To increase the identification of pharyngeal bursa invasive fungal disease with lower cranial nerve involvement, reduce the misdiagnosis and improve the awareness of invasive fungal disease. We report the clinical data of a case with lower cranial nerve involvement as the first manifestation and reviewed the related literature.
Aged ; Cranial Nerves ; pathology ; Female ; Humans ; Mycoses ; complications ; pathology ; Pharyngeal Diseases ; etiology ; pathology

A retrospective study of 29 cases of brain-stem gliomas(BSG's) from 1989 to 1993, was performed to determine prognostic factors. Our study also analyzed clinical features, growth patterns, pathologic findings and modalities of treatment in patients with brain-stem gliomas. The patients ranged in age from 6 to 65 years, most commonly in the first decade. The symptom duration prior to diagnosis was 1/2 to 6 months(mean 1 1/2 months). The most common symptom and sign were cranial nerve palsies, especially 6th or 7th cranial nerve. The growth patterns of BSG's were classified into diffuse tumors(7 patients), exophytic(9 patients), focal(2 patients) and cervicomedullary(1 patient). Twenty three of 29 patients were diagnosed pathologically by means of stereotactic biopsy(13 patients) and ope surgery(10 patients). The Pathologic findings were low grade astrocytoma in 9 patients, oligodendroglioma(3 patients), malignant astrocytoma(7 patients), and glioblastoma mulitiforme(4 patients). A significant correlation between diffuse growth pattern and malignant pathologic finding could be obtained(P=0.05). The methods of radiation therapy for BSG's were conventional(10 patients), hyperfractionated(13 patients), and Gamma knife radiosurgery(6 patients). The median survival time was 12 months. The Poor prognostic factors determined in our study were 1) short symptom duration prior to diagnosis(< or = 2 months), 2) diffuse growth pattern, 3) malignant pathologic finding, 4) tumor without cystic portion, and 5) tumor without hydrocephalus.
Astrocytoma ; Cranial Nerve Diseases ; Cranial Nerves ; Diagnosis ; Glioblastoma ; Glioma ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging ; Pathology* ; Prognosis* ; Retrospective Studies

Child ; Cranial Nerves ; pathology ; Eyelids ; Female ; Humans ; Male ; Ophthalmoplegia ; etiology ; Polyradiculopathy ; complications

BACKGROUNDAlthough neuroradiological findings of Möbius syndrome have been reported as a result of brain and brainstem abnormalities, magnetic resonance imaging (MRI) now permits the direct imaging of the cranial nerve (CN) and branches in the orbits. This study presents the MRI findings in patients with sporadic Möbius syndrome.

METHODSProspectively, CNs were imaged in the cistern using head coils and three dimensional fast imaging employing steady-state acquisition (3D-FIESTA), yielding a 0.5 mm(2) resolution in planes of 0.8 mm thickness in seven patients with sporadic Möbius syndrome. The cavernous and intraorbital segment of the CN and the extraocular muscles (EOMs) were imaged with T1 weighting in all patients. The cavernous segment was imaged in coronal planes, while the intraorbit in quasicoronal planes were imaged using surface coils. Intraorbital resolution was 0.16 mm(2) within 2.0 mm thick planes.

RESULTSIn the seven patients, the CN were absent or showed hypoplasia in the cistern, cavernous sinus, and orbit. Abducens (CN VI) and facial (CN VII) nerves were absent on the affected sides. Unilateral CN IX (glossopharyngeal nerve) in two cases displayed dysplasia. Branches from the inferior division of CN III were observed to innervate the lateral rectus (LR) bilaterally in three cases and unilaterally in one case, and had intimate continuity with the LR muscle in two cases bilaterally and two cases unilaterally. Hypoplasia of EOMs was shown in five cases. Dysplasia of the medulla on the left side was found in one patient.

CONCLUSIONSDirect imaging of CNs and EOMs by MRI is useful in diagnosis of Möbius syndrome. It can directly demonstrate the abnormalities of the CN and orbital structures. The absence or hypoplasia of CN VI and CN VII may be the most common radiologic features in sporadic Möbius syndrome, and hypoplasia of CN IX may be an associated feature. The abnormality of EOMs and aberrant innervations in the orbit should be observed, and may be important for the study of the etiology.

