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3.
Surg Oncol ; 37: 101522, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33549951

RESUMO

INTRODUCTION: The preservation of the spinal accessory nerve cannot be overlooked in neck dissection. Injury to the nerve results in shoulder dysfunction and other related morbidities. In this article, we describe a unique constant relationship between spinal accessory nerve and great auricular nerve, at the junction of the anterior and posterior triangles of the neck, eponymously labelled the X- pointer. METHODOLOGY: This was an observational study conducted at a tertiary care cancer centre that runs a comprehensive surgical training program. A 100 cases of modified radical neck dissection performed for oral cavity squamous cell carcinoma from January 2017 to January 2019 in were included. The relationship was analyzed in 100 cases of neck dissection for its constancy. RESULT: In all the 100 cases, the X-pointer was demonstrated as a constant anatomical relationship between the spinal accessory nerve and great auricular nerve. The crossing over of the nerve on the undersurface of the sternocleidomastoid muscle is constant and independent of the patient's body proportions. CONCLUSIONS: The relationship between the spinal accessory nerve and great auricular nerve remains constant irrespective of the technique of neck dissection and body habitus of the patient. In our view, this relationship can be used as an additional confirmatory landmark to prevent inadvertent injury to the spinal accessory nerve.


Assuntos
Nervo Acessório/anatomia & histologia , Nervo Acessório/cirurgia , Pescoço/anatomia & histologia , Pescoço/cirurgia , Doenças do Nervo Acessório/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias dos Nervos Cranianos/patologia , Humanos , Índia , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Esvaziamento Cervical/métodos , Músculos do Pescoço/inervação , Músculos do Pescoço/cirurgia
5.
Pan Afr Med J ; 36: 378, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33235655

RESUMO

The lesion of the accessory spinal nerve is often of iatrogenic origin. We report the case of an injury after a right jugulocarotid lymph node biopsy. A 30-year-old patient was referred for the treatment of right cervical lymphadenopathy suspected of tuberculosis. After the intervention and confirmation of tuberculosis diagnosis, the patient presented a functional impotence of the right shoulder and swarming of the right hand. The clinical examination found an active limitation of the shoulder, and a wasting of the upper bundle of the right trapezius muscle and the sternocleidomastoid. The EMG showed axonotmesis of the accessory spinal nerve and the MRI an amyotrophy of the trapezius with denervation edema. A simple rehabilitation has been scheduled. Damage of the accessory spinal nerve most often occurs after local surgery. EMG is essential for diagnosis. Rehabilitation is the first therapeutic option. Surgery can be considered if it fails. The surgeons must consider the protection of the accessory spinal nerve in case of cervical lymph node surgery.


Assuntos
Traumatismos do Nervo Acessório/etiologia , Linfonodos/patologia , Nervo Acessório/patologia , Doenças do Nervo Acessório/diagnóstico , Doenças do Nervo Acessório/etiologia , Traumatismos do Nervo Acessório/diagnóstico , Adulto , Biópsia/efeitos adversos , Humanos , Doença Iatrogênica , Masculino , Atrofia Muscular Espinal/diagnóstico , Atrofia Muscular Espinal/etiologia , Pescoço , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/patologia
6.
World Neurosurg ; 131: e136-e148, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31323416

RESUMO

BACKGROUND: While multisession dose fractionated Gamma Knife radiosurgery (DFGKS) is common, its use has never been described for jugular paragangliomas (JP), which are notoriously difficult to treat. OBJECTIVE: To define efficacy, safety, and complication profile of DFGKS in 2 or 3 consecutive sessions for the treatment of a cohort of 10 cases of JP. METHODS: Between 2012 and 2017, 10 patients with JP were treated with DFGKS in 2 or 3 sessions, because it was not safe to treat the lesion in a single session because of the large volume or proximity to organs at risk. The small to medium-sized JP are treated with 16-22 Gy radiation, but the large-volume JP were treated with 23-25 Gy radiation dose. The Leksell G frame was kept in situ during the whole procedure. The tumor volumes on pretreatment and posttreatment imaging were compared, using the Leksell Gamma Plan treatment plan software to assess tumor progression. The patients were regularly evaluated for their clinical outcome with radiologic correlation. RESULTS: The mean radiologic follow-up was 39 months (range, 12-78 months). The mean marginal dose for 3 fractions and 2 fractions was 7.64 Gy at 50% and 11.2 Gy at 50%, respectively. The mean tumor size was 29.9 cm3 (range, 9.95-47.63 cm3) at treatment and 21.9 cm3 (range, 8.83-37.5 cm3) at follow-up (suggestive of 26.7% reduction). Tumor control was achieved in all patients (100%). Of 110 potential neurologic problems (signs/symptoms) evaluated (11 in each patient), 56 (50.9%) were present preoperatively. Of them, 27 (48.2%) improved and 29 (51.8%) stabilized after treatment. There were 2 new-onset neurologic problems (of 110, 1.8%) attributable to treatment (new-onset headache and spinal accessory paresis). No patient had any permanent neurologic deterioration. CONCLUSIONS: DFGKS for large-volume JP leads to acceptable progression-free survival, tumor control rate, and symptomatic improvement. It may be preferred to surgery or fractionated radiotherapy given its better safety, efficacy, and complication profile.


