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

In the present study we made out an animal model on rabbit whose trigeminus and facialis nerves were simultaneously or only the latter one was severed. The pathological changes in facial muscle atrophy under different nerve injuries were investigated. The degeneration of contractile proteins of upper lip muscle -- myosin and actin was observed. In addition, we also examined the ultrastructural changes in the muscle atrophy in the two above-mentioned nerve injury cases. We observed that the intact trigeminus nerve could delay and lighten the atrophy of facialis-denervated facial muscle and attenuate the degeneration of myosin and actin, as well as decrease the increment of collagen and maintain the ultrastructure of the thick and thin muscle filaments. These results may provide the possibility of improvement of clinical treatment for facial muscle palsy.
Animals ; Denervation ; Facial Muscles ; innervation ; pathology ; Facial Nerve ; physiology ; surgery ; Female ; Muscle Fibers, Skeletal ; diagnostic imaging ; Muscular Atrophy ; pathology ; Rabbits ; Trigeminal Nerve ; physiology ; surgery ; Ultrasonography

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

A case of intracranial ganglioneuroma arising from the trigeminal nerve in the pontine and cerebellopontine angle cistern, in a 44-year-old female, is presented with an emphasis on diffusion-weighted imaging findings. We will discuss on how the tumor in the very unusual location should be differentiated particularly focused on diffusion-weighted imaging findings.
Adult ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Ganglioneuroma/*pathology/surgery ; Humans ; Trigeminal Nerve/*pathology/surgery

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 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