Cranial Nerves ; pathology ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; methods ; Mobius Syndrome ; pathology ; Oculomotor Nerve ; pathology

OBJECTIVE: To analyze the feature of cranial nerve involvement in nasopharyngeal carcinoma (NPC) and its relationship with the prognosis. METHOD: A total of 1892 patients who were diagnosed as NPC in our hospital from January 2002 to December 2003, of which the cranial nerve involvement was 183 (9.6%) patients, were analyzed the effect of cranial nerve involvement on the prognosis. RESULT: The percentage of cranial nerve involvement was 9.4%. The 5 year overall survival rate was 61.0%, disease free survival rate was 55.3%, local relapse free survival rate was 75.2% and distant metastasis free survival rate was 73.4%. Periods of cranial nerve involvement, clinical stage, the diameter of the lymph nodes, involvement of cavernous sinus, and the level of the recovery of cranial nerve involvement were significantly associated with prognosis in univariate analysis(P < 0.05). With multivariate analysis, the recovery level of cranial nerve involvement was the independent factor that affected the 5-year overall survival (RR = 2.087). The diameter of the lymph nodes and involvement of cavernous sinus were the independent factors that affected the 5-year distant metastasis-free survival (RR = 1.954 and 2.136, respectively). CONCLUSION Periods of cranial nerve involvement and the level of the recovery of cranial nerve involvement were significantly correlated with prognosis. Involvement of cavernous sinus could increase the rate of distant metastasis.
Adolescent ; Adult ; Aged ; Cranial Nerves ; pathology ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; Neoplasm Staging ; Prognosis ; Young Adult

This is a report of 15 consecutive cases of petroclival lesions performed by transpetrosal approach over five years. Pathologies from these cases include 13 cases of tumors and two cases of aneurysms. All cases of tumors were over 4.5cm in size. Two cases of very low-lying basilar bifurcation aneurysms and one case of facial schwanoma extended to the petrosal tip and temporal fossa were operated with anrerior transpetrosal approach, where as nine cases of petroclival tumor which was localized in the posterior fossa were operated via posterior transpetrosal approach. Of these nine cases, one case with lower clival extension was removed totally by adding a retrosigmoid dural opening. Remaining three cases extended to the Meckel's cave or cavernous sinus were operated by combined anterior-posterior transpetrosal approach. Of the 12 cases done with posterior transpetrosal or combined approach, nine cases with preserved serviceable hearing were approached by retrolabylinthine technique and remaining three cases without preservation of serviceable hearing were operated via retrolabylinthine technique. Total removal was achieved in 9 of 13 tumor cases. Of two cases, aneurysmal neck of the first case was clipped completely but was clipped together with right posterior cerebral artery in second case. There was no operative mortality. Immediate postoperative neurological dysfunction were appered in 12 cases. These were significantly improved by the time of follow up examination. Permanent postoperative dysfunction was present in 6 cases, hemiparesis in 2, facial paralysis in 2 and hearing impairment in 2 cases. These results suggest that when selecting the surgical approach to the petroclival lesions, the size, location, extent of the lesion and preoperative status of the hearing were important factors to be considered. We recommend combined anterior-posterior transpetrosal approach for the complex lesions in the petroclival area which extends into the middle fossa(Meckel's cavum or cavernous sinus). Also, we recommend combining with retrosigmoid dural opening or a far lateral type of suboccipital exposure in cases of complex petroclival lesions involving the entire clivus or foramen magnum. In cases with brain stem invasion by tumor, vascular encasement or cavernous sinus invasion without cranial nerve involvement, we recommend subtotal resection of the tumor and radiosurgery to prevent permanent postoperative sequele.
Aneurysm ; Brain Stem ; Cavernous Sinus ; Cranial Fossa, Posterior ; Cranial Nerves ; Facial Paralysis ; Follow-Up Studies ; Foramen Magnum ; Hearing ; Hearing Loss ; Mortality ; Neck ; Paresis ; Pathology ; Posterior Cerebral Artery ; Radiosurgery

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 evaluate the various surgical approaches in removing the jugular foramen region tumors in order to obtain the maximal functional preservation.

METHODSBetween March 1993 and May 2005, 32 patients with jugular foramen region tumors were operated. The mastoid and neck approach, the infratemporal fossa approach with and without rerouting the facial nerve, the combined transcochlear and infratemporal fossa approach were respectively used according to the tumor type, size, auditory, facial and lower cranial nerve functions. The cranial nerve monitoring was used and a postoperative CT or MRI scanning was taken in all cases.

