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1.
J Laryngol Otol ; 134(6): 519-525, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32613920

RESUMO

OBJECTIVE: To present our data evaluating the feasibility of simultaneous cochlear implantation with resection of acoustic neuroma. METHODS: This paper describes a case series of eight adult patients with a radiologically suspected acoustic neuroma, treated at a tertiary referral centre in Newcastle, Australia, between 2012 and 2015. Patients underwent cochlear implantation concurrently with removal of an acoustic neuroma. The approach was translabyrinthine, with facial nerve monitoring and electrically evoked auditory brainstem response testing. Standard post-implant rehabilitation was employed, with three and six months' follow-up data collected. The main outcome measures were: hearing, subjective benefit of implant, operative complications and tumour recurrence. RESULTS: Eight patients underwent simultaneous cochlear implantation with resection of acoustic neuroma over a 3-year period, and had 25-63 months' follow up. There were no major complications. All patients except one gained usable hearing and were daily implant users. CONCLUSION: Simultaneous cochlear implantation with resection of acoustic neuroma has been shown to be a safe treatment option, which will be applicable in a wide range of clinical scenarios as the indications for cochlear implantation continue to expand.


Assuntos
Implante Coclear/métodos , Terapia Combinada/métodos , Audição/fisiologia , Neuroma Acústico/cirurgia , Adolescente , Idoso , Austrália/epidemiologia , Terapia Combinada/estatística & dados numéricos , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Nervo Facial/cirurgia , Estudos de Viabilidade , Seguimentos , Testes Auditivos/métodos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Neuroma Acústico/reabilitação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento
4.
Otolaryngol Head Neck Surg ; 161(6): 1027-1030, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31570055

RESUMO

OBJECTIVE: Unilateral vestibular weakness has considerable potential etiologies. One source is a vestibular schwannoma. This article evaluates, in the absence of other symptoms and signs, if unilateral vestibular weakness is an analogue to asymmetric sensorineural hearing loss and serves as an indication for lateral skull base imaging. STUDY DESIGN: Retrospective chart review. SETTING: Academic tertiary center. SUBJECTS AND METHODS: All patients undergoing caloric assessment between January 1, 2012, and June 30, 2018, were investigated. Patients with unilateral vestibular weakness (a left-right difference >25% on electronystagmography) were included in the study. A provincial encompassing image library was surveyed for potential adequate imaging (computed tomography internal auditory canal infused, magnetic resonance imaging [MRI] brain, MRI internal auditory canal) of the target population within the preceding 5 years. Presence/absence of vestibular schwannoma on imaging was determined. RESULTS: Of the 3531 electronystagmography reports reviewed during the period, 864 patients were identified with unilateral vestibular weakness. Of these, 542 had sufficient imaging, and 14 vestibular schwannomas were identified. Only 1 individual had a vestibular weakness in isolation, while the remaining 13 patients also suffered from documented sensorineural hearing loss that would have mandated MRI scanning. CONCLUSION: The results of our study suggest that, in isolation, vestibular weakness is an insufficient indicator for lateral skull base imaging.


Assuntos
Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/etiologia , Neuroma Acústico/diagnóstico por imagem , Vestíbulo do Labirinto/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Testes Calóricos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/complicações , Seleção de Pacientes , Estudos Retrospectivos
5.
Ear Nose Throat J ; 98(8): NP120-NP124, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31522556

RESUMO

OBJECTIVES: To describe a unique case of isolated bilateral sarcoidosis of the cerebellopontine angle as well as the related imaging in the case. To conduct a literature review of the published articles regarding sarcoidosis of the cerebellopontine angle. DATA SOURCES: Representative case report from a single institution as well as PubMed and Scopus database searches. METHODS: In addition to a retrospective review, all published case reports and case series of sarcoidosis involving the cerebellopontine angle from 1960 to July 2018 in the English language were reviewed. Demographic data, presenting symptoms, and outcomes were collected. RESULTS: We identified 8 total cases with pertinent clinical information that were included. CONCLUSIONS: Isolated neurosarcoidosis of the cerebellopontine angle is an exceptionally rare phenomenon that, on history and imaging, presents similar to more common retrocochlear pathologies. Surgery may be required in large lesions unresponsive to traditional medical therapy with immunosuppression.