Assuntos
Tumor do Glomo Jugular/radioterapia , Radiocirurgia/métodos , Doenças do Nervo Acessório/etiologia , Adulto , Fracionamento da Dose de Radiação , Feminino , Tumor do Glomo Jugular/patologia , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Intervalo Livre de Progressão , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Resultado do Tratamento , Carga Tumoral , Adulto Jovem
7.
BMJ Case Rep ; 12(5)2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31088815

RESUMO

Schwannomas are benign tumours arising from Schwann cells in the peripheral nerve. The schwannoma of the accessory nerve is a very rare entity. We report a case of Schwannoma of the extracranial accessory nerve. A 22-year-old man presented with a slow-growing mass, located on the right upper neck. The patient did not have any neurological deficit. CT scan showed a hypodense mass behind sternocleidomastoid muscle. The suspected diagnosis was an adenopathy of the accessory spinal chain. Surgery was done via transcervical approach. The histopathological analysis concluded with a diagnosis of schwannoma. No recurrence was noted at the follow-up examination 29 months after surgery.


Assuntos
Doenças do Nervo Acessório/patologia , Neoplasias dos Nervos Cranianos/patologia , Neurilemoma/patologia , Doenças do Nervo Acessório/diagnóstico por imagem , Doenças do Nervo Acessório/cirurgia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Linfadenopatia/diagnóstico , Masculino , Pescoço/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Adulto Jovem
8.
World Neurosurg ; 128: 158-161, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31082561

RESUMO

BACKGROUND: Meningiomas that arise from the cranial nerve are rare. We present a case with an intradural extramedullary tumor at the foramen magnum originating from the spinal accessory nerve. CASE DESCRIPTION: The patient was a 69-year-old woman with dizziness and pain in the bilateral shoulder for 2 years. Neurologic examination revealed spinal accessory nerve palsy (difficult in raising the shoulder, deficit of 3/5) on the left side without further deficits. Magnetic resonance imaging showed medullar compression because of a left intradural extramedullary foramen magnum lesion dorsolateral to the medulla. Surgical exposure via a midline suboccipital approach with C1 laminectomy revealed that the lesion arises from the left accessory nerve without dural attachment. The tumor was resected without injury to the spinal accessory nerve, and histologic examination revealed that it was a meningothelial meningioma. The spinal accessory nerve palsy improved to 4 of 5 after 3 months after surgery. CONCLUSIONS: To our knowledge, this is the first report of an accessory nerve meningioma at the foramen magnum in which the spinal accessory nerve palsy appeared before operation and improved after tumor resection.


Assuntos
Doenças do Nervo Acessório/diagnóstico por imagem , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Doenças do Nervo Acessório/fisiopatologia , Doenças do Nervo Acessório/cirurgia , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/fisiopatologia , Neoplasias Meníngeas/cirurgia , Meningioma/fisiopatologia , Meningioma/cirurgia
9.
J Clin Neurophysiol ; 36(4): 306-311, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31021888

RESUMO

PURPOSE: Electrophysiological testing has been used for the early diagnosis of iatrogenic spinal accessory nerve palsy in clinical practice. However, the presence of low-amplitude compound action potential in 70% to 90% of the patients suffering from iatrogenic nerve transection was reported in several studies. We have encountered the same issue and made minor modifications to the methods of electrophysiological testing. The purpose of this study was to retrospectively evaluate the reliability of our modified electrophysiological testing as preoperative examination in patients receiving surgical revision. METHODS: In this study, we compared preoperative electrophysiological testing results with intraoperative diagnosis in the 24 patients with iatrogenic spinal accessory nerve palsy who were referred to our hospital from 2009 to 2018. RESULTS: During operation, 20 patients were diagnosed with neurotmesis and the remaining 4 patients were found axonotmesis depending on the results of surgical exploration and intraoperative electrophysiological examination. Six of the 20 patients with neurotmesis demonstrated a low-amplitude compound muscle action potential of the upper trapezius during preoperative electrophysiological testing. Needle electromyography revealed voluntary motor unit potentials in 8 of the 20 patients. Meanwhile, concomitant great auricular nerve or dorsal scapular nerve injuries were preoperatively revealed in 7 of 24 patients. CONCLUSIONS: The rate of low-amplitude compound muscle action potentials in these patients suffering from spinal accessory nerve neurotmesis was about 30% with our modified electrophysiological testing. We should be aware of this pitfall before surgical nerve repair. Furthermore, electrophysiological testing is an informative preoperative examination revealing the concomitant nerve injuries.


