1/62. Combined posterior and posterolateral one-stage removal of a giant cervical dumbbell schwannoma.OBJECTIVE: Huge dumbbell schwannomas in the cervical region are not a rare clinical entity in neurosurgical practice. Despite the benign nature, the adhesions between tumor capsule and spinal cord, vertebral artery, cervical plexus, and carotid sheath can complicate surgery, leading to a fatal outcome. We performed one-stage combined surgery through the posterior midline and an unusual posterolateral cervical route in the same position and describe its advantages. METHOD: We removed the intraspinal component totally through a posterior midline approach and freed spinal cord and vertebral artery. After removal of the posterolateral extraspinal component using the same incision, a posterolateral cervical approach along the posterior margin of sternocleidomastoid muscle was performed, and the anterolateral extraspinal tumor was excised totally through the dissection plane between anterior and middle scalene muscles. RESULTS AND CONCLUSIONS: The operative time was less than 3 h, and the patient was discharged on the 3rd postoperative day without any neurological sequel. The combination of posterior midline and posterolateral approach in large dumbbell schwannomas is easier to perform and a more safe technique than the combination with anterolateral accesses in the cervical region and also less invasive than the transuncodiscal technique in selected cases. This approach reduces the risk of neurovascular injury, since it does not require retraction and repositioning of the patient and, therefore, facilitates total excision and reduces the operative time.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/62. Malignant triton tumor of the head and neck: A case report and review of the literature.BACKGROUND: Malignant triton tumor (MTT) is a relatively rare, aggressive tumor comprised of both malignant schwannoma cells and malignant rhabdomyoblasts. Because MTT frequently arises in the head and neck, the otolaryngologist must be aware of the nature of the tumor and its response to various treatment modalities. METHOD: This article reviews the treatment and outcome of all reported cases of MTT arising in the head and neck. CONCLUSIONS: Although statistical analysis is limited by the short duration of follow-up of many patients, complete tumor resection appears to carry an improved chance of survival. Adjuvant radiation and chemotherapy may also improve survival, although a benefit of these therapies was not well demonstrated in this small series.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/62. Conservative facial nerve management in jugular foramen schwannomas.OBJECTIVE: Although transposition of the facial nerve is crucial in infiltrative vascular lesions involving the jugular foramen, the objective was to show that a conservative approach to management of the facial nerve is sufficient with jugular foramen neuromas because of their noninfiltrative, less vascular nature and medial location in the jugular foramen. STUDY DESIGN: Retrospective case review. SETTING: Tertiary, private, multiphysician, otologic practice. patients: Sixteen patients with jugular foramen schwannoma (18 procedures) treated between January 1975 and October 1995. The 8 male and 8 female patients ranged in age from 13 to 66 years (mean age 47.7 years). INTERVENTION: One-stage, total jugular foramen neuroma removal without transposition of the facial nerve, using a variety of surgical approaches. MAIN OUTCOME MEASURES: facial nerve transposition (yes or no), House-Brackmann facial nerve grade, lower cranial nerve status, complications. RESULTS: One-stage total tumor removal was accomplished in all the cases. In 13 (72%) of the neuromas, removal was accomplished without facial nerve transposition. Transposition was performed in 2 revision cases in which scar tissue from a previous operation prevented complete control of the carotid artery and safe removal, 2 cases with large tumor extension anteriorly to the petrous apex, and 1 case with extensive involvement of the middle ear. A House-Brackmann facial nerve Grade I or II was obtained in 16 of the 18 procedures, with 1 Grade III and 1 case that remained Grade V, as it was preoperatively. CONCLUSIONS: One-stage, total tumor removal can be achieved with excellent control of the important vascular structures and without transposition of the facial nerve in a majority of jugular foramen schwannomas.