The direct electrical stimulation of the root at the level of the TP (during radiofrequency-thermorhizotomy procedures) confirmed a clear-cut somatotopy. CONCLUSION: An understanding of both the morphological and the functional anatomy of the triangular plexus can contribute to accuracy and safety on the surgeries performed for trigeminal neuralgia and tumor removal inside the trigeminal cave.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Traumatismos do Nervo Trigêmeo/prevenção & controle , Nervo Trigêmeo/anatomia & histologia , Neoplasias dos Nervos Cranianos/cirurgia , Humanos , Procedimentos Neurocirúrgicos/métodos , Osso Petroso/inervação , Traumatismos do Nervo Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia
19.
World Neurosurg ; 126: 30-36, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30844522

RESUMO

BACKGROUND: Renal cell carcinoma (RCC) accounts for ∼8% of all brain metastatic disease; however, spread to the cranial nerves and their ganglia is uncommon. To the best of our knowledge, we report the first case of RCC metastatic to Meckel's cave, which was diagnosed secondary to new trigeminal sensory loss. METHODS: A 45-year-old man had presented with acute-onset right V3 numbness. Magnetic resonance imaging demonstrated contrast enhancement of the ipsilateral V3, extending from its root at the Gasserian ganglion to the foramen ovale. RESULTS: He elected for observation, and his symptoms resolved over several weeks. At the scheduled, routine 3-month follow-up examination, he reported symptomatic relapse with new concomitant hyperesthetic/neuropathic pain. Magnetic resonance imaging demonstrated interval enlargement of the enhancing lesion in an atypical pattern, potentially consistent with trigeminal schwannoma versus meningioma, and operative resection was recommended. CONCLUSION: We have reported a case of RCC presenting with numbness via metastatic spread to Meckel's cave. Although uncommon, metastasis is an important diagnostic consideration for enhancing cranial nerve lesions. Our case has demonstrated that, although a history of malignancy, multiple lesions, or systemic/constitutional symptoms are typical, rare cases can demonstrate isolated central nervous system findings. Thus, short-term radiographic surveillance is indicated if the diagnosis of an intracranial or cranial nerve mass lesion is equivocal.


Assuntos
Carcinoma de Células Renais/secundário , Neoplasias Renais/patologia , Metástase Neoplásica/patologia , Gânglio Trigeminal/patologia , Gânglio Trigeminal/cirurgia , Carcinoma de Células Renais/diagnóstico , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neuralgia do Trigêmeo/cirurgia
20.
Am J Otolaryngol ; 40(2): 341, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30704809

RESUMO

The retrosigmoid approach for vestibular schwannoma surgery has remained the standard approach by most neurosurgeons. Drilling the posterior wall of the internal auditory meatus (IAM) is an essential step in removing the intrameatal tumor. During IAM drilling, three anatomical structures can be encountered, including the posterior semicircular canal, vestibular aqueduct, and jugular bulb. Any of these can be injured during drilling, especially if the jugular bulb lies above the inferior edge of the IAM. Although IAM drilling is performed in most vestibular schwannoma surgeries, information on how to manage complications such as jugular bulb injury is lacking. Here we use an intraoperative video to demonstrate how to manage the inadvertent injury to the jugular bulb in order to avoid massive blood loss. We present a case of a 39-year-old woman with hearing loss, diagnosed with a cerebellopontine angle mass extending into the IAM. Surgery was required due to tumor progression. We used the retrosigmoid approach to access the tumor. During IAM drilling, the jugular bulb was injured. A thin layer of bone wax was applied under continuous suction. The margins of the wax were then gently compressed with a dissector; great care was taken to avoid pushing the wax into the jugular bulb. Excess bone wax was removed (video 1). A small diamond drill (2 mm) was used for further drilling. Our instructional video shows the surgical approach, microsurgical anatomy, and technical aspects of managing massive bleeding from jugular bulb injury. It should therefore be helpful for young neurosurgeons.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Meato Acústico Externo/cirurgia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Veias Jugulares/anatomia & histologia , Veias Jugulares/lesões , Microcirurgia/métodos , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Procedimentos Cirúrgicos Otológicos/métodos , Cirurgia Assistida por Computador/métodos , Doenças do Nervo Vestibulococlear/cirurgia , Gravação em Vídeo , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle , Ângulo Cerebelopontino , Feminino , Humanos , Palmitatos/administração & dosagem , Ceras
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