1/9. Immediate neurological deterioration after gamma knife radiosurgery for acoustic neuroma. Case report.The authors describe acute deterioration in facial and acoustic neuropathies following radiosurgery for acoustic neuromas. In May 1995, a 26-year-old man, who had no evidence of neurofibromatosis Type 2, was treated with gamma knife radiosurgery (GKS; maximum dose 20 Gy and margin dose 14 Gy) for a right-sided intracanalicular acoustic tumor. Two days after the treatment, he developed headache, vomiting, right-sided facial weakness, tinnitus, and right hearing loss. There was a deterioration of facial nerve function and hearing function from pretreatment values. The facial function worsened from House-Brackmann Grade 1 to 3. Hearing deteriorated from Grade 1 to 5. Magnetic resonance (MR) images, obtained at the same time revealed an obvious decrease in contrast enhancement of the tumor without any change in tumor size or peritumoral edema. facial nerve function improved gradually and increased to House-Brackmann Grade 2 by 8 months post-GKS. The tumor has been unchanged in size for 5 years, and facial nerve function has also been maintained at Grade 2 with unchanged deafness. This is the first detailed report of immediate facial neuropathy after GKS for acoustic neuroma and MR imaging revealing early possibly toxic changes. Potential explanations for this phenomenon are presented.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
2/9. The crucial role of imaging in detection of facial nerve haemangiomas.facial nerve haemangioma is a rare benign neoplasm accounting for 0.7 per cent of all tumours involving the temporal bone. The diagnosis of a facial nerve tumour is often missed or delayed. early diagnosis is imperative as it influences the eventual outcome for facial nerve function. prognosis is related to the size of the tumour, the severity and the duration of pre-operative paralysis. The definitive diagnosis of a facial nerve tumour rests exclusively with high resolution imaging of the temporal bone using enhanced magnetic resonance imaging (MRI) and thin-sectioned computed tomography (CT). This case emphasizes the crucial role that high quality imaging can play in the diagnosis of facial nerve tumours, and elegantly illustrates the imaging features of facial nerve haemangiomas.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
3/9. Intracranial trigeminal neuroma involving the infratemporal fossa: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Intracranial trigeminal neuroma extending extracranially is not a common finding. We report the case of a patient with a right cystic trigeminal neuroma arising in the middle temporal fossa and infratemporal areas. The clinical, radiological, and intraoperative features of these unusual lesions are discussed, and the relevant literature is reviewed. CLINICAL PRESENTATION: A 35-year-old woman presented with a 4-year history of right serous otitis media associated with recent right facial paresthesia. A neurological examination revealed hypesthesia in the mandibular division of the right trigeminal nerve. Computed tomographic and magnetic resonance imaging scans demonstrated a 6 x 6 x 4-cm well-enhancing cystic mass arising from the middle temporal fossa and extending extracranially to the infratemporal fossa through the enlarged foramen ovale. INTERVENTION: The tumor was extradural and originated from the right mandibular nerve. It was subtotally removed via a subtemporal-intradural and extradural approach. A pathological examination revealed a cystic neuroma. The patient has remained well during 12 months of follow-up, and no evidence of recurrence has been noted on magnetic resonance imaging studies. CONCLUSION: Unilateral serous otitis media by obstruction of the eustachian tube is a rare initial manifestation of trigeminal neuroma. We emphasize the benefit of neuroradiological examinations (both computed tomographic scanning and magnetic resonance imaging), which provided the clearest preoperative localization of this large intra- and extracranial tumor. A combined frontotemporal and infratemporal fossa approach is preferred, considering the difficulty of surgical removal. The prognosis for most patients was good. Twenty-five previously reported cases were also reviewed.- - - - - - - - - - ranking = 0.5keywords = size (Clic here for more details about this article) |
4/9. facial nerve palsy in posterior fossa arachnoid cysts: report of two cases.CASE REPORT: Two patients with a posterior fossa arachnoid cyst responsible for isolated facial nerve palsy are reported. DISCUSSION: The relationships between the cyst and the facial nerve and between the facial nerve palsy and the size variation of the cyst are discussed and documented by pre- and postoperative magnetic resonance imaging.- - - - - - - - - - ranking = 0.5keywords = size (Clic here for more details about this article) |
