WorldWideScience

Sample records for giant sacral schwannoma

  1. Atypical presentations of retroperitoneal giant schwannomas

    Directory of Open Access Journals (Sweden)

    Sait Ozbir

    2011-06-01

    Full Text Available Schwannomas are usually benign rare tumors that originating from Schwann cells of peripheral nerve sheaths. Presentation is generally varied and changed in a non-specific range from abdominal mass, flank pain to incidental findings. Herein we report 2 cases of retroperitoneal giant schwannomas with different clinical presentations, of whom one presented with vague abdominal pain, palpable abdominal mass for 4 years, swelling and bilateral hydronephrosis that caused by giant abdominal mass; the other one presented with right flank pain, rectal hemorrhage and lower extremities edema. Two patients were treated by complete surgical excision of masses. The histological and immunohistochemical diagnosis was reported as benign schwannoma. Both of patients are doing well and had no recurrence in 9 years and 28 months follow-up, respectively.

  2. Differentiation of primary chordoma, giant cell tumor and schwannoma of the sacrum by CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Si, Ming-Jue, E-mail: smjsh@hotmail.com [Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China); Wang, Cheng-Sheng [Department of Radiology, Union Hospital, Fujian Medical University, Fuzhou 350001 (China); Ding, Xiao-Yi, E-mail: dingxiaoyi1965@hotmail.com [Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China); Yuan, Fei, E-mail: yuanfeirj@hotmail.com [Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China); Du, Lian-Jun; Lu, Yong [Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China); Zhang, Wei-Bin [Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China)

    2013-12-01

    Objective: To evaluate criteria to differentiate sacral chordoma (SC), sacral giant cell tumor (SGCT) and giant sacral schwannoma (GSS) with CT and MRI. Materials and methods: CT and MR images of 22 SCs, 19 SGCTs and 8 GSSs were reviewed. The clinical and imaging features of each tumor were analyzed. Results: The mean ages of SC, SGCT and GSS were 55.1 ± 10.7, 34.3 ± 10.7 and 42.4 ± 15.7 years old. SCs (77.3%) were predominantly located in the midline of lower sacrum, while most SGCTs (73.7%) and GSSs (87.5%) were eccentrically located in upper sacrum. There were significant differences in age, location, eccentricity, morphology of bone residues, intratumoral bleeding and septations. Multiple small cysts were mainly observed in SGCTs (73.7%) with large central cysts in GSSs (87.5%). SGCTs expanded mainly inside sacrum while SCs and GSSs often extended into pelvic cavity (P = 0.0022). Involvement of sacroiliac joints and muscles were also different. Ascending extension within sacral canal was only displayed in SCs. The preservation of intervertebral discs showed difference between large and small tumors (P = 0.0002), regardless of tumor type (P = 0.095). No significant difference was displayed in gender (P = 0.234) or tumor size (P = 0.0832) among three groups. Conclusion: Age, epicenter of the lesion (midline vs. eccentric and upper vs. lower sacral vertebra), bone residues, cysts, bleeding, septation, expanding pattern, muscles and sacroiliac joint involvement can be criteria for diagnosis. Fluid–fluid level is specific for SGCTs and ascending extension within the sacral canal for SCs. The preservation of intervertebral discs is related to tumor size rather than tumor type.

  3. Giant Sacral Chondrosarcoma in an Elderly Male : A Case Report

    Directory of Open Access Journals (Sweden)

    HZ Chan

    2014-03-01

    Full Text Available Primary sacral tumours are rare, therefore experience of managing their associated complications are very limited. Effective surgical treatment of pelvic chondrosarcoma remains a major challenge for orthopaedic surgeons, due to the complex anatomic structure of the pelvis, the lack of defined compartment borders, the close vicinity to vital structures, and the risk of jeopardizing pelvic structural stability. We report a rare case of a giant sacral chondrosarcoma (100cm x 80cm in an elderly male who successfully underwent tumour resection with good functional outcome and recovery. Long term follow up is essential in view of the possibility of local tumour recurrence.

  4. ROBOTIC SURGERY FOR GIANT PRESACRAL DUMBBELL-SHAPE SCHWANNOMA

    Directory of Open Access Journals (Sweden)

    Farid Yudoyono

    2015-03-01

    Full Text Available Objective: To demonstrate the feasibility of using da Vinci robotic surgical system to perform spinal surgery. Methods: Magnetic resonance imaging (MRI of a 29-year-old female patient complaining right pelvic pain for 1 month revealed a 17x8x10 cm non-homogeneous dumbbell shape encapsulated mass with cystic change located in the pelvic cavity and caused an anterior displacement of urinary bladder and colon. Results: There was no systemic complication and pain decrease 24 hours after surgery and during 2 years of follow up. The patient started a diet 6 hours after the surgery and was discharged 72 hours after the surgery. The pathological diagnosis of the tumor was schwannoma. Conclusions: Giant dumbbell shape presacral schwannomas are rare tumours and their surgical treatment is challenging because of the complex anatomy of the presacral. Clinical application of da Vinci robotic surgical system in the spinal surgical field is currently confined to the treatment of some specific diseases or procedures. However, robotic surgery is expected to play a practical future role as it is minimally invasive. The advent of robotic technology will prove to be a boon to the neurosurgeon.

  5. Giant thoracic schwannoma presenting with abrupt onset of abdominal pain: a case report

    Science.gov (United States)

    2009-01-01

    Introduction Giant intradural extramedullary schwannomas of the thoracic spine are not common. Schwannomas, that is, tumors derived from neoplastic Schwann cells, and neurofibromas represent the most common intradural extramedullary spinal lesions. We report the case of a patient with a giant thoracic schwannoma presenting unusually with acute abdominal pain and with delayed neurological impairment. Case presentation A 26-year-old Hispanic man with no previous medical problems presented with acute periumbilical pain. After extensive work-up including an exploratory laparotomy for appendectomy, magnetic resonance imaging scans of the lumbar and thoracic spine revealed a giant intradural extramedullary thoracic schwannoma within the spinal canal posterior to the T9, T10, and T11 vertebral bodies. Magnetic resonance imaging signal prolongation was noted in the spinal cord both rostral and caudal to the schwannoma. The patient underwent an urgent laminectomy from T8 to L1. After sacrificing the T10 root, the tumor was removed en bloc. Postoperatively, the patient improved significantly gaining antigravity strength in both lower extremities. Conclusion The T10 dermatome is represented by the umbilical region. This referred pain may represent a mechanism by which a giant thoracic schwannoma may present as acute abdominal pain. Acute, intense abdominal pain with delayed neurologic deficit is a rare presentation of a thoracic schwannoma but should be considered as a possible cause of abdominal pain presenting without clear etiology. Although these lesions may be delayed in their diagnosis, early diagnosis and treatment may lead to an improved clinical outcome. PMID:19946504