Assuntos
Doenças do Nervo Acessório/diagnóstico , Eletromiografia/métodos , Doença Iatrogênica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
10.
JBJS Case Connect ; 7(2): e23, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29244663

RESUMO

CASE: A 37-year-old man with scapular winging, caused by combined palsy of the spinal accessory nerve and the long thoracic nerve, was successfully treated with a pectoralis major transfer to substitute for the serratus anterior muscle, and with levator scapulae and rhomboid muscle transfers to substitute for the trapezius muscle. CONCLUSION: The serratus anterior paralysis was thought to have occurred secondary to traction of the long thoracic nerve by the unsupported scapula following the spinal accessory nerve palsy. Even with combined paralyses of the serratus anterior and trapezius muscles, combined muscle transfers that substitute for the paralyzed muscles can improve shoulder function.


Assuntos
Doenças do Nervo Acessório/cirurgia , Músculos Peitorais/transplante , Doenças do Sistema Nervoso Periférico/cirurgia , Escápula/fisiopatologia , Músculos Superficiais do Dorso/transplante , Doenças do Nervo Acessório/fisiopatologia , Adulto , Humanos , Masculino , Doenças do Sistema Nervoso Periférico/fisiopatologia , Nervos Torácicos/lesões
11.
J Neurol Sci ; 362: 127-30, 2016 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-26944132

RESUMO

UNLABELLED: To investigate (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) signal changes of denervated muscles in patients with electrophysiologically confirmed neuropathy. METHODS: This is a case series of three cancer patients who were referred to the electromyography laboratory in 2013 due to shoulder discomfort after surgery including neck dissection. Spinal accessory neuropathy was diagnosed based on electrophysiological studies. Patients' medical history, electrophysiological data, and FDG-PET images were reviewed retrospectively. Mean standard uptake values (SUV) of trapezius muscles were measured. RESULTS: The patients (3 men, aged 61-78years) showed spinal accessory neuropathy with different degrees of severity. In all patients, preoperative or postoperative FDG-PET showed increased FDG uptake in the ipsilateral trapezius muscle. These results were compatible with previously reported glucose hypermetabolism in denervated skeletal muscles. CONCLUSION: This is the first clinical report of increased FDG uptake by denervated muscles in electrophysiologically confirmed neuropathy.


Assuntos
Doenças do Nervo Acessório/patologia , Fluordesoxiglucose F18/metabolismo , Músculos Superficiais do Dorso/diagnóstico por imagem , Idoso , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons
12.
CA Cancer J Clin ; 66(3): 203-39, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27002678

RESUMO

Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society.


Assuntos
Assistência ao Convalescente , Neoplasias de Cabeça e Pescoço/terapia , Sobreviventes , Doenças do Nervo Acessório/diagnóstico , Doenças do Nervo Acessório/terapia , American Cancer Society , Ansiedade/diagnóstico , Ansiedade/psicologia , Ansiedade/terapia , Bursite/diagnóstico , Bursite/terapia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Assistência Odontológica , Cárie Dentária/diagnóstico , Cárie Dentária/terapia , Depressão/diagnóstico , Depressão/psicologia , Depressão/terapia , Gerenciamento Clínico , Distonia/diagnóstico , Distonia/terapia , Fadiga/diagnóstico , Fadiga/terapia , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Neoplasias de Cabeça e Pescoço/psicologia , Promoção da Saúde , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Linfedema/diagnóstico , Linfedema/terapia , Músculos do Pescoço , Osteonecrose/diagnóstico , Osteonecrose/terapia , Periodontite/diagnóstico , Periodontite/terapia , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/terapia , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/terapia , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapia , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/terapia , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Distúrbios do Paladar/diagnóstico , Distúrbios do Paladar/terapia , Trismo/diagnóstico , Trismo/terapia
13.
Clin Radiol ; 71(4): 316-20, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26787069

RESUMO

AIM: To characterise the magnetic resonance imaging (MRI) appearance of patients with spinal accessory nerve (SAN) denervation. MATERIAL AND METHODS: Twelve patients who had SAN denervation on electromyography (EMG) were included. The sternocleidomastoid and trapezius muscles and the SAN were assessed using MRI. RESULTS: Trapezius muscle atrophy was seen in 11 (92%), and of those patients, T2/short tau inversion recovery (STIR) signal hyperintensity was also demonstrated in seven (58%). All three patients with prior neck surgery had scarring around the SAN, and one of these patients demonstrated a neuroma, which was confirmed surgically. CONCLUSION: Features of SAN neuropathy on MRI include atrophy and T2/STIR signal hyperintensity of the trapezius, and in patients who have had posterior triangle neck surgery, scarring may be seen around the nerve.