5/9. Acoustic neuroma (schwannoma) surgery 1978-1990.A series of 151 patients with 154 acoustic schwannomas have been operated upon in Manchester Royal Infirmary by a joint Otological and Neurosurgical team, employing either the translabyrinthine or the suboccipital approach. The perioperative mortality rate was 3 per cent. Anatomical preservation of the facial nerve was achieved in 89 per cent of tumour removals and a good to normal functional result in 79 per cent of cases. Attempts at hearing preservation have been unsuccessful, largely because of the small number of patients in the series in whom useful hearing was present preoperatively. Complications included major brain stem ischaemia (1.2 per cent), CSF fistula (5 per cent) and facial dysaesthesia (7 per cent). The incidence of mortality and morbidity is directly related to tumour size and to the experience of the surgeons. A number of patients experienced an unusual type of post-operative dreamlike state which appeared to be a form of hypnagogic hallucination, and the possible neurophysiological mechanism responsible for this phenomenon is discussed. The continuing failure to attain the ideal of early diagnosis is lamented, and the importance of a flexible bidisciplinary surgical approach emphasized.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
6/9. Computed tomographic analysis of the intratemporal facial nerve and facial nerve neuromas.High-resolution computed tomography (HRCT) has replaced multidirectional tomography in the detailed analysis of the temporal bone because of its excellent resolution of fine bony detail. Small soft-tissue masses not discernible on plain tomograms are easily seen using HRCT. Unsuspected early disease which has not caused recognizable bone erosion in also demonstrable by HRCT. Last but not least, the amount of radiation received by a patient as a result of HRCT is considerably less. We illustrate the normal course of the facial nerve through the temporal bone, its anatomical relationship to various adjacent structures, and the numerous branches given off during its course through the temporal bone. The clinical features of facial nerve neuromas (schwannomas) depend on their location and include facial nerve weakness or paralysis, otalgia or facial pain, hearing loss or imbalance, and loss of taste sensation. HRCT allows the identification of a soft-tissue mass along the course of the facial nerve, with its bony canal usually enlarged by the mass. pressure erosion of the underlying bone is often noted and erosion of the ossicles may be demonstrated in the case of middle ear involvement. The importance of both clinical and radiological correlation cannot be overemphasized in the discovery of these tumors.- - - - - - - - - - ranking = 0.5keywords = size (Clic here for more details about this article) |
7/9. facial nerve neuromas: CT findings.Although neuromas of the facial nerve are rare, they present with uniform clinical and radiological findings. Their pluridirectional tomography findings have been well described; however, the appearance of the intracranial extension of the neuroma which is best visualized by CT has not been emphasized. We report five cases of facial nerve neuromas with particular attention to their intracranial extension. For comparative purposes we also have reviewed 10 cases of acoustic and eight cases of trigeminal neuromas, all involving the cerebellopontine angle (CPA) and the middle cranial fossa. Two of the five facial nerve neuromas affected the second and third segments of the facial canal, and three involved both the CPA and the middle cranial fossa spreading across the midpetrosal bone. This type of tumor extension seems to be characteristic of facial nerve neuromas. In acoustic and trigeminal neuromas the tumor crossing toward the middle fossa takes place via the tentorial hiatus (acoustic) and the petrous apex (trigeminal).- - - - - - - - - - ranking = 0.5keywords = size (Clic here for more details about this article) |
8/9. magnetic resonance imaging-enhancing lesions of the labyrinth and facial nerve. Clinical correlation.OBJECTIVE: gadolinium-enhanced magnetic resonance imaging (MRI) is useful in assessing inflammatory and neoplastic lesions of the labyrinth and facial nerve. The following cases demonstrate the ability of MRI to differentiate neoplastic from inflammatory lesions within the labyrinth. patients OR OTHER PARTICIPANTS: Nine patients were selected with enhancing lesions of the labyrinth and the facial nerve identified on MRI. INTERVENTION: acyclovir and prednisone were prescribed for herpes zoster oticus; surgical removal of neoplastic lesions was performed. MAIN OUTCOME MEASURE: The hypothesis was developed in the course of clinical practice. No planned outcome was emphasized, as this article is based on the differential diagnoses of the cases reported. RESULTS: gadolinium-enhanced MRI is useful in differentiating neoplastic from inflammatory lesions within the labyrinth. Axial and coronal 3-mm sections with gadolinium enhancement were necessary for identifying these lesions and particularly for recognizing the sharp enhancement of the neoplastic margin in contrast to the dull cloudy margins of an inflammatory lesion. CONCLUSIONS: The MRI differentiation of these lesions is helpful in providing appropriate medical and surgical management of neoplastic and inflammatory lesions of the labyrinth.- - - - - - - - - - ranking = 0.5keywords = size (Clic here for more details about this article) |
9/9. Cavernous haemangioma of the facial nerve.facial nerve haemangiomas are probably the most frequent benign tumours involving the facial nerve in its intratemporal portion. Usually facial nerve dysfunction is present when these tumours are of extremely small size, the average tumour being less than 10 mm. We present a case of a 15 mm diameter cavernous haemangioma of the geniculate region, with histological findings of nerve infiltration, without facial nerve symptoms. The atypical clinical presentation justifies the report and subsequent literature review.- - - - - - - - - - ranking = 0.5keywords = size (Clic here for more details about this article) |