Assuntos
Doenças do Sistema Nervoso Central/diagnóstico por imagem , Doenças do Sistema Nervoso Central/patologia , Neuroma Acústico/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Sarcoidose/patologia , Doenças do Sistema Nervoso Central/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Sarcoidose/cirurgia
6.
World Neurosurg ; 132: e34-e39, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520763

RESUMO

OBJECTIVE: Vestibular schwannomas (VSs) can either be solid or contain variable amounts of cystic components. It has been established that gamma knife radiosurgery (GKRS) is an effective treatment modality for solid VSs. However, in the case of cystic VS, given the somewhat unpredictable growth of the cystic portion of these tumors, microsurgery has often been preferred to GKRS in the management of cystic VS. However, to date, a relative paucity of data evaluating the outcomes after GKRS for cystic VS has been available. In the present study, we reviewed our experience treating cystic VSs with GKRS and evaluated the results. METHODS: The data from patients with a diagnosis of cystic VS who had undergone GKRS from 1999 to 2018 were analyzed. Only those patients who had undergone GKRS as the initial treatment of cystic VSs were included in the present study. Patients who had undergone previous surgical treatment were excluded. The cystic VSs were divided into intratumoral and peritumoral cysts. RESULTS: A total of 24 patients were enrolled in the present study. The mean age was 60.8 ± 2.4 years (range, 38-82 years). The mean follow-up period was 55.8 ± 8.1 months (range, 8-145 months). Of the 24 patients, 11 were men. The control rate after GKRS for cystic VSs was 75%. The 5-year progression-free rate was 70%. Six patients had presented with an increasing lesion size after GKS. Of these 6 patients, 2 underwent surgical treatment and 1 underwent repeat GKRS. No statistically significant differences were found between the control rate and cystic type (P = 0.093). CONCLUSION: The results from the present study have demonstrated that GKRS is an effective treatment modality for cystic VSs.


Assuntos
Neuroma Acústico/cirurgia , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos/patologia , Cistos/cirurgia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento
7.
World Neurosurg ; 132: e228-e234, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493607

RESUMO

PURPOSE: To search for texture features of routine magnetic resonance imaging to predict tumor volume reduction and transient versus permanent tumor progression of vestibular schwannomas treated by Gamma Knife stereotactic radiosurgery. MATERIALS AND METHODS: Included were 23 patients with vestibular schwannomas treated in our center and followed over a period of 23.7-80.3 months (mean 42.7). Magnetic resonance imaging was performed on a 3-Tesla scanner and included T1-weighted images with and without contrast enhancement, T2-weighted, and fluid-attenuated inversion recovery images. Volumetric results were followed longitudinally over time and correlated to texture features as mean, minimum, maximum, standard deviation, skewness, and kurtosis of normalized signals taken from regions of interest covering the total tumor volume. RESULTS: In total, 14 tumors showed early progression during the first 5-18 months (2 cases permanent, 12 cases transient), whereas 9 tumors regressed immediately after SRS. Kurtosis of T2-weighted image intensity values turned out to predict progression best with a sensitivity and specificity of 71% and 78%. From all texture feature parameters, only the minimum of the normalized T2-weighted image intensity values correlated significantly to the final reduction of tumor volume per month (correlation coefficient = -0.634, P < 0.05, corrected for false discovery rate). CONCLUSIONS: Texture feature analysis helps to predict permanent versus transient enlargement and final volume reduction of schwannomas after SRS. Thus, alternative treatment strategies might be considered, mainly in large tumors, where further clinical deterioration cannot be excluded. To confirm these results, a prospective study including more cases and a longer follow-up period is necessary.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Neuroimagem/métodos , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Neuroma Acústico/cirurgia , Adolescente , Adulto , Idoso , Criança , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Radiocirurgia , Adulto Jovem
8.
Acta Neurochir (Wien) ; 161(11): 2265-2269, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31392568

