The neck has intricately connected neural structures, including cervical and brachial plexi, the sympathetic system, lower cranial nerves, and their branches. Except for brachial plexus, there has been little research regarding the normal imaging appearance or corresponding pathologies of neural structures in the neck. The development in imaging techniques with better spatial resolution and signal-to-noise ratio has made it possible to see many tiny nerves to predict complications related to image-guided procedures and to better assess treatment response, especially in the management of oncology patients. The purposes of this review is to present imaging-based anatomy of major nerves in the neck and explain their relevant clinical significance according to representative pathologies of regarded nerves in the neck.
Accessory Nerve ; Brachial Plexus ; Cervical Plexus ; Cervical Vertebrae ; Cranial Nerves ; Female ; Ganglia, Sympathetic ; Humans ; Magnetic Resonance Imaging ; Neck* ; Pathology* ; Signal-To-Noise Ratio ; Vagus Nerve

OBJECTIVETo investigate the medium- and long-term outcomes of multisession cyberknife radiosurgery intreating cavernous sinus hemangiomas (CSH).

METHODSBetween January 2008 and February 2012, 45 patients with CSH, including 35 female and 10 male patients with a mean age of 53 years (range: 26-80 years), underwent multisession cyberknife radiosurgery. The mean diameter of the CSH was 47.0 mm (range: 23.0-75.0 mm). The tumor volume ranged from 2.9 to 140.1 cm³, with a mean of 40.1 cm³. Eleven giant CSH with tumor volume ≥ 40.0 cm³ were irradiated by cyberknife in 4 fractions, 28 large tumors with tumor volume 10.0-40.0 cm³ in 3 fractions, 4 tumors with tumor volume 5.0-10.0 cm³ in 2 fractions, 2 small tumors with tumor volume ≤ 5.0 cm³ in 1 fraction. After the treatment, all patients had regular clinical and radiological follow-up at 6-month intervals. A combination of the neurologic examination and MRI information was used to evaluate the overall response.

RESULTSAll patients were followed up for 22-70 months with a mean of 37.7 months. One patient died of stroke 3 years post cyberknife, but the follow-up MRI showed that the CSH shrank in volume. Eight patients with giant CSH had slight headache after finishing cyberknife radiosurgery, and relieved with mannitol and dexamethasone treatment. Neurological deficits in patients had improved or disappeared at 6 to 12 months post cyberknife. None of these patients showed any deterioration in symptoms or new cranial nerve deficits during the follow-up. Latest follow-up imaging demonstrated that tumors decrease > 80% in 15 patients, > 60% to 80% in 18 patients (including the death patient), 40%-60% in 12 patients post cyberknife. Two patients reported occurrence of seizures and maintaining seizure control after antiepileptic drugs administration.

CONCLUSIONSMultisession cyberknife radiosurgery is confirmed to provide medium and long-term local tumor control and symptom improvement. It is a safe and effective treatment modality for CSH, and may serve as a promising treatment option in the future.

Adult ; Aged ; Aged, 80 and over ; Cavernous Sinus ; pathology ; surgery ; Cranial Nerves ; physiopathology ; Female ; Hemangioma ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiosurgery ; methods ; Treatment Outcome ; Tumor Burden

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

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

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

OBJECTIVE: To explore the relationships between the sphenoid-sinus-o-tumoropathy and local anatomy, as well as the characteristics of invasive damages of nerve system in sphenoid-sinus-o-tumoropathy, and emphasize that it is crucial of early diagnosis and surgery for sphenoid-sinus-o-tumoropathy. METHOD: Retrospective analysis of the characteristics of invasive damages of nerve system in 13 patients with sphenoid-sinus-o-tumoropathy, and follow-up the outcomes of nerve system after transnasal endoscopic surgery. RESULT: 1) The majority clinical manifestations of invasive damages in nerve system are cranial nerves, there are 9 cases optic nerve, 7 cases oculomotorius nerve, 4 cases trochlear nerve, 4 cases abducent nerve and 1 cases trigeminal nerve have been found damage at different levels in this group, and the secondly are 3 cases dysfunction of pituitary and 2 cases central nerve damage. 2) The improvement of invasive damages in nerve system after transnasal endoscopic surgery are as follow: at the day of operation or the next day, there are 4 cases to be reported that the symptoms of headache and eyes relieve very well; during 3 to 7 days after operation there are 9 cases to be reported that the symptoms of headache and eyes relieve or disappear significantly; 2 weeks after operation, there are 8 cases to be reported that the optical sights recovery at different levels, and there are many symptoms such as headache (9 cases), visual diplopia (1 cases), ptosis (2 cases), fixation of eyeball (1 cases), exophthalmoptosis (2 cases), face pain (2 cases), orbital paralysis (2 cases) disappeared completely. No complications of cerebrospinal fluid rhinorrhea, brain edema and hemorrhage to be found during the period of operation and follow-up. CONCLUSION The majority clinical characteristics of invasive damage in nerve system with sphenoid-sinus-o-tumoropathy are cranial nerve manifestations, and the second manifestation is dysfunction of pituitary. Transnasal endoscopic surgery could inhibit the invasive damages in cranial nerves of sphenoid-sinus-o-tumoropathic patients effectively.
Adolescent ; Adult ; Aged ; Child ; Cranial Nerves ; pathology ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Paranasal Sinus Neoplasms ; pathology ; surgery ; Retrospective Studies ; Sphenoid Sinus ; pathology ; Young Adult

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

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

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