1/16. The use of ultrasound-assisted liposuction in the treatment of an involuted hemangioma.The authors report a case of a large, residual involuted hemangioma of the facial region in a 10-year-old girl. Ultrasound-assisted liposuction was used to debulk the tumor mass and to avoid the possibility of inadvertent iatrogenic damage to the facial nerve during surgical excision.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/16. A case of endolymphatic sac tumor with long-term survival.A 72-year-old man developed left facial palsy at age 14 and left-sided hearing loss at age 20. At the age of 59, he presented with gait disturbance, and a large left cerebellopontine angle tumor was detected, which had markedly destroyed the pyramidal bone. The tumor was subtotally resected, but he required two more operations at the ages of 64 and 69 because of tumor regrowth. At the present time, recurrent tumor has destroyed the occipital bone and is invading the scalp. However, even though he has several cranial nerve palsies and cerebellar ataxia, he remains in stable condition and demonstrates long-term survival. The patient's surgical specimens revealed a papillary adenoma, which was recently thought to be of endolymphatic sac origin, although the origin of this kind of tumor, whether arising from the middle ear or from the endolymphatic sac, has not been established with certainty so far. In this paper, we provide further evidence that this tumor originates from the endolymphatic sac, based on anatomical, histopathological, and embryological evidence.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/16. Primary B-cell lymphoma of the clivus: case report.BACKGROUND: Lymphomas usually present in extranodal sites late in the course of the disease. Moreover, it is uncommon for a primary non-Hodgkin's lymphoma to present with cranial nerve palsies; reports in the literature are rare. CASE DESCRIPTION: We report the case of a 60-year-old woman with complaints of headache and double vision. MRI revealed an expansive clival lesion without pituitary invasion. An endoscopic transsphenoidal procedure was performed for diagnosis and partial resection of the mass. CONCLUSION: Primary diffuse large B-cell lymphoma of the clivus is rare. An endoscopic transsphenoidal approach to the skull base is described, along with characteristic clinical, radiologic, and pathologic findings of the lesions.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/16. Growing teratoma syndrome in a patient with a non-germinomatous germ cell tumor in the neurohypophysis--case report.A 16-year-old woman presented with a non-germinomatous germ cell tumor in the neurohypophysis manifesting as progressive visual disturbance, amenorrhea, hydrodipsia, and polyuria. Her serum alpha-fetoprotein and human chorionic gonadotropin levels were elevated. She experienced sudden, rapid visual deterioration and underwent emergency partial tumor removal to decompress the optic nerves. Her vision subsequently improved. Histological examination of the surgical specimens confirmed immature teratoma. She received chemotherapy (ifosphamide 900 mg/m2, cisplatin 20 mg/m2, etoposide 60 mg/m2) for 5 consecutive days. Although the tumor marker levels decreased remarkably, her vision again declined rapidly due to enlargement of the tumor after the first course of chemotherapy. A second radical operation resulted in vision improvement. The tumor specimen showed only mature teratoma elements. This phenomenon, called the growing teratoma syndrome, is very rare in intracranial non-germinomatous germ cell tumors.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
5/16. Cerebellar mutism in adults after posterior fossa surgery: a report of 2 cases.BACKGROUND: mutism has been associated with injury to midline cerebellar structures secondary to degenerative disease, tumors, hemorrhage, or surgery. Typically, cerebellar mutism syndrome (CMS) has been seen in children and only rarely described in adults after surgery of the posterior fossa. This syndrome typically arises 48 hours after the initiating event and resolves approximately 7 to 8 weeks later. Characteristics of CMS include complete absence of speech without impaired consciousness, other cranial nerve deficits, or long tract signs. CASE DESCRIPTION: The authors report on 2 patients each of whom developed cerebellar mutism after tumor resection using a posterior fossa approach. The first patient underwent gross total resection of a pineal region tumor via a supracerebellar approach. The second patient underwent posterior fossa decompression for a left cerebellar hemispheric renal cell carcinoma metastasis with adjacent hemorrhage. One patient displayed a variant of cerebellar mutism with severe ataxic dysarthria without complete absence of speech, whereas the other demonstrated frank mutism. After neuroimaging studies confirmed the absence of a surgically treatable postoperative cause for the patients' symptoms, they were managed in a supportive fashion (eg, speech therapy) and improved within 3.5 months and 1 year, respectively. CONCLUSION: It is paramount that neurosurgeons be aware of cerebellar mutism with regard to its very rare occurrence in adults, its time of onset, and typical self-limiting course.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/16. Bilateral vidian nerve schwannomas associated with facial palsy. Case report and review of the literature.Intracranial schwannomas are relatively common benign tumors arising from schwann cells. Among the cranial nerves, the vestibular division of the vestibulocochlear nerve is the site most commonly affected by these lesions, followed by the trigeminal nerve. The authors report a case of bilateral schwannomas arising from both of the pterygoid canals. A 13-year-old girl presented with intermittent headaches and left-sided facial palsy. Preoperative computerized tomography scans and magnetic resonance images revealed nonenhancing round masses within the bilateral vidian canals, bone erosion, and sclerosis. The transnasal transseptal transsphenoidal approach was used to remove the masses. Postoperatively, the patient recovered uneventfully. On histopathological examination, the masses were confirmed as schwannomas. The clinical presentation and probable histogenesis of schwannomas arising in this location are discussed together with a review of the literature.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