RESUMO

BACKGROUND: Advances in various diagnostic and/or treatment modalities, including radiological imaging, neuromonitoring, and microsurgical techniques, have resulted in treatments of vestibular schwannomas being aimed at preserving facial and hearing functions while achieving optimal tumor control. METHOD: We describe our surgical technique for hearing preservation in vestibular schwannoma surgery. CONCLUSION: The retrosigmoid transmeatal approach under continuous neuromonitoring (auditory brainstem response, cochlear nerve action potentials, and continuous facial nerve monitoring) enables gross-total resection of vestibular schwannomas, while preserving hearing and facial functions. Radiological assessment and microsurgical techniques, such as meticulous tumor dissection, are also essential for functional preservation with sufficient tumor removal.


Assuntos
Perda Auditiva/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/métodos , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Potenciais Evocados Auditivos do Tronco Encefálico , Nervo Facial/diagnóstico por imagem , Nervo Facial/cirurgia , Feminino , Audição , Perda Auditiva/etiologia , Humanos , Masculino , Neuroma Acústico/diagnóstico por imagem , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia
9.
J Laryngol Otol ; 133(8): 640-649, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366414

RESUMO

OBJECTIVE: To review the literature regarding screening for vestibular schwannoma in the context of demographic changes leading to increasing numbers of elderly patients presenting with asymmetric auditory symptoms. METHODS: A systematic review of the literature was performed, with narrative synthesis and statistical analysis of data where appropriate. RESULTS: Vestibular schwannomas diagnosed in patients aged over 70 years exhibit slower growth patterns and tend to be of smaller size compared to those tumours in younger age groups. This fact, combined with reduced life expectancy, renders the probability of these tumours in the elderly requiring active treatment with surgery or stereotactic radiotherapy to be extremely low. Vestibular schwannomas in the elderly are much more likely to be managed by serial monitoring with magnetic resonance imaging. The weighted yield of magnetic resonance imaging in the diagnosis of vestibular schwannoma in all age groups is 1.18 per cent, with almost 85 scans required to diagnose 1 tumour. CONCLUSION: An evidence-based approach to the investigation of asymmetric hearing loss and tinnitus in the elderly patient can be used to formulate guidelines for the rational use of magnetic resonance imaging in this population.


Assuntos
Envelhecimento/fisiologia , Perda Auditiva/etiologia , Neuroma Acústico/diagnóstico por imagem , Zumbido/etiologia , Idoso , Medicina Baseada em Evidências , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Vigilância da População
10.
PLoS One ; 14(7): e0217253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276518

RESUMO

OBJECTIVE: Meningitis after microsurgery for vestibular schwannoma (VS) is a severe complication that results in high morbidity. However, few studies have focused on meningitis after VS surgery. The purpose of this study was to identify the risk factors for meningitis after VS surgery. METHODS: We performed a retrospective analysis of all VS patients who underwent microsurgery and survived for at least 7 days after surgery, between 1 June 2015 and 30 November 2018 at West China Hospital of Sichuan University. Univariate and multivariate analyses were performed to identify the risk factors for postoperative meningitis (POM). RESULTS: We enrolled 410 patients, 27 of whom had POM. Through univariate analysis, the factors of hydrocephalus (p = 0.018), Koos grade IV (p = 0.04), operative duration > 3 hours (p = 0.03) and intraoperative bleeding volume ≥400 ml (p = 0. 02) were significantly correlated with POM. The multivariate analysis showed that Koos grade IV (p = 0.04; OR = 3.19; 95% CI 1.032-3.190), operation duration > 3 hours (p = 0.03; OR = 7.927; 95% CI 1.043-60.265), and intraoperative bleeding volume ≥ 400 ml (p = 0.02; OR = 2.551; 95% CI 1.112-5.850) were the independent influencing factors of POM. CONCLUSIONS: Koos grade IV, operation duration > 3 hours, and intraoperative blood loss ≥ 400 ml were identified as independent risk factors for POM after microsurgery for VS. POM also caused a prolonged hospital stay.


