1/46. Treatment of a neuroma-in-continuity of the peroneal nerve with nerve bypass grafts--a case report.Treatment of neuroma-in-continuity involves neurolysis or resection with interposition nerve grafting of the involved segment. These techniques may be complicated by loss of remaining conduction through axons that were intact prior to surgical neurolysis or grafting. The authors have shown previously that axonal regeneration occurs in an autologous bypass graft in the rat model. They applied this technique to a neuroma-in-continuity of the peroneal nerve of a 22-year-old woman who sustained an injury to the peroneal nerve after arthroscopic surgery, with excellent results. Nerve bypass may be the procedure of choice for treatment of neuroma-in-continuity.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
2/46. Traumatic neuroma as a cause of obstructive jaundice.A 70-year-old man with previous cholecystectomy developed progressive obstructive jaundice, 3 months before hospitalization. Intraoperatively, a 2 x 2 x 1.5-cm mass in the distal part of the right hepatic duct was excised to release complete obstruction. It was verified as traumatic (amputation) neuroma. Despite rarity, traumatic neuroma of the bile duct should be considered in patients who have antecedent surgical procedure of the biliary tract with subsequent occurrence of extrahepatic biliary obstruction.- - - - - - - - - - ranking = 62.882350951477keywords = extrahepatic, bile duct, bile, duct, obstruction (Clic here for more details about this article) |
3/46. Bowler's thumb treated by translocation of the digital nerve.A case of neuroma of the ulnar digital nerve of the thumb in a bowler was treated successfully by translocation of the nerve beneath the adductor pollicis.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
4/46. temporal bone findings in multiple endocrine neoplasia type 2b.To our knowledge, present case is the first published report of temporal bone findings in multiple endocrine neoplasia type 2b (MEN-2B). We describe a 43-year-old Japanese man with medullary thyroid carcinoma (MTC), pheochromocytoma, mucosal neuroma and a Marfanoid body habitus. The collateral adrenal tumors and MTC were removed surgically. However, 14 years after surgery, the MTC and pheochromocytoma recurred and the patient died of intracranial hemorrhage due to hypertension. During the autopsy, metastatic MTC was detected in the liver, lungs, kidneys, pancreas and cervical lymph nodes. Recurrent pheochromocytoma was present in the right kidney. Mucosal neuromas were found in the tongue, gastrointestinal tract and vesical nerve plexus. The following histopathological findings were seen in both temporal bones: metastatic MTC was found as well as neuromas and the cochlear aqueduct was widely patent.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
5/46. Axillary nerve injuries in children.Isolated axillary nerve injury is uncommon, particularly in children. The motor deficit of shoulder abduction may not recover spontaneously and can be a substantial handicap. Detection may be difficult initially, as the injury is masked by trauma such as head injury, and concomitant shoulder injury requiring immobilization. After mobilization, patients learn to partially compensate by using alternate muscles. There are few reports of surgical management of this nerve injury. Most concern predominantly adults, and the results are mixed with on average slightly greater than half having a good recovery (defined as grade 4-5 Medical research Council muscle power). We present our experience with 4 pediatric patients who had axillary nerve injury. Three patients had an interposition nerve graft, and 1 patient underwent neurolysis. All patients recovered to grade 4-5 deltoid muscle power. Children with an axillary nerve injury which fails to recover spontaneously by 4-6 months should strongly be considered for surgical exploration.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