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/62. Fluid-fluid levels in intracranial schwannomas.Intracranial cystic neurogenic tumours constitute an uncommon subset of tumours with a distinct clinico-biological behaviour. The presence of fluid-fluid levels within the tumours, although rare, confirms the cystic nature of the neoplasms. Barring the acoustic schwannomas, cystic cranial nerve schwannomas are exceptionally uncommon. Imaging findings of fluid-fluid levels in two non-acoustic cranial nerve schwannomas are described; one was a cystic trigeminal schwannoma and the other was a glossopharyngeal nerve schwannoma. The causes of the fluid-fluid level and its implications are analysed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/62. Intraosseous neurilemmoma of the mandible.We report a rare case of intraosseous neurilemmoma of the mandible, with an emphasis on radiographic findings. The tumor, located mainly in the premolar region, presented as an expansive, unilocular, well-defined, radiolucent lesion on plain radiography. No dilatation of the mandibular canal was identified. MR imaging helped to identify the solid nature of the tumor. A biopsy was necessary to make the final diagnosis because of the relatively nonspecific nature of the lesion.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
6/62. Malignant triton tumour of the parapharyngeal space.We report the clinical course in a 25-year-old male patient of neurofibromatosis with malignant triton tumour (MTT). Triton tumour is a peripheral nerve sheath tumour with rhabdomyoblastic differentiation. This is relatively rare tumour of head and neck region and only 26 cases have been reported to date. The present case is the first reported MTT of parapharyngeal space, one of the most aggressive course among all head and neck MTTs, resulting in the death of the patient within three months following surgical resection. The aggressive nature of this tumour necessitates adjuvant therapeutic measures in addition to radical surgery in order to obtain better survival rates.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/62. Perineal neoplasms.Experience with 2 cases of neurally-derived perineal masses is described. A relevant review of the literature spanning 50 years revealed 36 cases of perineal neoplasm of diverse nature, disclosing that such lesions typically present as otherwise asymptomatic enlarging masses and may comprise a broad spectrum of neoplasia with diagnosis and prognosis often relating to the age of the patient. Management naturally relates to tissue type and degree of local involvement.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/62. Intra-rachidian disorders: two unusual cases of recurrent abdominal pain in children.Recurrent abdominal pain (RAP) is generally thought to be of psychological origin but organic aetiologies are increasingly being identified. The cases of two children with vertebral disorders revealed by recurrent abdominal pain are reported. A 14-y-old girl presented with RAP associated with scoliosis, due to a T8-T9 intra-dural extra-medullary tumour. A 7-y-old girl who suffered from nocturnal RAP located in the right iliac fossa for 1 y had decreased muscular strength, pyramidal signs, and a 10 degree Lassegue sign in the right lower limb, revealing a vascular malformation extending from T12 to L2. Conclusion: Atypical pain and associated neurological signs or scoliosis must raise the possibility of intra-rachidian disorders. Magnetic resonance examination will then precisely state the location and nature of the pathological process, avoiding excessive delay in therapeutic management.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/62. Cellular schwannoma: a rare spinal benign nerve-sheath tumor with a pseudosarcomatous appearance: case report.We report a case of cellular schwannoma, a rare benign nerve-sheath tumor in a 27 year-old woman. It was presented as a voluminous lesion in the paraspinal region that caused lumbar vertebral body destruction. These features, in association to the microscopic aspects of a hypercellular, pleomorphic neoplasm may lead to a false impression of a malignant tumor. Therefore, it is important to have an accurate examination to confirm the benign nature of this tumor thus avoiding unnecessary therapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/62. diagnostic imaging of the digestive tract. Reasoned approach to a duodenal filling defect.A case of a patient with sideropenic anemia of suspected gastrointestinal origin is presented. A radiologic study of the upper digestive tract was performed. It documented a duodenal filling defect giving rise to an analytic discussion throughout various perceptive-interpretative logical steps: the image reality, the formation of the filling defect image and its nature. The radiologist's conclusions supported the presence of a benign submucosal neoformation to be treated with surgical resection for its size and for the patient's clinical conditions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
| | Next -> |