Assuntos
Perda Sanguínea Cirúrgica , Imagem por Ressonância Magnética , Meningite , Microcirurgia/efeitos adversos , Neuroma Acústico , Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Meningite/diagnóstico por imagem , Meningite/epidemiologia , Meningite/etiologia , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/epidemiologia , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
11.
Clin Nucl Med ; 44(11): 883-885, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31306195

RESUMO

A 77-year-old man with newly diagnosed prostate adenocarcinoma with a total prostate-specific antigen level of 6.4 ng/mL and Gleason score 7 (4 + 3) was referred to Ga-prostate-specific membrane antigen-11 (PSMA) PET/CT for initial staging. An intense focal PSMA uptake was shown in the right peripheral zone of the prostate gland consistent with the primary tumor. Additionally, PET/CT demonstrated a PSMA-avid soft tissue mass in the left cerebellopontine angle. The patient had a history of left-sided sensorineural hearing loss.


Assuntos
Ácido Edético/análogos & derivados , Achados Incidentais , Neuroma Acústico/diagnóstico por imagem , Oligopeptídeos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Humanos , Masculino , Estadiamento de Neoplasias , Neuroma Acústico/complicações , Neoplasias da Próstata/complicações , Neoplasias da Próstata/patologia
12.
Neurosurgery ; 85(6): E1084-E1094, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31270543

RESUMO

BACKGROUND: Gamma Knife radiosurgery (GKRS; Elekta AB) remains a well-established treatment modality for vestibular schwannomas. Despite highly effective tumor control, further research is needed toward optimizing long-term functional outcomes. Whereas dose-rate effects may impact post-treatment toxicities given tissue dose-response relationships, potential effects remain largely unexplored. OBJECTIVE: To evaluate treatment outcomes and potential dose-rate effects following definitive GKRS for vestibular schwannomas. METHODS: We retrospectively reviewed 419 patients treated at our institution between 1998 and 2015, characterizing baseline demographics, pretreatment symptoms, and GKRS parameters. The cohort was divided into 2 dose-rate groups based on the median value (2.675 Gy/min). Outcomes included clinical tumor control, radiographic progression-free survival, serviceable hearing preservation, hearing loss, and facial nerve dysfunction (FND). Prognostic factors were assessed using Cox regression. RESULTS: The study cohort included 227 patients with available follow-up. Following GKRS 2-yr and 4-yr clinical tumor control rates were 98% (95% CI: 95.6%-100%) and 96% (95% CI: 91.4%-99.6%), respectively. Among 177 patients with available radiographic follow-up, 2-yr and 4-yr radiographic progression-free survival rates were 97% (95% CI: 94.0%-100.0%) and 88% (95% CI: 81.2%-95.0%). The serviceable hearing preservation rate was 72.2% among patients with baseline Gardner-Robertson class I/II hearing and post-treatment audiological evaluations. Most patients experienced effective relief from prior headaches (94.7%), tinnitus (83.7%), balance issues (62.7%), FND (90.0%), and trigeminal nerve dysfunction (79.2%), but not hearing loss (1.0%). Whereas GKRS provided effective tumor control independently of dose rate, GKRS patients exposed to lower dose rates experienced significantly better freedom from post-treatment hearing loss and FND (P = .044). CONCLUSION: Whereas GKRS provides excellent tumor control and effective symptomatic relief for vestibular schwannomas, dose-rate effects may impact post-treatment functional outcomes. Further research remains warranted.