  6. Giant thoracic schwannoma presenting with abrupt onset of abdominal pain: a case report

    Directory of Open Access Journals (Sweden)

    Yang Isaac

    2009-10-01

    Full Text Available Abstract Introduction Giant intradural extramedullary schwannomas of the thoracic spine are not common. Schwannomas, that is, tumors derived from neoplastic Schwann cells, and neurofibromas represent the most common intradural extramedullary spinal lesions. We report the case of a patient with a giant thoracic schwannoma presenting unusually with acute abdominal pain and with delayed neurological impairment. Case presentation A 26-year-old Hispanic man with no previous medical problems presented with acute periumbilical pain. After extensive work-up including an exploratory laparotomy for appendectomy, magnetic resonance imaging scans of the lumbar and thoracic spine revealed a giant intradural extramedullary thoracic schwannoma within the spinal canal posterior to the T9, T10, and T11 vertebral bodies. Magnetic resonance imaging signal prolongation was noted in the spinal cord both rostral and caudal to the schwannoma. The patient underwent an urgent laminectomy from T8 to L1. After sacrificing the T10 root, the tumor was removed en bloc. Postoperatively, the patient improved significantly gaining antigravity strength in both lower extremities. Conclusion The T10 dermatome is represented by the umbilical region. This referred pain may represent a mechanism by which a giant thoracic schwannoma may present as acute abdominal pain. Acute, intense abdominal pain with delayed neurologic deficit is a rare presentation of a thoracic schwannoma but should be considered as a possible cause of abdominal pain presenting without clear etiology. Although these lesions may be delayed in their diagnosis, early diagnosis and treatment may lead to an improved clinical outcome.

  7. Benign giant mediastinal schwannoma presenting as cardiac tamponade in a woman: a case report

    Directory of Open Access Journals (Sweden)

    Sekiya Mitsuaki

    2011-02-01

    Full Text Available Abstract Introduction Mediastinal schwannomas are typically benign and asymptomatic, and generally present no immediate risks. We encountered a rare case of a giant benign posterior mediastinal schwannoma, complicated by life-threatening cardiac tamponade. Case presentation We report the case of a 72-year-old Japanese woman, who presented with cardiogenic shock. Computed tomography of the chest revealed a posterior mediastinal mass 150 cm in diameter, with pericardial effusion. The cardiac tamponade was treated with prompt pericardial fluid drainage. A biopsy was taken from the mass, and after histological examination, it was diagnosed as a benign schwannoma, a well-encapsulated non-infiltrating tumor, originating from the intrathoracic vagus nerve. It was successfully excised, restoring normal cardiac function. Conclusion Our case suggests that giant mediastinal schwannomas, although generally benign and asymptomatic, should be excised upon discovery to prevent the development of life-threatening cardiopulmonary complications.

  8. Giant mediastinal schwannoma located in the lower right side of the ...

    African Journals Online (AJOL)

    2016-01-18

    Jan 18, 2016 ... nerve. The tumor was coated with a white envelope and filled. Giant mediastinal schwannoma located in the lower right side of the chest. Y Wu, J Zhang, Y Chai. Department of Thoracic Surgery, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China. Access this article online.

  9. A giant plexiform schwannoma of the brachial plexus: case report

    Directory of Open Access Journals (Sweden)

    Kohyama Sho

    2011-11-01

    Full Text Available Abstract We report the case of a patient who noticed muscle weakness in his left arm 5 years earlier. On examination, a biloculate mass was observed in the left supraclavicular area, and Tinel's sign caused paresthesia in his left arm. Magnetic resonance imaging showed a continuous, multinodular, plexiform tumor from the left C5 to C7 nerve root along the course of the brachial plexus to the left brachia. Tumor excision was attempted. The median and musculocutaneous nerves were extremely enlarged by the tumor, which was approximately 40 cm in length, and showed no response to electric stimulation. We resected a part of the musculocutaneous nerve for biopsy and performed latissimus dorsi muscle transposition in order to repair elbow flexion. Morphologically, the tumor consisted of typical Antoni A areas, and immunohistochemistry revealed a Schwann cell origin of the tumor cells moreover, there was no sign of axon differentiation in the tumor. Therefore, the final diagnosis of plexiform Schwannoma was confirmed.

  10. Intracranial Epidural Haematoma following Surgical Removal of a Giant Lumbosacral Schwannoma: A Case Report and Literature Review.

    Science.gov (United States)

    Nemir, Jakob; Peterković, Vjerislav; Trninić, Ines; Domazet, Ivan; Barić, Hrvoje; Vukić, Miroslav

    2018-01-01

    Postoperative intracranial epidural haematoma (EDH) is an extremely rare complication following spinal surgery, with only a handful of cases described in the literature. We report the case of a 16-year-old girl who underwent a successful subtotal resection of a giant lumbosacral schwannoma (L2-S2 level). Recovery from general anaesthesia was uneventful; however, her neurological status deteriorated rapidly within 24 h after surgery. A head computed tomography scan revealed a large right frontoparietal EDH with midline shift. An immediate frontotemporoparietal osteoplastic craniotomy and evacuation of the EDH were performed. At 1 year postoperatively, the patient regained full neurological recovery with no radiological signs of growth of the residual tumour. © 2017 S. Karger AG, Basel.

  11. Sacral Neuromodulation

    DEFF Research Database (Denmark)

    Matzel, Klaus E; Chartier-Kastler, Emmanuel; Knowles, Charles H

    2017-01-01

    INTRODUCTION: Sacral neuromodulation (SNM) (sacral nerve stimulation SNS) has become an established therapy for functional disorders of the pelvic organs. Despite its overall success, the therapy fails in a proportion of patients. This may be partially due to inadequate electrode placement...... with suboptimal coupling of the electrode and nerve. Based on these assumptions the technique of sacral spinal neuromodulation has been redefined. All descriptions relate to the only currently available system licensed for all pelvic indications (Medtronic Interstim(®) ). METHOD: An international...

  12. Morphological evaluation of the thoracic, lumbar and sacral column of the giant anteater (Myrmecophaga tridactyla Linnaeus, 1758

    Directory of Open Access Journals (Sweden)

    Naida C. Borges

    Full Text Available ABSTRACT: This study aimed to describe the number of thoracic, lumbar and sacral vertebrae in tridactyla through radiographic examinations associated with gross anatomy determination. For this purpose, 12 adult specimens of M. tridactyla were analyzed, assigned to the Screening Center of Wild Animals (CETAS, IBAMA-GO, and approved by the Ethics Committee on the Use of Animals (Process CEUA-UFG nr 018/2014. In the radiographic examinations the following numbers of thoracic (T and lumbar (L vertebrae were observed: 16Tx2L (n=7, 15Tx2L (n=3, and 15Tx3L (n=2. In contrast, the numbers of vertebrae identified by anatomical dissection were as follows: 16Tx2L (n=4, 15Tx2L (n=3, and 15Tx3L (n=5. This difference occurred in cases of lumbarization of thoracic vertebrae, as seen in three specimens, and was explained by changes in regional innervations identified by anatomical dissection and the presence of floating ribs (right unilateral=1, left unilateral=1 and bilateral=1, which were not identified by radiographic exams. Regarding the sacral vertebrae there was no variation depending on the methods used, which allowed the identification of 4 (n=1 or 5 (n=11 vertebrae. Thus, we concluded that there is variation in the number of thoracic, lumbar and sacral vertebrae, in addition to lumbarization, which must be considered based on the presence of floating ribs, in this species.