Assuntos
Doenças do Nervo Acessório/patologia , Nervo Acessório/patologia , Imageamento por Ressonância Magnética , Adulto , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
J Neurosurg Spine ; 21(4): 565-7, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25014503

RESUMO

Jugular foramen syndrome is a condition characterized by unilateral paresis of cranial nerves IX, X, and XI in the setting of extrinsic compression. Here, the authors describe the case of a giant cervical osteophyte resulting in compression of the jugular foramen. A 74-year-old man who presented with progressive dysphagia and dysarthria was found to have right-sided tongue deviation, left palatal droop, and hypophonia. His dysphagia had progressed to the point that he had lost 25 kg over a 4-month period, necessitating a gastrostomy to maintain adequate nutrition. He underwent extensive workup for his dysphagia with several normal radiographic studies. Ultimately, CT scanning and postcontrast MRI revealed a posterior osteophyte arising from the C1-2 joint space and projecting into the right jugular foramen. This resulted in a jugular foramen syndrome in addition to delayed filling of the patient's right internal jugular vein distal to the osteophyte. Although rare, a posterior cervical osteophyte should be considered in cases of jugular foramen syndrome.


Assuntos
Vértebras Cervicais , Doenças dos Nervos Cranianos/etiologia , Veias Jugulares , Osteofitose Vertebral/complicações , Doenças do Nervo Acessório/etiologia , Idoso , Doenças dos Nervos Cranianos/diagnóstico , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Diagnóstico Diferencial , Diagnóstico por Imagem , Doenças do Nervo Glossofaríngeo/etiologia , Humanos , Masculino , Osteofitose Vertebral/diagnóstico , Síndrome , Doenças do Nervo Vago/etiologia
16.
Arq. bras. neurocir ; 33(2)jun. 2014. ilus
Artigo em Português | LILACS | ID: lil-721678

RESUMO

Cisternal spinal accessory schwannoma are still a rare condition without neurofibromatosis with only 32 cases reported so far. We describe a cisternal accessory schwannoma presented in a 36-year-old woman with posterior cervical pain and cervical mieolopaty, defined by grade IV tetraparesia. A suboccipital craniectomy with C1 posterior arch resection was performed. During microsurgical dissection together with electrophysiological monitoring and nerve stimulation tumor was identified as having the spinal accessory root as its origins. Carefully intraneural dissection was then performed with complete lesion removal, histopatological examination confirmed the hypothesis of schwannoma. The patient was free from pain and improved her neurological status with no accessory nerve palsy. Complete surgical resection is indicated for such lesions and can be achieved with good outcome.


O schwannoma do ramo espinhal do nervo acessório em sua porção cisternal, quando não associado à neurofibromatose, é uma condição rara, com apenas 32 relatos de caso na literatura. O diagnóstico diferencial da lesão deve ser atentado, principalmente no que diz respeito à preservação da função motora do nervo acessório. Este é um relato de caso de uma paciente do sexo feminino de 36 anos com queixa de cervicalgia associada à mielopatia cervical compressiva secundária à lesão expansiva intradural, extramedular, estendendo-se do forame magno até a porção superior da lâmina de C2. A paciente foi submetida a uma craniectomia de fossa posterior e ressecção do arco posterior de C1. Durante exploração cirúrgica, auxiliada por monitoração eletrofisiológica e estimulação neural, foi identificado que a lesão tinha origem no ramo espinhal do nervo acessório direito. Foi então ressecada de forma completa com preservação dos fascículos íntegros do nervo de origem. O exame anatomopatológico confirmou a hipótese de schwannoma. A paciente evoluiu sem dor e com melhora do quadro neurológico, sendo preservada a função do nervo acessório. O schwannoma do ramo espinhal do nervo acessório é uma condição rara. A ressecção cirúrgica total é o tratamento de escolha para esses pacientes e pode ser alcançada sem lesões neurológicas significativas secundárias ao ato cirúrgico.


Assuntos
Humanos , Feminino , Adulto , Doenças do Nervo Acessório , Microcirurgia , Neurilemoma
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