7/16. Revision glomus tumor surgery.The infratemporal fossa approach type A is the best way to deal with recurrent tympano-jugular paragangliomas because facial nerve rerouting is fundamental to reaching the area of the internal carotid artery, where recurrence is likely to occur. Preservation of lower cranial nerve function is not feasible when there is tumor infiltration of the medial wall of the jugular bulb; any attempt at nerve dissection increases the risk of leaving some tumor remnants. Correct management of the internal carotid artery, including preoperative stent insertion or permanent preoperative balloon occlusion, is usually a fundamental step when dealing with these highly vascularized lesions. Because of the tumor tendency to infiltrate the bony structures, aggressive drilling of the temporal bone is also advised, especially at the level of the petrous apex. patients affected by uncontrolled recurrences still die of this disease.- - - - - - - - - - ranking = 3keywords = nerve (Clic here for more details about this article) |
8/16. Necrotizing brainstem leukoencephalopathy six weeks following radiotherapy.A 71-year-old male with a null cell pituitary macroadenoma was given peripituitary region radiotherapy (4,346 Gy units) over a 1-month-period and 6 weeks later developed the rapid onset of blurred vision, diplopia, ataxia, incoordination, cranial nerve palsy, somnolence, and respiratory distress. His fixed neurologic deficits required ventilatory support, feeding tube placement, and chronic hospitalization until his death 1 year later. At autopsy, necrotic foci with dystrophic axonal calcification were found throughout the brainstem, associated with mild focal vascular hyalinization but without fibrinoid necrosis, telangiectasias or large vessel abnormalities. This unusual case of fatal "early delayed" radiation injury is compared to previous literature cases.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/16. The use of gold foil wrapping for radiation protection of the spinal cord for recurrent tumor therapy.PURPOSE: The development of a technique to provide sufficient radiation protection to previously irradiated spinal cord in such a manner that interstitial brachytherapy can be conducted after resection of a recurrent tumor and decompression of the cord. methods AND MATERIALS: A technique was developed that uses multiple layers of gold foil that are applied around the thecal sac and nerve root sleeves to produce an enveloping radiation shield after resection of recurrent tumor. Once the layers of gold foil are in place, interstitial I125 seeds are permanently placed in the bed of the tumor resection to prevent any recurrence from microcellular disease. The technique is described and its application in the case of a 28-year-old with a third recurrence of chondrosarcoma after external fractionated radiation therapy at the second to the fourth thoracic segments is reviewed. RESULTS: This technique has been used in this first patient. An additional tumor dose of 120.0 Gy was delivered to the tumor bed while the spinal cord was calculated to receive only 1% of the dose over the life span of the implant. To date, this dose of radiation has prevented tumor recurrence for more than 18 months of follow-up. CONCLUSION: This technique of multiple layers of gold foil shielding over the spinal cord and nerve roots has the potential to be a useful tool for the shielding of a previously irradiated spinal cord in the setting of resection of recurrent tumor. It may also have a wider application to a number of other radiosensitive tumors where interstitial brachytherapy may be useful to provide additional treatment after external fractionated radiation therapy.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
10/16. Aggressive papillary middle ear tumors: a report of two cases with review of the literature.Adenomatous tumors of the middle ear are rare, with only approximately 100 cases reported. A distinct subclass of this tumor demonstrates microscopic papillary architecture and has a propensity to erode the petrous bone and extend intracranially. The term "aggressive papillary middle ear tumor" has recently been proposed to describe this more invasive type of middle ear tumor. Thirty-seven cases of aggressive papillary middle ear tumors have been reported. We present two additional cases and discuss the clinical, radiologic, histologic, and operative features of this locally aggressive neoplasm. The tumor affects adults of both sexes. The clinical prodrome is prolonged. Presenting signs and symptoms most often relate to the involvement of cranial nerves V-VIII. Imaging studies reveal large, enhancing, destructive tumors with a generous vascular supply. Intraoperatively, the tumors are bloody, fibrous, and adherent to surrounding structures. Various surgical approaches in combination or in series may be used. Preoperative embolization may be helpful. The role of adjunctive radiation is unclear. Aggressive papillary middle ear tumors are histologically benign tumors with clinically destructive behavior. However, it appears that aggressive surgical management affords prolonged survival with minimal worsening of cranial nerve deficits.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
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