  13. Imaging of sacral tumours

    International Nuclear Information System (INIS)

    Gerber, S.; Ollivier, L.; Brisse, H.; Neuenschwander, S.; Leclere, J.; Vanel, D.; Missenard, G.; Pinieux, G. de

    2008-01-01

    All components of the sacrum (bone, cartilage, bone marrow, meninges, nerves, notochord remnants, etc.) can give rise to benign or malignant tumours. Bone metastases and intraosseous sites of haematological malignancies, lymphoma and multiple myeloma are the most frequent aetiologies, while primary bone tumours and meningeal or nerve tumours are less common. Some histological types have a predilection for the sacrum, especially chordoma and giant cell tumour. Clinical signs are usually minor, and sacral tumours are often discovered in the context of nerve root or pelvic organ compression. The roles of conventional radiology, CT and MRI are described and compared with the histological features of the main tumours. The impact of imaging on treatment decisions and follow-up is also reviewed. (orig.)

  14. Imaging of sacral tumours

    Energy Technology Data Exchange (ETDEWEB)

    Gerber, S.; Ollivier, L.; Brisse, H.; Neuenschwander, S. [Institut Curie, Department of Radiology, Paris (France); Leclere, J. [Institut Gustave Roussy, Department of Radiology, Villejuif (France); Vanel, D. [The Rizzoli Institute, Department of Radiology, Bologna (Italy); Missenard, G. [Institut Gustave Roussy, Comite de pathologie tumorale de l' appareil locomoteur, Villejuif (France); Pinieux, G. de [CHRU de Tours, Department of Pathology, Hopital Trousseau, Tours (France)

    2008-04-15

    All components of the sacrum (bone, cartilage, bone marrow, meninges, nerves, notochord remnants, etc.) can give rise to benign or malignant tumours. Bone metastases and intraosseous sites of haematological malignancies, lymphoma and multiple myeloma are the most frequent aetiologies, while primary bone tumours and meningeal or nerve tumours are less common. Some histological types have a predilection for the sacrum, especially chordoma and giant cell tumour. Clinical signs are usually minor, and sacral tumours are often discovered in the context of nerve root or pelvic organ compression. The roles of conventional radiology, CT and MRI are described and compared with the histological features of the main tumours. The impact of imaging on treatment decisions and follow-up is also reviewed. (orig.)

  15. Facial Nerve Schwannoma Involving Middle Cranial Fossa: When the Unilateral Sensorineural Hearing Loss Guide to the Correct Diagnosis

    OpenAIRE

    De Stefano, Alessandro; Dispenza, Francesco; Kulamarva, Gautham

    2011-01-01

    The Facial Nerve Schwannoma is a rare tumor and it seldom involved the middle cranial fossa. Facial nerve schwannoma has various manifestations, including facial palsy but unfortunately facial nerve is very resistant to compression and often facial nerve paralysis or a facial weakness are not present. We present a case of giant facial nerve schwannoma involved the middle cranial fossa without facial nerve paralysis. In these cases the unilateral hearing loss (if present) guide to a correct di...

  16. Solitary eyelid schwannoma

    Directory of Open Access Journals (Sweden)

    Renu M Magdum

    2014-01-01

    Full Text Available Schwannomas are rare benign tumors arising from Schwann cells of peripheral nerves that form the neural sheath. While there have been reports of such tumors in the orbit, solitary schwannomas arising from the eyelids are very rare. There are reports of schwannomas being erroneously diagnosed as chalazion, inclusion cysts or even eyelid malignancy. We are reporting a case of a 20-year-old female who presented with a painless, non-tender, slow-growing mass in the upper eyelid of the right eye. The external appearance of the mass was suggestive of an implantation cyst of the eyelid and it could be completely excised as it had a well-defined capsule. Histopathological examination showed characteristic hypercellular and hypocellular areas with fusiform nuclei that tended to form palisades. The purpose of reporting this case of schwannoma in a young female is to recommend the inclusion of this entity as a differential diagnosis of well-defined lid tumors.

  17. Angiogenesis in vestibular schwannomas

    DEFF Research Database (Denmark)

    Møller, Martin Nue; Werther, Kim; Nalla, Amarnadh

    2010-01-01

    Vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs) are potent mediators of tumor angiogenesis. It has been demonstrated that vestibular schwannoma VEGF expression correlates with tumor growth pattern, whereas knowledge on the expression of MMPs is lacking. This study...

  18. Sympathetic chain Schwannoma

    International Nuclear Information System (INIS)

    Al-Mashat, Faisal M.

    2009-01-01

    Schwannomas are rare, benign, slowly growing tumors arising from Schwann cells that line nerve sheaths. Schwannomas arising from the cervical sympathetic chain are extremely rare. Here, we report a case of a 70-year-old man who presented with only an asymptomatic neck mass. Physical examination revealed a left sided Horner syndrome and a neck mass with transmitted pulsation and anterior displacement of the carotid artery. Computed tomography (CT) showed a well-defined non-enhancing mass with vascular displacement. The nerve of origin of this encapsulated tumor was the sympathetic chain. The tumor was excised completely intact. The pathologic diagnosis was Schwannoma (Antoni type A and Antoni type B). The patient has been well and free of tumor recurrence for 14 months with persistence of asymptomatic left sided Horner syndrome. The clinical, radiological and pathological evaluations, therapy and postoperative complications of this tumor are discussed. (author)

  19. The sacral foramina

    International Nuclear Information System (INIS)

    Jackson, H.; Burke, J.T.

    1984-01-01

    The sacral foramina, particularly the first three, are not simple fenestrations. Each foramen is a Y-shaped complex of canals, all with indefinite margins. The complexes lie obliquely at approximately 45 0 to the coronal plane. An appreciation of these facts facilitates the recognition of the anatomy of plain films, tomographs, and computerized scans. (orig.)