Assuntos
Audição/efeitos da radiação , Neuroma Acústico/radioterapia , Doses de Radiação , Radiocirurgia/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Audição/fisiologia , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Testes Auditivos/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
13.
PLoS One ; 14(6): e0217752, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163048

RESUMO

BACKGROUND: The natural history of sporadic vestibular schwannoma is unpredictable, with tumors growing, non-growing and even showing spontaneous regression in some rare cases. OBJECTIVE: This retrospective study aims to describe the radiologic signs characterizing and identifying the shrinking vestibular schwannoma. METHODS: Involution was considered to have occurred if tumor size had decreased by 2 mm or more on its largest diameter. All magnetic resonance imaging scans were reviewed for tumor size, internal auditory meatus size, and tumor characteristics. Volumetric measurements were performed on the first and last scan. Audiometric data were collected at the first and last visit. RESULTS: Fourteen patients with a confirmed spontaneous regression were included, with a mean follow-up of 5 ± 2.6 years. The mean shrinkage rate was 0.9 ± 0.59 mm/year on 2D measurements, and 0.2 ± 0.17 cm3/year on volumetric measurements, with a relative shrinkage of 40 ± 16.9%. Two remarkable radiologic features were observed: First, a festooned aspect, defined by multiple curves in the tumor outline, noticed in 12 cases (86%); second, the appearance of cerebrospinal fluid filling the internal auditory meatus, associated with an enlargement of the internal auditory meatus compared to the contralateral side, and observed in 10 out of 13 cases with internal auditory meatus invasion (77%). Those two aspects were associated in 64% of cases. CONCLUSION: These two newly reported radiologic features could help neurosurgeons, oto-neurosurgeons and neuroradiologists to identify a spontaneous vestibular schwannoma involution at first visit. This could allow any treatment to be postponed, monitoring to be more widely spaced, and patients to be reassured.


Assuntos
Regressão Neoplásica Espontânea/patologia , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/diagnóstico , Cóclea/diagnóstico por imagem , Cóclea/patologia , Cóclea/fisiopatologia , Audição/fisiologia , Humanos , Imagem por Ressonância Magnética , Regressão Neoplásica Espontânea/fisiopatologia , Neuroma Acústico/patologia , Neuroma Acústico/fisiopatologia
14.
Otol Neurotol ; 40(5S Suppl 1): S67-S71, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31225825

RESUMO

OBJECTIVE: To compare linear and volumetric vestibular schwannoma (VS) measurements between different magnetic resonance imaging (MRI) sequences. STUDY DESIGN: Retrospective case series. SETTING: Tertiary care university hospital. PATIENTS: Those with VS that had at least two separate MRI studies containing both T1-weighted contrast (T1C) and high-resolution T2-weighted (HRT2) images. INTERVENTION: Two neurotologists measured the greatest linear axial dimension and segmentation volumes of VS. MAIN OUTCOME MEASURE: 1) Correlation between T1C and HRT2 VS linear and volumetric measurements. 2) Comparing the interpretation of VS growth between T1C and HRT2 sequences and reviewers, defined as an increase in tumor diameter of more than or equal to 2 mm or a volume increase of more than or equal to 20%. RESULTS: Twenty-three patients met inclusion criteria. Imaging studies encompassed a median of 25.2 months. At the initial imaging study, inter-observer measurements between reviewers, analyzed with intraclass correlation coefficients, for T1C diameters, T1C volumes, HRT2 diameters, and HRT2 volumes were 0.983 (95% confidence interval [CI] 0.972-0.989), 0.989 (95% CI 0.982-0.993), 0.992 (95% CI 0.988-0.995), and 0.998 (95% CI 0.995-0.999), respectively. The Cohen's kappa for growth rates between T1C diameters, T1C volumes, HRT2 diameters, and HRT2 volumes was 0.564 (95% CI 0.284-0.844), 0.704 (95% CI 0.514-0.894), 0.605 (95% CI 0.319-0.891), and 0.475 (95% CI 0.242-0.708), respectively. CONCLUSIONS: There are significant differences in VS volume measurements when utilizing T1C versus HRT2 images. However, there is "excellent" interobserver agreement between T1C and HRT2 diameters and volumes. T1C VS volumes may be more reliable than HRT2 volumes to determine growth.


