Adolescent ; Adult ; Child ; Cranial Fossa, Middle ; pathology ; Cranial Fossa, Posterior ; pathology ; Cranial Nerve Neoplasms ; diagnosis ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Neurilemmoma ; diagnosis ; pathology ; surgery ; Trigeminal Nerve Diseases ; diagnosis ; pathology ; surgery

In most cases, while schwannoma is sporadically manifested as a single benign neoplasm, the presence of multiple schwannomas in one patient is usually indicative of neurofibromatosis 2. However, several recent reports have suggested that schwannomatosis itself may also be a distinct clinical entity. This study examines an extremely rare case of probable schwannomatosis associated with intracranial, intraspinal and peripheral involvements. A 63-year-old woman presented with a seven-year history of palpable lumps on both sides of the supraclavicular area and hearing impairment in both ears. On physical examination, no skin manifestations were evident. Facial sensory change, deafness in the left ear and decreased gag reflex were revealed by neurological examination. Magnetic resonance imaging revealed multiple lesions of the trigeminal nerves, acoustic nerves, lower cranial nerves, spinal accessory nerve, brachial plexuses, and spinal nerves. Pathological examination of tumors from the bilateral brachial plexuses, the spinal nerve in the T8 spinal position and the neck mass revealed benign schwannomas. Following is this patient case report of multiple schwannomas presenting with no skin manifestations of neurofibromatosis.
Brachial Plexus Neuropathies/*pathology/surgery ; Case Report ; Cranial Nerve Neoplasms/*pathology/surgery ; Female ; Human ; Magnetic Resonance Imaging ; Middle Age ; Neurilemmoma/*pathology/surgery ; Neurofibromatoses/*pathology ; Spinal Canal/*pathology ; Trigeminal Nerve Diseases/*pathology/surgery ; Vestibulocochlear Nerve Diseases/*pathology/surgery

OBJECTIVE: To evaluate the injuring and rehabilitation of lower cranial nerve after surgery of jugular foramen tumors. METHOD: The lower cranial nerve functions were analyzed retrospectively in 32 cases with jugular foramen tumors in the past six years, including 12 jugular glomus, 10 schwannomas, three meningiomas, one cholesteatoma, two giant cell tumors, one fibromatosis, one chondromyxosarcoma, one adenoid cystic carcinoma and one embryonal rhabdomyosarcoma. All patients received surgical procedures. Total tumor removal was achieved in 30 cases, subtotal and partial resection were performed on one case respectively. RESULT: One case was died of intracranial bleeding after surgery, the other 31 were followed-up with a period from one to six years. Normal lower nerve functions were observed in five cases and new nerve deficits were observed in eight cases. Eighteen cases with poor nerve functions before surgery experienced additional nerve injuring manifestations. Eight cases received tracheotomy in perisurgical period, in which three were transient and five went home with tubes. Twenty cases were compensated well after a short period, and six cases failed to compensate. With a long-term follow-up for these six patients, three cases had well functional rehabilitation, two were partially compensated, and one was decompensated. CONCLUSION Lower cranial nerve dysfunction was the most common complication after jugular foramen tumor surgery. Preoperative nerve function evaluations, protection of nerve during surgery and early postoperative functional rehabilitation training were the key to better prognosis.
Adolescent ; Adult ; Aged ; Child ; Cranial Nerve Injuries ; etiology ; prevention & control ; Cranial Nerve Neoplasms ; surgery ; Cranial Nerves ; pathology ; Female ; Humans ; Jugular Veins ; pathology ; Male ; Middle Aged ; Neurosurgical Procedures ; adverse effects ; Retrospective Studies ; Young Adult

OBJECTIVETo provide the experience for early diagnosis and management of facial nerve neuromas, and to discuss the clinic and imaging feature of facial nerve schwannoma and facial nerve fibroma in 22 cases.