  20. Two cases of sacral agenesis

    Energy Technology Data Exchange (ETDEWEB)

    Choi, J Y; Bae, Y K; Hahm, C K; Kang, S R [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    1979-06-15

    Sacral agenesis is a central component in the spectrum of anomalies comprising the caudal regression syndrome. Sacral agenesis occurs more frequently in an infant born to mother of diabetes, rubella infection in first trimester than normal mothers. In a patient of sacral agenesis, it is important to recognize the neurologic deficit, neurogenic bladder dysfunction and other congenital anomalies. A case of partial sacral agenesis of 10 years old girl and another case of complete total agenesis associated with multiple anomalies in autopsied newborn are reported.

  1. Two cases of sacral agenesis

    International Nuclear Information System (INIS)

    Choi, J. Y.; Bae, Y. K.; Hahm, C. K.; Kang, S. R.

    1979-01-01

    Sacral agenesis is a central component in the spectrum of anomalies comprising the caudal regression syndrome. Sacral agenesis occurs more frequently in an infant born to mother of diabetes, rubella infection in first trimester than normal mothers. In a patient of sacral agenesis, it is important to recognize the neurologic deficit, neurogenic bladder dysfunction and other congenital anomalies. A case of partial sacral agenesis of 10 years old girl and another case of complete total agenesis associated with multiple anomalies in autopsied newborn are reported.

  2. Imaging findings of sacral tumors

    International Nuclear Information System (INIS)

    Kim, Seung Ho; Hong, Sung Hwan; Choi, Ja Young; Koh, Sung Hye; Chung, Hye Won; Choi, Jung Ah; Kang, Heung Sik

    2003-01-01

    The various pathologic conditions detected at CT and MRI and subsumed by the term 'sacral tumor' include primary bone tumors, sacral canal tumors and metastases. Among these, metastases are much more common than primary bone tumors, of which chordoma is the most common. Although the imaging findings of sacral tumors are nonspecific, a patient's age and sex, and specific findings such as calcification or fluid-fluid levels, can help radiologists in their differential diagnosis. We describe the imaging findings of primary sacral tumors, emphasizing the MRI findings

  3. Deregulated genes in sporadic vestibular schwannomas

    DEFF Research Database (Denmark)

    Cayé-Thomasen, Per; Helweg-Larsen, Rehannah Holga Andrea; Stangerup, Sven-Eric

    2010-01-01

    In search of genes associated with vestibular schwannoma tumorigenesis, this study examines the gene expression in human vestibular nerve versus vestibular schwannoma tissue samples using microarray technology.......In search of genes associated with vestibular schwannoma tumorigenesis, this study examines the gene expression in human vestibular nerve versus vestibular schwannoma tissue samples using microarray technology....

  4. True incidence of vestibular schwannoma?

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Tos, Mirko; Thomsen, Jens

    2010-01-01

    The incidence of diagnosed sporadic unilateral vestibular schwannomas (VS) has increased, due primarily to more widespread access to magnetic resonance imaging.......The incidence of diagnosed sporadic unilateral vestibular schwannomas (VS) has increased, due primarily to more widespread access to magnetic resonance imaging....

  5. Cytodiagnosis of Sacral Chordoma

    Directory of Open Access Journals (Sweden)

    Saumya Shukla

    2014-12-01

    Full Text Available We report the cytological findings of a sacro-coccygeal chordoma in a 53 year male diagnosed preoperatively by guided fine needle aspiration cytology. The smears shows characteristic Physalliphorous cells in a metachromatic background of myxoid material entrapping cords of cuboidal cells. Differential diagnosis in cytology include conventional and myxoid chondrosarcoma, myxoid liposarcoma, myxoid malignant fibrous histiocytoma, metastatic mucinous carcinoma and myxo-papillary ependymoma. The distinguishing features between these neoplasms are discussed. Preoperative diagnosis of chordoma permits optimum planned surgery. Keywords: chordoma; myxoid; sacral.

  6. Schwannoma of the Colon

    Directory of Open Access Journals (Sweden)

    Ronaldo Nonose

    2009-09-01

    Full Text Available Schwannomas are neoplasms originating from Schwann cells, which are the cells forming nerve sheaths. These neoplasms generally involve peripheral nerves. They rarely affect the gastrointestinal tract and primary colon involvement is extremely rare. The objective of the present paper was to present a case of primary schwannoma of the sigmoid colon, unassociated with von Recklinghausen disease, that was histopathologically confirmed by means of an immunohistochemical panel. The patient was a 71-year-old woman who had had rectal bleeding when evacuating, with pain and tenesmus, for 4 months. She underwent colonoscopy, which identified a raised submucous lesion of 2.8 cm in diameter, located in the sigmoid colon, 30 cm from the anal margin. During examination, loop polypectomy with lesion excision was performed. Histopathological evaluation showed that this was a tumor of stromal origin. Its resection margins were compromised by neoplasia, and colon resection by means of videolaparoscopy was indicated. Conventional histopathological examination using the hematoxylin-eosin technique suggested that the neoplasm was of mesenchymal origin. An immunohistochemical panel was run for etiological confirmation, using anti-CD34 antibodies, desmin, cytokeratins (AE1/AE3, cKit, chromogranin and S-100 protein. The panel showed intense immunoexpression of S-100 protein. Investigation of the proliferative activity rate using Ki-67 antibodies showed that there was a low rate of mitotic activity, thus confirming the diagnosis of primary benign schwannoma of the colon. The patient’s postoperative evolution was uneventful and she remains in good health, without signs of tumor recurrence, 15 months after surgical excision.

  7. Sacral orientation and spondylolysis.

    Science.gov (United States)

    Peleg, Smadar; Dar, Gali; Steinberg, Nili; Masharawi, Youssef; Been, Ella; Abbas, Janan; Hershkovitz, Israel

    2009-12-01

    A descriptive study (based on skeletal material) was designed to measure sacral anatomic orientation (SAO) in individuals with and without spondylolysis. To test whether a relationship between SAO and spondylolysis exists. Spondylolysis is a stress fracture in the pars interarticularis (mainly of L5). The natural history of the phenomenon has been debated for years with opinions divided, i.e., is it a developmental condition or a stress fracture phenomenon. There is some evidence to suggest that sacral orientation can be a "key player" in revealing the etiology of spondylolysis. The pelvis was anatomically reconstructed and SAO was measured as the angle created between the intersection of a line running parallel to the superior surface of the sacrum and a line running between the anterior superior iliac spine (ASIS) and the anterior-superior edge of the symphysis pubis (PUBIS).SAO was measured in 99 adult males with spondylolysis and 125 adult males without spondylolysis. The difference between the groups was tested using an unpaired t test. Spondylolysis prevalence is significantly higher in African-Americans compared to European-Americans: 5.4% versus 2.04% in males (P < 0.001) and 2.31% versus 0.4%, P < 0.001 in females. SAO was significantly lower in the spondylolytic group (44.07 degrees +/- 11.46 degrees) compared to the control group (51.07 degrees +/- 8.46 degrees, P < 0.001). A more horizontally oriented sacrum leads to direct impingement on L5 pars interarticularis by both L4 inferior articular facet superiorly and S1 superior articular facet inferiorly. Repetitive stress due to standing (daily activities) or sitting increases the "pincer effect" on this area, and eventually may lead to incomplete synostosis of the neural arch.