RESULTSIn this series of 32 patients, 13 were paragangliomas, 10 schwannomas,2 meningiomas, 2 giant cell tumors, 1 chondrosarcoma, 1 mucochondrosarcoma, 1 adenoid cystic carcinoma, 1 rhabdomyosarcoma and 1 case cholesterol Granuloma. The follow-up period was 3-60 months. Total removals were achieved in 26 cases, near-total removal in 5 cases, and subtotal removal in one case. One patient died after surgery because of intracranial hemorrhage. Another patient died two year after operation because of recurrence. Postoperative cerebrospinal fluid leakage was occurred in 5 cases and meningitis in two cases. They were all treated conservatively. The facial function one week after operation was grade 1-2 in 13 cases, grade 3-4 in 12 cases and grade 5-6 in 7 cases. It changed into grade 1-2 in 23 cases, grade 3-4 in 7 cases and grade 5-6 in 2 cases. The postoperative hearing was improved in 4 cases, stable in 10 cases, deteriorated in 11 cases and totally lost in 7 cases. The lower cranial nerve function was normal in 9 cases, transient palsy in 11 cases, permanent paralysis with compensation in 10 cases and without compensation in 2 cases.

CONCLUSIONThe jugular foramen region tumor could be removed with maximal function preservation by using various surgical approaches. The postoperative life quality was acceptable in most cases. Surgical techniques and postoperative complications management were fundamental in achieving a good result.

Adult ; Aged ; Cranial Nerves ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neurilemmoma ; pathology ; surgery ; Paraganglioma ; pathology ; surgery ; Skull Base Neoplasms ; pathology ; surgery

OBJECTIVETo summarize the clinical, pathological and prognosis character of malignant carotid body tumor and explore its methods of diagnosis and treatment.

METHODSThe data of clinic, pathology, treatment and follow-up of nine patients with malignant carotid body tumor in Tianjin Cancer Hospital from February 1982 to June 2006 were analyzed retrospectively.

RESULTSFour Male and five female cases were included, their average history was 6.5 years. Shamblin classification: one case was type II, eight cases were type III. All the patients were underwent ultrasonic inspection, four digital subtraction arteriography (DSA) and three magnetic resonance angiography (MRA). Seven cases were diagnosed as carotid body tumor. Five cases underwent Matas test training course. All the patients were performed wide excision of tumor and surrounding tissue. Three carotids were occludes, one of them reconstructed with vascular prosthesis, two were resected. There were no perioperative hemiplegias or deaths. Before operation, one case had atrophy of left side of tongue and fixed left vocal card; two cases had Horner syndrome. After operation, eight cases had 13 cranial nerve deficits, they were: two cerchnus, four glossal deviation, three Horner syndrome and one drop of oral corner, one choking cough. Pathologic diagnosis included nine malignant carotid body tumors, two with capsule, seven without capsule, one cervical and one lung metastasis. Two of them underwent radiotherapy. The median follow-up was 6 years (range: 6 months-14 years). Six patients survived. Two cases died, one died of cervical recurrence, the other of lung cancer. One case was lost.

CONCLUSIONSMalignant carotid body tumor is rare in clinic, and often invade the carotid and cranial nerve, the diagnosis of malignant tumor should base on occurring extensive invasion of adjacent organs and metastasis; Wide surgical excision should be selected early, radiotherapy is effective, the effect of chemotherapy is uncertainty.

Adult ; Carotid Body Tumor ; pathology ; surgery ; Cranial Nerves ; pathology ; Female ; Head and Neck Neoplasms ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Treatment Outcome

BACKGROUNDWith the technical advances, magnetic resonance imaging (MRI) is now sensitive enough to detect subtle structural abnormalities of ocular motor nerves arising from the brainstem and orbits of living subjects. This study was designed to delineate the MRI characteristics in patients with special forms of strabismus.

METHODSA total of 29 patients with special forms of strabismus underwent orbital and intracalvarium MRI. Imaging of the ocular motor nerves in the brainstem was performed in 0.8 mm thickness image planes using the three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) sequence. Nerves to extraocular muscles (EOMs), EOMs and their associated connective tissues were imaged with T1 weighting in tri-planar scans by dual-phased coils within 2.0 mm thick planes.

RESULTSPatients with congenital fibrosis of the extraocular muscles exhibited hypoplasia of the oculomotor (CN3), abducens (CN6), trochlear (CN4) nerves, and the EOMs; hypoplasia of CN6 in the brainstem and an extra branch of the inferior division of CN3 to the lateral rectus were the most common but not the only presentation of Duane's retraction syndrome. Hypoplasia of CN6, facial (CN7) and hypoglossal (CN12) nerves were revealed in patients with Möbius syndrome. In a rare case of bilateral synergistic convergence and divergence, an enlarged branch of CN3 to the medial rectus and a questionable branch of CN3 to the inferior rectus bilaterally were found.

CONCLUSIONMRI can reveal subtle structures of the ocular motor nerves and their corresponding EOMs. This can provide valuable information regarding pathogenesis in some special forms of strabismus.

Adolescent ; Adult ; Child ; Child, Preschool ; Cranial Nerves ; pathology ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Oculomotor Muscles ; pathology ; Prospective Studies ; Strabismus ; pathology