METHODSTwenty cases facial nerve schwannoma and two cases of facial nerve neurofibroma were diagnosed and reviewed retrospectively. Surgical removal were performed through the middle cranial fossa in 2 cases, through intratemporal approach in 8 cases, through intraparotid approach in 2 cases, and combined intra-temporal with out-temporal approaches in 10 cases. Seventeen cases underwent facial nerve graft for repairing a facial nerve defect. Great auricular nerve was used in 3 cases with intratemporal approach and 1 case with intratemporal combined intraparotid approach. Sural nerve graft was used in 5 cases with intratemporal approach and 8 cases with intra-temporal combined intraparotid approach. Two cases were employed two-stage facial muscle flap-plasty.

RESULTSFacial nerve neuromas were totally removed in 21 cases and subtotal neuroma removed in 1 case. In these cases, 20 patients were no recurrence and 1 patient was lost follow-up. One patient with subtotal neuroma removal received Gamma Knife treatment before and after surgery, and this case was no recurrence. The CT imaging of the temporal bone showed that schwannoma was separated "white mass" with smooth margin along the region of facial nerve without intact canal. But neurofibroma locate in enlarge fallopian with intact canal. Magnetic resonance imaging had the advantage of evaluating all segments of the facial nerve and showed continuity of intratemporal and intraparotid mass with the facial nerve. Pathological results indicated that 20 cases were diagnosed as facial nerve schwannoma and 2 cases were neurofibroma.

CONCLUSIONSAlthough tumors originating from the facial nerve are extremely rare, it is possible to make early diagnosis through finding clinical feature and imaging methods. Generally, systematic surgical approach for tumor removal and facial nerve reconstruction should be considered in the cases with facial neurinoma.

Adolescent ; Adult ; Child ; Cranial Nerve Neoplasms ; diagnosis ; pathology ; surgery ; Facial Nerve ; pathology ; transplantation ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Neurilemmoma ; diagnosis ; pathology ; surgery ; Neurofibroma ; diagnosis ; pathology ; surgery ; Neuroma ; diagnosis ; pathology ; surgery ; Retrospective Studies ; Young Adult

OBJECTIVE: 10 summarize tne clinical features of the facial nerve tumors involving the internal auditory canal and promote the management of facial nerve tumor. METHOD: We retrospectively reviewed the clinical manifestations, the experiences of diagnosis and treatment of the facial nerve tumor involving the internal auditory canal. All these 5 cases were enrolled during January 2013 to Apr 2015. RESULT: Among the 5 cases, 3 cases were facial neurilemmoma and the others were facial neurofibroma. The main symptoms of facial nerve tumors involving the internal auditory canal most commonly were facial paralysis companied with hearing loss. All the patients accepted the surgical treatment with various approaches, 3 cases of translabyrinthine approach, 1 case of middle fossa approach, and 1 case of combination of translabyrinthine and transotic approach. Total tumor resection were achieved in all 5 cases. Facial-hypoglossal nerve anastomosis was performed in one case, another case was undergone great auricular nerve graft. CONCLUSION Surgical intervention for patients with facial neuroma involving internal auditory canal should be considered when facial weakness has deteriorated to grade 4. The management should be based on the patient's hearing, facial nerve function, tumor size and invasive extension to select the appropriate surgical procedures.
Anastomosis, Surgical ; Cranial Nerve Neoplasms ; diagnosis ; surgery ; Facial Nerve ; pathology ; surgery ; Facial Nerve Diseases ; diagnosis ; surgery ; Facial Paralysis ; complications ; Hearing Loss ; complications ; Humans ; Hypoglossal Nerve ; surgery ; Neurilemmoma ; diagnosis ; Neurofibroma ; diagnosis ; Retrospective Studies

OBJECTIVETo study the diagnosis and microneurosurgical treatment of cavernous sinus neurinoma.