  8. Landmarks for Sacral Debridement in Sacral Pressure Sores.

    Science.gov (United States)

    Choo, Joshua H; Wilhelmi, Bradon J

    2016-03-01

    Most cases of sacral osteomyelitis arising in the setting of sacral pressure ulcers require minimal cortical debridement. When faced with advanced bony involvement, the surgeon is often unclear about how much can safely be resected. Unfamiliarity with sacral anatomy can lead to concerns of inadvertent entry into the dural space and compromise of future flap options. A cadaveric study (n = 6), in which a wide posterior dissection of the sacrum, was performed. Relationships of the dural sac to bony landmarks of the posterior pelvis were noted. The termination of the dural sac was found in our study to occur at the junction of S2/S3 vertebral bodies, which was located at a mean distance of 0.38 ± 0.16 cm distal to the inferior-most extent of the posterior superior iliac spine (PSIS). The mean thickness of the posterior table of sacrum at this level was 1.7 cm at the midline and 0.5 cm at the sacral foramina. The PSIS is a reliable landmark for localizing the S2/S3 junction and the termination of the dural sac. Sacral debridement medial to the sacral foramina above the level of PSIS must be conservative whenever possible. If aggressive debridement is necessary above this level, the surgeon must be alert to the possibility of dural involvement.

  9. Schwannoma of the sigmoid colon

    OpenAIRE

    Çakır, Tuğrul; Aslaner, Arif; Yaz, Müjgan; Gündüz, Umut rıza

    2015-01-01

    Colonic schwannomas are very rare gastrointestinal tumours originating from Schwann cells, which form the neural sheath. Primary schwannomas of the lower gastrointestinal tract are very rare and usually benign in nature. However, if they are not surgically removed, malign degeneration can occur. We report a case of a 79-year-old woman who presented to our clinic with rectal bleeding and constipation. She underwent a lower gastrointestinal tract endoscopy. A mass subtotally obstructing the lum...

  10. Vulval schwannoma: A cytological diagnosis

    Directory of Open Access Journals (Sweden)

    Das Subhashish

    2008-01-01

    Full Text Available Schwannomas are the most common peripheral nerve sheath tumors, the frequent sites of involvement being the head and neck, the flexor aspect of the limbs, especially near the elbow, wrist, knee, and trunk. Involvement of the female genital tract is extremely rare. We present one such rare case of a solitary vulval schwannoma which was diagnosed by fine needle aspiration cytology in a 48 year-old female, and confirmed by histopathological examination.

  11. CT findings of adrenal schwannoma

    International Nuclear Information System (INIS)

    Zhang, Y.-M.; Lei, P.-F.; Chen, M.-N.; Lv, X.-F.; Ling, Y.-H.; Cai, P.-Q.; Gao, J.-M.

    2016-01-01

    Aim: To analyse the computed tomography (CT) imaging features of patients with adrenal schwannoma. Materials and methods: Eight cases of adrenal schwannoma confirmed by histopathology were included in this study. All eight patients had undergone multiphase CT examinations. The features of the adrenal schwannoma in the CT images were analysed retrospectively in detail, including size, shape, margin, radiodensity, calcification, and enhancement pattern. Results: There were six male and two female patients, with a median age of 44.5 years (range, 25–52 years). Two patients complained of right flank pain, and two with left upper abdominal discomfort, while the remaining patients were diagnosed by routine ultrasound examinations. On unenhanced CT images, all cases of adrenal schwannoma were well circumscribed, rounded or oval, heterogeneous masses with cystic components, with two cases exhibiting calcification, and three cases with septa. On enhanced CT images, all cases displayed mild heterogeneous enhancement of the tumour during the arterial phase, and progressive enhancement during the portal venous phase and equilibrium phase. Conclusion: Adrenal schwannoma commonly presents as a well-defined unilateral mass with cystic degeneration, septa, and a characteristic progressive contrast-enhancement pattern on multiphase enhanced scans. - Highlights: • Adrenal schwannomas were extremely rare, and eight cases' medical data of this disease were collected in this study. • They usually presented a well-defined unilateral mass with cystic degeneration and sepations. • They manifested characteristic progressive contrast enhancement pattern on enhanced CT images.

  12. Tongue schwannomas associated with neurofibromatosis type 2

    Directory of Open Access Journals (Sweden)

    Harusachi Kanazawa

    2018-06-01

    Full Text Available Schwannomas are typically solitary benign neural tumors; however, multiple lesions associated with the rare genetic disorder neurofibromatosis type 2 (NF2 have been reported in some cases. We present the case of a tongue schwannomas in a 36-year-old woman previously diagnosed with NF2 with bilateral vestibular schwannomas. To alleviate difficulties with swallowing, tongue nodular masses were surgically removed, and schwannoma was histologically diagnosed. Our patient represents the first case of histologically confirmed tongue schwannoma associated with NF2. This indicates that in patient with NF2, schwannoma may be detected in the oral cavity as well as in other parts of the body. Thus, careful clinical and histological examinations are warranted to identify schwannomas associated with NF2 even in the oral cavity. Keywords: Schwannoma, Tongue, Oral manifestation, Neurofibromatosis type 2 (NF2

  13. Osteolytic extra-axial sacral myxopapillary ependymoma.

    Science.gov (United States)

    Biagini, R; Demitri, S; Orsini, U; Bibiloni, J; Briccoli, A; Bertoni, F

    1999-10-01

    The authors report an unusual case of sacral osteolytic myxopapillary ependymoma treated with curettage and radiotherapy. There is no evidence of recurrence 8 years after treatment. A review of the literature is presented on sacral ependymomas presenting with an osteolytic radiographic appearance (24 cases in 18 reports). The differential diagnosis with other sacral neoplasms is discussed.

  14. Osteolytic extra-axial sacral myxopapillary ependymoma

    Energy Technology Data Exchange (ETDEWEB)

    Biagini, R.; Demitri, S.; Orsini, U. [Clinica Ortopedica, Istituto Ortopedico Rizzoli, Bologna (Italy); Bibiloni, J. [Medical Sciences Campus San Juan, University of Puerto Rico (Puerto Rico); Briccoli, A. [Istituto di Patologia Chirurgica, University of Modena (Italy); Bertoni, F. [Servizio di Anatomia Patologica, Istituto Ortopedico Rizzoli Bologna (Italy)

    1999-10-01

    The authors report an unusual case of sacral osteolytic myxopapillary ependymoma treated with curettage and radiotherapy. There is no evidence of recurrence 8 years after treatment. A review of the literature is presented on sacral ependymomas presenting with an osteolytic radiographic appearance (24 cases in 18 reports). The differential diagnosis with other sacral neoplasms is discussed. (orig.)