Assuntos
Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Neuroma Acústico/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Variações Dependentes do Observador , Estudos Retrospectivos
15.
Acta Neurochir (Wien) ; 161(9): 1817-1819, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31254066

RESUMO

Vestibular schwannomas (VSs) are generally benign and slow-growing tumors, and microsurgical resection is the commonly recommended treatment. Some reports suggested that inserting a cystoperitoneal shunt was effective for treatment of cystic VSs; however, there was no report of a cyst-cisternal shunt which diverts cyst fluid into cistern. We report a case of cystic VS with repeated cyst regrowth within weeks after repeated surgeries. We prevented further recurrence using cyst-cisternal shunt. This technique may be a new treatment option for refractory cyst regrowth of cystic VSs.


Assuntos
Anastomose Cirúrgica/métodos , Neuroma Acústico/cirurgia , Idoso , Cisterna Magna/diagnóstico por imagem , Cisterna Magna/cirurgia , Cistos/diagnóstico por imagem , Cistos/cirurgia , Humanos , Masculino , Neuroma Acústico/diagnóstico por imagem
16.
Acta Otolaryngol ; 139(7): 547-551, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31050576

RESUMO

Background: Patients may suffer postoperative facial nerve injury, hearing loss, or other postoperative complications after the operation, which seriously affect their postoperative life quality. Aims/objectives: To investigate the differences in QOL (quality of life) of patients with acoustic neuroma resection by the translabyrinthine or retrosigmoid approach. Material and methods: Patients with acoustic neuroma resection in our department were enrolled in this experimental study, among which fifty patients underwent the translabyrinthine approach resection, the other 50 patients underwent the retrosigmoid approach resection. Different scores by the SF-36 scale between these two groups of patients one month after discharge were then analyzed. Results: Scores of patients undergoing the retrosigmoid approach were higher in the three dimensions of Social Functioning, Role-emotional and Mental Health than those of patients undergoing the translabyrinthine approach with statistical significance. However, scores of patients undergoing the translabyrinthine approach were higher in the two dimensions of Body Pain and Vitality than those of the patients undergoing the retrosigmoid approach. Conclusions and significance: The results indicated that individual nursing interventions for different patients are necessary to improve the QOL of patients after hospitalization. Moreover, the operated patients with translabyrinthine approach were more advantage than patients with retrosigmoid approach.


Assuntos
Traumatismos do Nervo Facial/psicologia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Qualidade de Vida , Adulto , Bases de Dados Factuais , Orelha Interna/cirurgia , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento
17.
World Neurosurg ; 128: 324-327, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31125772

RESUMO

BACKGROUND: Intracranial metastasis is a common complication of systemic malignancy. A rare subset of intracranial masses constitutes tumor-to-tumor metastasis, in which an extracranial neoplasm hematogenously spreads to an existing intracranial lesion. CASE DESCRIPTION: Here we present the unique case of a 59-year-old man with known hepatocellular carcinoma who presented with acute headaches, double vision, vertigo, and gait instability in the context of 2 years of right-sided hearing loss. Head imaging showed a heterogeneous right cerebellopontine angle mass extending into the porus acousticus with adjacent cerebellar edema. Histopathologic analysis after resection found coexisting hepatocellular carcinoma within a vestibular schwannoma. CONCLUSIONS: Tumor-to-tumor metastasis is an important consideration in the diagnostic work-up and treatment of patients with known systemic malignancy who present with a new intracranial lesion. This pathologic entity could be missed if this patient were treated with single-fraction radiosurgery such as Gamma Knife.


Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Neuroma Acústico/secundário , Ângulo Cerebelopontino/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos , Radiocirurgia , Doenças Vestibulares/diagnóstico por imagem , Doenças Vestibulares/etiologia , Doenças Vestibulares/fisiopatologia
18.
World Neurosurg ; 128: 72-76, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31026654

RESUMO

BACKGROUND: A fixed retractor is routinely used during surgery for vestibular schwannoma to maintain the surgical corridor; however, brain injuries can be caused by use of retractors. The aim of this study was to present strategies for retractorless surgery for giant vestibular schwannomas and compare retractorless surgery with traditional retractor-assisted surgery to illustrate feasibility and potentially superiority of retractorless surgery. METHODS: Clinical data of 61 patients with giant (≥4 cm diameter) vestibular schwannomas undergoing craniotomy were retrospectively analyzed. Patients were divided into 2 cohorts: 1) 35 patients with traditional retractor surgery performed between June 2016 and July 2017; 2) 26 patients with retractorless surgery performed between June 2016 and July 2018. Duration of operation, intraoperative blood loss, extent of resection, rate of retention of facial nerve function, postoperative brain injury rate, intracranial infection rate, hospitalization time, and grade of facial nerve function were compared between the 2 groups. RESULTS: The incidence of postoperative brain injury was 3.84% in the retractorless surgery group, which was significantly lower compared with the traditional retractor surgery group (22.86%) (P < 0.05). No significant differences were found regarding the other characteristics compared. CONCLUSIONS: Through appropriate comprehensive measures, retractorless surgery for giant vestibular schwannomas is an achievable goal. This procedure can reduce the incidence of postoperative brain injury with satisfactory tumor resection.


Assuntos
Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Perda Sanguínea Cirúrgica , Lesões Encefálicas/epidemiologia , Doenças do Nervo Facial/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Instrumentos Cirúrgicos , Tração/métodos , Carga Tumoral
19.
Otol Neurotol ; 40(6): 826-835, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31033921

RESUMO

OBJECTIVE: To investigate whether [F]fluorothymidine (FLT) and/or [F]fluorodeoxyglucose (FDG) positron emission tomography (PET) can differentiate growth in neurofibromatosis 2 (NF2) related vestibular schwannomas (VS) and to evaluate the importance of PET scanner spatial resolution on measured tumor uptake. METHODS: Six NF2 patients with 11 VS (4 rapidly growing, 7 indolent), were scanned with FLT and FDG using a high-resolution research tomograph (HRRT, Siemens) and a Siemens Biograph TrueV PET-CT, with and without resolution modeling image reconstruction. Mean, maximum, and peak standardised uptake values (SUV) for each tumor were derived and the intertumor correlation between FDG and FLT uptake was compared. The ability of FDG and FLT SUV values to discriminate between rapidly growing and slow growing (indolent) tumors was assessed using receiver operator characteristic (ROC) analysis. RESULTS: Tumor uptake was seen with both tracers, using both scanners, with and without resolution modeling. FDG and FLT uptake was correlated (R = 0.67-0.86, p < 0.01) and rapidly growing tumors displayed significantly higher uptake (SUVmean and SUVpeak) of both tracers (p < 0.05, one tailed t test). All of the PET analyses performed demonstrated better discriminatory power (AUCROC range = 0.71-0.86) than tumor size alone (AUCROC = 0.61). The use of standard resolution scanner with standard reconstruction did not result in a notable deterioration of discrimination accuracy. CONCLUSION: NF2 related VS demonstrate uptake of both FLT and FDG, which is significantly increased in rapidly growing tumors. A short static FDG PET scan with standard clinical resolution and reconstruction can provide relevant information on tumor growth to aid clinical decision making.


Assuntos
Fluordesoxiglucose F18 , Neurofibromatose 2/diagnóstico por imagem , Neuroma Acústico/diagnóstico por imagem , Adulto , Didesoxinucleosídeos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Adulto Jovem
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