METHODSTwenty-two patients with cavernous sinus neurinoma which had been diagnosed by MRI were operated on by microsurgery. Fourteen patients received excision of tumor through frontotemporal approach with zygomatic osteotomy and, 8 patients via subtemporal and suboccipital transtentorial approaches.

RESULTSTotal resection was achieved in 21 patients (95.5%), and subtotal resection in 1. There was no operative death. The all operative samples were confirmed neurinoma pathologically. The symptoms postoperation such as headache and exophthalmos were reduced. Three months after operation, the function of the 6th nerve was improved in 12 of 19 patients with paresis of the 6th nerve. One patient with hemiplegia recovered well. The function of the 3th nerve recovered in 4 of 6 patients with recurrent paresis of the 3th nerve. Those patients with hydrocephalus were improved after operation. The patients were follow up 8 - 60 months (mean 20 months). No tumor recurrence was observed.

CONCLUSIONCavernous sinus neurinoma can be removed successfully via subtemporal and suboccipital transtentorial approaches.

Angiography, Digital Subtraction ; Cavernous Sinus ; pathology ; Cranial Nerve Neoplasms ; diagnosis ; surgery ; Female ; Humans ; Magnetic Resonance Angiography ; Male ; Microsurgery ; Neurilemmoma ; diagnosis ; surgery ; Neurosurgical Procedures ; Retrospective Studies ; Tomography, X-Ray Computed ; Trigeminal Nerve

OBJECTIVETo discuss surgical approach selection and treatment strategy for preservation of the facial and lower cranial nerves' function in jugular foramen schwannomas surgery.

METHODSRetrospectively analyzed the clinical presentation, surgical approaches selection, facial and lower cranial nerves follow-up outcomes of 38 jugular foramen Schwannomas, who received operations in the Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital affiliated to Shanghai Jiaotong University, School of Medicine during 2002 and 2012.

RESULTSA total of 38 patients, including 18 men and 20 women, with ages ranged from 21 to 70 years (mean 45.3). Headache or neck pain in preoperative clinical presentation was present in 27 patients (71.1%) and cervical mass in 9 patients (23.7%). Cranial nerve impairments, mainly the vagus nerve, were present in 21 patients (55.3%). MRI finding: 19 tumors were intra- and extracranial, 10 were intracranial and 9 were extracranial. According to the tumor location and region, select the surgical approaches. 25 patients used infratemporal fossa type A approach, 5 patients used petrous occipital transsigmoid approach and 8 patients used transcervial approach to remove tumors. The percentage of total resection was 92.1% (35/38). Adjunctive radiosurgery was used in the management of residual tumor in two patients. All cases obtained ultimately tumor control. Patients were followed by MRI every 6 months for 1 year. Thereafter, they performed follow-up imaging every 1-2 years, and the cranial nerve function was analyzed and evaluated. They were followed up from 26-124 months (median follow-up was 62.3 months). During follow-up period, good facial function was obtained in 36 patients (94.7%). All patients had no swallowing disorder. Complete compensation of lower cranial nerve function was achieved in all patients.

CONCLUSIONSThe preoperative estimation and location of tumor in nature is of great importance in the determination of proper surgical planning of jugular foramen Schwannomas. Facial nerve and lower cranial nerve function can be preserved in maximal degree by proper surgical approaches and careful operative manipulation. Initial surgical resection followed by radiosurgery may be an effective option for some special patients.

Adult ; Aged ; China ; Cranial Nerves ; physiopathology ; Facial Nerve ; physiopathology ; Female ; Head and Neck Neoplasms ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurilemmoma ; pathology ; surgery ; Retrospective Studies ; Young Adult

AIMTo detect the expression of nerve growth factor (NGF) and vascular endothelial growth factor (VEGF) in salivary adenoid cystic carcinoma (SACC) tissues, as well as to determine the correlation between growth factor expression and prognosis in SACC.