  15. Osteolytic extra-axial sacral myxopapillary ependymoma

    International Nuclear Information System (INIS)

    Biagini, R.; Demitri, S.; Orsini, U.; Bibiloni, J.; Briccoli, A.; Bertoni, F.

    1999-01-01

    The authors report an unusual case of sacral osteolytic myxopapillary ependymoma treated with curettage and radiotherapy. There is no evidence of recurrence 8 years after treatment. A review of the literature is presented on sacral ependymomas presenting with an osteolytic radiographic appearance (24 cases in 18 reports). The differential diagnosis with other sacral neoplasms is discussed. (orig.)

  16. Gastric Schwannoma: a case report

    International Nuclear Information System (INIS)

    Lee, Kye Ho; Jee, Keum Nahn

    2006-01-01

    Gastric Schwannoma is a rare benign intramural tumor arising from the stomach, and it accounts for only 0.1% of all the different kinds of gastric neoplasms, and it's less than 4% of all the benign gastric tumors. This tumor is very difficult to differentiate from the other mesenchymal tumors by the clinical, endoscopic and radiologic findings. In this study, we demonstrate the appearance of this tumor on endoscopic ultrasound and contrast-enhanced abdomen CT. We also show the histopathologic findings of a surgically confirmed gastric Schwannoma that was located in the proper muscle layer

  17. Retroperitoneal Schwannoma: A Rare Case

    Directory of Open Access Journals (Sweden)

    Murat Kalaycı

    2011-01-01

    Case Presentation. A 38-year-old woman was admitted to the emergency service with the complaints of progressive abdominal pain and nausea for the last 24 hours. Abdominal examination was compatible with acute abdomen. Acute appendicitis was diagnosed by CT. During CT evaluation, a round shaped soft-tissue mass at the retroperitoneal area inferior to the right kidney was detected, The mass was resected and histology revealed schwannoma. Conclusion. Rare tumoral lesions with benign course such as schwannoma can be detected incidentally.

  18. Clinical features and surgical treatment of cauda equina schwannoma

    Directory of Open Access Journals (Sweden)

    Jun-jun HUANG

    2011-03-01

    Full Text Available Objective To investigate the clinical features and surgical treatment method of cauda equina schwannoma.Methods Clinical symptoms,imaging characteristics and functional outcomes after surgical treatment of 32 patients with cauda equina schwannoma from June 2007 to March 2009 were retrospectively reviewed.Results Most patients(30 cases suffered lower extremity numbness/pain before operations and 18 of them suffered in both lower extremities.Physical examination showed bilateral nerve damage or unilateral multiple nerve damage in 25 cases.The initial symptom of 12 cases was simple lumbago.Ten cases were misdiagnosed as lumbar disc herniation.Six patients were scanned by computed tomography but none of them was diagnosed correctly.All the patients were definitely diagnosed by magnetic resonance imaging(MRI,the typical appearance of the schwannoma was a round or ovoid mass with isointense or slightly hyperintense on T1-weighted images,while on T2-weighted images with heterogeneous hyperintense in 25 cases,slightly hyperintense in 2,and homogeneous hyperintense in 5.Gadolinium-enhanced MRI was performed in 13 patients,of whom 10 cases showed heterogeneous or annular enhancing.In all patients,the tumor was resected completely,the functional outcomes were satisfactory except one with a giant tumor,in whom the neurological symptom was aggravated,and no recurrence was found during a short-term follow-up.Conclusions The characteristic features of cauda equina schwannoma were lower extremities numbness/pain and bi-or unilateral polyradiculopathy in physical examination.MRI is helpful for early diagnosis and recommended as the first choice.Functional outcomes are satisfactory in patients with tumor completely resected.

  19. MR findings in intralabyrinthine schwannomas

    Energy Technology Data Exchange (ETDEWEB)

    Montague, Mary-Louise; Kishore, Ameet; Hadley, Donald M.; O' Reilly, Brian

    2002-05-01

    AIM: Intralabyrinthine schwannomas (ILS) are rare benign tumours. They are not always recognized on routine magnetic resonance imaging (MRI). We aimed to study the clinical presentation and MRI findings in our patients with ILS. MATERIALS AND METHODS: Retrospective analysis of patients with vestibular schwannomas treated at this center. RESULTS: Of 144 vestibular schwannomas studied at this centre, three patients had an ILS. The most common presenting symptoms were unilateral hearing loss, tinnitus and vertigo. Two patients demonstrated a progressive sensorineural hearing loss (SNHL). The third patient had a severe SNHL at presentation. MRI enhanced with contrast medium was positive in the two patients with progressive SNHL and negative in the patient with the severe SNHL. CONCLUSION: This series demonstrates the ability of MRI to identify schwannomas filling the labyrinth, and also its inability to identify extremely small ILS. It underlines the importance of sending the cristae of patients undergoing labyrinthectomy for presumed Meniere's disease for histological examination. Montague, M.-L. et al. (2002)

  20. MR findings in intralabyrinthine schwannomas

    International Nuclear Information System (INIS)

    Montague, Mary-Louise; Kishore, Ameet; Hadley, Donald M.; O'Reilly, Brian

    2002-01-01

    AIM: Intralabyrinthine schwannomas (ILS) are rare benign tumours. They are not always recognized on routine magnetic resonance imaging (MRI). We aimed to study the clinical presentation and MRI findings in our patients with ILS. MATERIALS AND METHODS: Retrospective analysis of patients with vestibular schwannomas treated at this center. RESULTS: Of 144 vestibular schwannomas studied at this centre, three patients had an ILS. The most common presenting symptoms were unilateral hearing loss, tinnitus and vertigo. Two patients demonstrated a progressive sensorineural hearing loss (SNHL). The third patient had a severe SNHL at presentation. MRI enhanced with contrast medium was positive in the two patients with progressive SNHL and negative in the patient with the severe SNHL. CONCLUSION: This series demonstrates the ability of MRI to identify schwannomas filling the labyrinth, and also its inability to identify extremely small ILS. It underlines the importance of sending the cristae of patients undergoing labyrinthectomy for presumed Meniere's disease for histological examination. Montague, M.-L. et al. (2002)

  1. Atypical Manifestation of Vestibular Schwannoma

    Directory of Open Access Journals (Sweden)

    Webster, Guilherme

    2013-09-01

    Full Text Available Introduction: Vestibular schwannoma (also known as acoustic neuroma is a benign tumor whose cells are derived from Schwann sheaths, which commonly occurs from the vestibular portion of the eighth cranial nerve. Furthermore, vestibular schwannomas account for ∼8% of intracranial tumors in adults and 80 to 90% of tumors of the cerebellopontine angle. Its symptoms are varied, but what stands out most is a unilateral sensorineural hearing loss, with a low index of speech recognition. Objective: Describe an atypical manifestation of vestibular schwannoma. Case Report: The 46-year-old woman had vertigo and binaural hearing loss and fullness, with ear, nose, and throat examination suggestive of cochlear injury. After 6 months, the patient developed worsening of symptoms and onset of right unilateral tinnitus. In further exams the signs of cochlear damage remained, except for the vestibular test (hyporeflexia. Magnetic resonance imaging showed an expansive lesion in the right cerebellopontine angle. Discussion: This report warns about the atypical manifestations of vestibular schwannoma, which must always be remembered in investigating and diagnosing hearing loss.