6/46. facial nerve neuromas: report of 10 cases and review of the literature.OBJECTIVE: This study reviewed the management and outcomes of facial neuromas during the past decade at our institution. The goal was to analyze differences in presentation on the basis of location of the facial neuroma, review facial nerve function and hearing preservation postoperatively, and understand the characteristics of patients with tumors limited to the cerebellopontine angle or internal auditory canal. We also report an unusual case of a facial neuroma limited to the nervus intermedius. methods: Nine patients with facial neuromas and one with Jacobson's nerve neuroma underwent surgery, and total resection was accomplished in nine patients. A chart review for pre- and postoperative data was performed, after which all patients were evaluated on an outpatient basis. RESULTS: The mean age of the patients was 47 years; mean follow-up time was 33.1 months. The most common presenting symptoms were hearing loss (six patients) and facial paresis (five patients). A total of five patients had progressive (four patients) or recurrent (one patient) facial paresis. No patient experienced worsened hearing as a result of surgery, and one experienced improvement in a conductive hearing deficit. Five patients required cable graft repair of the facial nerve; four improved to House-Brackmann Grade 3 facial paresis. Four of five patients with preserved anatomic continuity of the facial nerve regained normal facial function. There were no surgical complications. No tumors have recurred during follow-up. We report the second nerve sheath tumor limited to the nervus intermedius. CONCLUSION: This series documents that facial neuromas can be resected safely with preservation of facial nerve and hearing function. Preservation of anatomic continuity of the facial nerve should be attempted, and it does not seem to lead to frequent recurrence. Tumors limited to the cerebellopontine angle/internal auditory canal are a unique subset of facial neuromas with characteristics that vary greatly from facial neuromas in other locations, and they are indistinguishable clinically from acoustic neuromas.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
7/46. 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 = 0.21222213052442keywords = obstruction (Clic here for more details about this article) |
8/46. Intraductal ultrasonography of traumatic neuroma of the bile duct.We report a case of a 70-year-old female with traumatic neuroma of the bile duct. Transpapillary intraductal ultrasonography showed a cystic duct stump, from which a smooth and homogeneous hypoechoic mass arose; the adjacent bile duct wall had a normal structure. Intraductal ultrasonography is useful for distinguishing traumatic neuroma from bile duct carcinoma.- - - - - - - - - - ranking = 108.1701494677keywords = bile duct, bile, duct (Clic here for more details about this article) |
9/46. Neuromas of the extrahepatic bile ducts as a cause of obstructive jaundice.We present four cases of extrahepatic bile duct neuromas causing obstructive jaundice. Two patients with neuromas localized in the hepatic duct had no evidence of gallstones or history of previous surgery. In these subjects, partial resection of the common bile duct and cholecystectomy was followed by hepatico-jejunostomy with Roux-en-Y reconstruction. In another patient, 7 years after cholecystectomy, a neuroma localized in the hepatic duct was treated by insertion of a T-tube. In the fourth patient, 9 years after laparoscopic cholecystectomy, partial common bile duct resection and Roux-en-Y hepatico-jejunostomy was performed. In all cases, the correct diagnosis of this very rare cause of extrahepatic bile duct obstruction was established postoperatively.- - - - - - - - - - ranking = 399.86541926386keywords = extrahepatic, bile duct, bile, duct, obstruction (Clic here for more details about this article) |
10/46. Biliary stricture due to neuroma after an innocent blunt abdominal trauma.A traumatic neuroma of the biliary tract is rarely associated with biliary obstruction. However, when it arises in the common bile duct (CBD) and is associated with obstructive jaundice, it is difficult to distinguish it from bile duct cancer. We describe a patient who developed obstructive jaundice and itching, due to CBD stricture, 8 years after innocent blunt abdominal trauma. The stricture was resected and hepatico-jejunal anastomosis was performed. Histological examination revealed a traumatic neuroma and a fibrous scar around the common bile duct. Symptoms disappeared following surgical removal of the lesion. Blunt abdominal injury may cause the late onset of a fibrous scar and traumatic neuroma in the common bile duct. To our knowledge, a traumatic neuroma of the biliary tract after blunt abdominal trauma has not been reported previously. We review the clinical picture of this relatively rare problem, along with its diagnosis, pathogenesis and treatment.- - - - - - - - - - ranking = 58.023736112066keywords = bile duct, bile, duct, obstruction (Clic here for more details about this article) |
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