METHODOLOGYMedical records of 63 patients surgically treated for SACC between January 1988 and October 2005 were reviewed. Immunohistochemistry was performed to examine the expression of NGF and VEGF in tumor tissues. Kaplan-Meier analysis and Cox's proportional hazard regression model were applied to assess predictors of survival.

RESULTSNGF and VEGF were overexpressed in SACC tissues, compared with those in normal salivary tissues (P < 0.05), and the staining intensity of these two factors was stronger in groups of solid subtype, advanced TNM stage, perineural invasion and recurrence. Patients with high-expression of NGF and VEGF, solid subtype, advanced stage, perineural invasion, recurrence and extended resection alone had worse survival rates (P < 0.05).

CONCLUSIONNGF and VEGF are expressed increasingly in the tissues of SACC cases with invasion and metastasis. NGF expression and VEGF expression are independent

Adult ; Aged ; Carcinoma, Adenoid Cystic ; pathology ; surgery ; Cranial Nerves ; pathology ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; pathology ; Neoplasm Staging ; Nerve Growth Factor ; analysis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Salivary Gland Neoplasms ; pathology ; surgery ; Salivary Glands ; pathology ; Salivary Glands, Minor ; pathology ; Survival Rate ; Vascular Endothelial Growth Factor A ; analysis ; Young Adult

OBJECTIVETo identify the landmarks of transpterygoid approach and to report its application in a series of cases.

METHODSTwo silicon-injected adult cadaveric heads(4 sides) were dissected by performing an endoscopic endonasal transpterygoid approach after CT scanning for imaging guidance. High-quality pictures were obtained. This approach was used to treat twelve patients with skull base lesions including 3 spontaneous cerebrospinal fluid (CSF) leaks in the lateral recess of the sphenoid sinus, 2 neurofibromas and 2 Schwannomas involving the pterygopalatine fossa and infratemporal fossa, 1 dermoid cyst involving the middle fossa and infratemporal fossa, 1 invasive fungal sinusitis invading the middle fossa base, 1 basal cell adenoma in the upper parapharyngeal space, 1 chondrosarcoma in the parasellar region and 1 adenoid cystic carcinoma. Clinical records were reviewed.

RESULTSIn terms of approach dissection, important landmarks, such as the sphenopalatine foramen and artery, vidian canal and nerve, foramen rotundum and maxillary branch of trigeminal nerve, foramen ovale and mandibular branch of trigeminal nerve, as well as pterygoid segment of Eustachian tube were identified. In terms of clinical data, three patients with spontaneous CSF leak underwent repair. Six patients with benign lesions underwent complete tumor resection. In the patient with invasive fungal disease, thorough debridement was undertaken and antifungal drug was administered for one month. For these benign skull base lesions, there was no recurrence during the follow-up period. In the patient with chondrosarcoma, most of the tumor was removed in the first operation, and was followed by two endoscopic operations because of fast growth of the tumor. Final control was achieved with chemotherapy and radiation. In the patient with adenoid cystic carcinoma, tumor recurred five years after surgery, and was reoperated.

CONCLUSIONAn understanding of the landmarks of the transpterygoid approach is paramount for surgically dealing with disease located within and adjacent to the region of the pterygoid process of the sphenoid bone. The endoscopic endonasal transpterygoid approach is feasible and safe in selected patients with skull base lesions.

Adult ; Cerebrospinal Fluid Leak ; surgery ; Cranial Fossa, Middle ; pathology ; Dissection ; Endoscopy ; Eustachian Tube ; anatomy & histology ; Humans ; Nasal Cavity ; surgery ; Neoplasm Recurrence, Local ; Orbit ; anatomy & histology ; Otorhinolaryngologic Surgical Procedures ; methods ; Pterygopalatine Fossa ; pathology ; Skull Base ; anatomy & histology ; surgery ; Skull Base Neoplasms ; surgery ; Sphenoid Bone ; anatomy & histology ; Tomography, X-Ray Computed ; Trigeminal Nerve ; anatomy & histology