  2. MR findings in intralabyrinthine schwannomas

    Energy Technology Data Exchange (ETDEWEB)

    Montague, Mary-Louise; Kishore, Ameet; Hadley, Donald M; O' Reilly, Brian

    2002-05-01

    AIM: Intralabyrinthine schwannomas (ILS) are rare benign tumours. They are not always recognized on routine magnetic resonance imaging (MRI). We aimed to study the clinical presentation and MRI findings in our patients with ILS. MATERIALS AND METHODS: Retrospective analysis of patients with vestibular schwannomas treated at this center. RESULTS: Of 144 vestibular schwannomas studied at this centre, three patients had an ILS. The most common presenting symptoms were unilateral hearing loss, tinnitus and vertigo. Two patients demonstrated a progressive sensorineural hearing loss (SNHL). The third patient had a severe SNHL at presentation. MRI enhanced with contrast medium was positive in the two patients with progressive SNHL and negative in the patient with the severe SNHL. CONCLUSION: This series demonstrates the ability of MRI to identify schwannomas filling the labyrinth, and also its inability to identify extremely small ILS. It underlines the importance of sending the cristae of patients undergoing labyrinthectomy for presumed Meniere's disease for histological examination. Montague, M.-L. et al. (2002)

  3. AN INTERESTING CASE OF ANCIENT SCHWANNOMA

    Directory of Open Access Journals (Sweden)

    Binu

    2015-01-01

    Full Text Available INTRODUCTION : Schwannoma is a common benign tumour of nerve sheath. Degenerating type of schwannoma is called ancient schwannoma. Ancient schwannomas of scalp are rare and are often misdiagnosed as sebaceous cyst or dermoid cyst. CASE REPORT : We present a thirty two year old male presented with scalp swel ling of eight years duration. X - ray showed no intracranial extension. He underwent excision of the tumour and histopathology was reported as ancient schwannoma. DISCUSSION : Histopathologically , ancient schwannomas charecterised by cellular Antoni type A ar eas and less cellular Antoni type - B areas. 9 th , 7 th , 11 th , 5 th and 4 th cranial nerves are often affected and may be associated with multiple neuro fibramatosis (Von - Recklinghausen’s disease. Impact : Case is presented for its rarity and possible pre - operative misdiagnosis

  4. Schwannomas of the head and neck

    Directory of Open Access Journals (Sweden)

    Anastasios Kanatas

    2011-12-01

    Full Text Available Schwannomas are benign encapsulated nerve sheath tumors composed of Schwann cells. Malignant change in head and neck schwannomas is rare, with the incidence varying between 8 and 13.9%. In this review, we discuss the presentation and the management of head and neck schwannomas. The issues and difficulties based on our own experience as well as the experience of published reports from the literature are presented.

  5. Schwannoma Originating From the Periphereral Intercostal Nerves

    Directory of Open Access Journals (Sweden)

    Yunus Aksoy

    2017-06-01

    Full Text Available Schwannomas are usually solitary, encapsulated, and asymptomatic, benign neurogenic tumors originating from the nerve sheath. Schwannomas rarely show malignant transformation, however, require close monitoring. They are primarily located in the thorax in the costovertebral sulcus, may rarely originate from peripheral intercostal nerves. Less than 10% of primary thoracic neurogenic tumors originate from the peripheral intercostal nerves. The main treatment and diagnosis of schwannomas are complete surgical resection. We report a rare case of a 40-year-old male with asymptomatic schwannoma originating from an intercostal nerve which was found incidentally on his chest X-ray and was treated with surgery.

  6. Epidemiology and natural history of vestibular schwannomas

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Caye-Thomasen, Per

    2012-01-01

    This article describes various epidemiologic trends for vestibular schwannomas over the last 35 years, including a brief note on terminology. Additionally, it provides information on the natural history of tumor growth and hearing level following the diagnosis of a vestibular schwannoma. A treatm......This article describes various epidemiologic trends for vestibular schwannomas over the last 35 years, including a brief note on terminology. Additionally, it provides information on the natural history of tumor growth and hearing level following the diagnosis of a vestibular schwannoma...

  7. Stereotactic radiotherapy for vestibular schwannoma

    DEFF Research Database (Denmark)

    Muzevic, Dario; Legcevic, Jelena; Splavski, Bruno

    2014-01-01

    BACKGROUND: Vestibular schwannomas (acoustic neuromas) are common benign tumours that arise from the Schwann cells of the vestibular nerve. Management options include observation with neuroradiological follow-up, microsurgical resection and stereotactic radiotherapy. OBJECTIVES: To assess...... the effect of stereotactic radiotherapy compared to observation, microsurgical resection, any other treatment modality, or a combination of two or more of the above approaches for vestibular schwannoma. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL......; Web of Science; CAB Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the search was 24 July 2014. SELECTION CRITERIA: Randomised controlled trials (RCTs) exploring the efficacy of stereotactic radiotherapy compared with observation alone, microsurgical...

  8. Schwannoma of the adrenal gland

    Directory of Open Access Journals (Sweden)

    Anunayi Jeshtadi

    2014-07-01

    Full Text Available Visceral schwannomas are extremely rare and are usually discov-ered incidentally on USG/CT-Scan. Primary schwannomas of the adrenal gland are extremely uncommon. It has been theorized that they originate from Schwann cells that insulate the nerve fi-bers innervating the adrenal medulla. Histopathological examina-tion coupled with immunohistochemistry provides the definitive diagnosis. A 55 year old normotensive female presented with pain in the right loin since 5 months. Her renal parameters were normal. Contrast enhanced computed tomography of abdomen showed a well delineated 6.5 x 5cms mass at upper pole of her right kidney. 24-hour urinary metanephrine was slightly elevated (3.07mg/24hrs. A decline in Serum cortisol levels was observed following a dexamethasone suppression test (18.89nmol/l. Histopathological examination revealed a spindle cell tumor. Immunohistochemistry showed strong and diffuse positive staining for S-100 with negative expression for CD-117, desmin, CD-34, HMB-45, synaptophysin, chromogranin, cytokeratin, and SMA. Ki-67 index was 2%.A diagnosis of cellular schwannoma of adrenal gland was confirmed.

  9. Temporal fossa intra-extracranial dumbbell schwannoma.

    LENUS (Irish Health Repository)

    Wong, Limy

    2011-02-01

    Intra-extracranial schwannomas arising unrelated to major cranial nerves are exceedingly rare neoplasms. We report the case of a 23-year-old male who presented with a 9 month history of progressive temporal swelling which was excised and found histologically to be a schwannoma. A succinct review of the relevant literature is presented.

  10. Temporal fossa intra-extracranial dumbbell schwannoma.

    LENUS (Irish Health Repository)

    Wong, Limy

    2012-02-01

    Intra-extracranial schwannomas arising unrelated to major cranial nerves are exceedingly rare neoplasms. We report the case of a 23-year-old male who presented with a 9 month history of progressive temporal swelling which was excised and found histologically to be a schwannoma. A succinct review of the relevant literature is presented.

  11. A rare adrenal incidentaloma: adrenal schwannoma.

    Science.gov (United States)

    Adas, Mine; Ozulker, Filiz; Adas, Gokhan; Koc, Bora; Ozulker, Tamer; Sahin, Ilknur Mansuroglu

    2013-01-01

    Adrenal schwannoma is an extremely uncommon cause of incidentaloma. It originates from neural sheath Schwann cells of the adrenal gland. We report the case of a left adrenal schwannoma incidentally discovered in a 32-year-old woman during examination of bloated feeling and stomach ache. The patient was incidentally found to have a left adrenal mass of 9 cm on abdominal ultrasonography. Computed tomography (CT) of the abdomen and [(18)F] fluorodeoxyglucose positron emission tomography (PET) were also performed. Metabolic evaluation was unremarkable. Due to the large size of the tumor, left adrenalectomy was performed. The postoperative course was uneventful. Histological examination established the diagnosis of schwannoma. This diagnosis was supported by immunohistochemistry of S-100 and vimentin positivity. In conclusion, adrenal schwannoma is an extremely rare entity and can grow considerably in size. The present case report emphasizes that clinicians should be aware of the possibility of retroperitoneal schwannoma. Total excision of benign schwannoma is associated with a favorable outcome. To our knowledge, there are case reports of schwannoma with CT and magnetic resonance imaging findings in the literature, although this is the first schwannoma case with PET-CT imaging.

  12. A case of a massive mandibular schwannoma

    Directory of Open Access Journals (Sweden)

    Shishir Ram Shetty

    2011-01-01

    Full Text Available Schwannoma, a benign nerve sheath tumor is relatively rare in occurrence and even rarer in sites, such as jaw bones. There are only 45 reported cases of intraosseous schwannoma of the jaws reported in the literature. We report a rare case of mandibular schwannoma in a 50-year-old Indian male. The clinical features resembled that of a residual cyst, fibro-osseous lesion or an odontogenic tumor/cyst. Radiological differential diagnoses of ameloblastoma or odontogenic keratocyst was made based on the findings of the orthopantomogram. The lesion was examined histopathologically and a final diagnosis of schwannoma arising from the inferior alveolar nerve was made. The aim of this report is to add information to the existing sparse literature on intraosseous schwannomas of the jaw.

  13. Intracochlear Schwannoma: Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Bittencourt, Aline Gomes

    2014-01-01

    Full Text Available Introduction Schwannomas of the eighth cranial nerve are benign tumors that usually occur in the internal auditory canal or the cerebellopontine angle cistern. Rarely, these tumors may originate from the neural elements within the vestibule, cochlea, or semicircular canals and are called intralabyrinthine schwannomas. Intracochlear schwannomas (ICSs represent a small percentage of these tumors, and their diagnosis is based on high-resolution magnetic resonance imaging (MRI. Objectives To report the clinical and radiologic features and audiometric testing results of an ICS in a 48-year-old man after a 22-month follow-up period. Resumed Report A patient with an 8-year history of persistent tinnitus in his right ear, combined with ipsilateral progressive hearing loss and aural fullness. Audiometry revealed normal hearing in the left ear and a moderate to severe sensorineural hearing loss in the right ear, with decreased speech reception threshold and word recognition score, compared with the exam performed 5 years previously. MRI showed a small intracochlear nodular lesion in the modiolus, isointense on T1 with a high contrast enhancement on T1 postgadolinium images. During the follow-up period, there were no radiologic changes on imaging studies. Thus, a wait-and-scan policy was chosen as the lesion remained stable with no considerable growth and the patient still presents with residual hearing. Conclusions Once diagnosed, not all ICS patients require surgery. Treatment options for ICS include stereotactic radiotherapy and rescanning policy, depending on the tumor's size, evidence of the tumor's growth, degree of hearing loss, intractable vestibular symptoms, concern about the pathologic diagnosis, and the patient's other medical conditions.

  14. Schwannoma in the vestibule and cochlea

    Energy Technology Data Exchange (ETDEWEB)

    Susilawati, S. [Fatmawati Hospital, Jakarta (Indonesia). Department of Ear, Nose and Throat; Adler, J. [Sutherland Imaging Centre, Sydney, NSW (Australia); Fagan, P. [St Vincents Hospital, Darlinghurst, NSW (Australia)

    1997-05-01

    Schwannoma of the vestibule or the cochlea is an unusual lesion. In the past, most examples have been found at autopsy or as unsuspected findings at surgery for vertigo. The symptoms of isolated labyrinthine schwannoma may be indistinguishable from advanced Meniere`s disease. Magnetic resonance imaging has led to pre-operative diagnosis in some cases. Two cases of schwannoma within the labyrinth from a series of 339 symptomatic acoustic tumours, are presented and the imaging findings are discussed. 8 refs., 2 figs.

  15. Vestibular Schwannoma or acoustic neuroma

    Directory of Open Access Journals (Sweden)

    Hekmatara M

    1997-04-01

    Full Text Available Vestibular schwannoma is the most common tumor of the posterior fossa of the skull. Patients referred with the primary otologic symptoms such as hearing loss, tinnitus, vertigo, imbalance, and the cranial nerve palsy. Thirty-three patients were operated and treated by a team of otolaryngologist and neurosurgeon, anudiometrist, and internist. Patients'chiefcomplaint was due to 94% hearing loss and 27% tinnitus. They scarcely complain of vertigo. If a patient refers with the palsy or paralysis of facial nerve preoperation, we must think of the facial nerve schwannoma or hemangioma or congential cholestoma or malignant metastases rather than acoustic neuroma. The best way for preoperative diagnosis is audiometry, ABR (Auditory Brain Response, and SDS (speech discrimination score with 90% success, but computer Tomography (CT scan and MRI (Magnetic Resonance Image are the valuable anatomic diagnostic radiographic devices. The best method of operation is translabirynthine approach (TLA, since it has the advantages such as an easy access to nerve paths and being the nearest path to CPA (Cerebellopontine Angle. Physicians ought to talk to patients about the importance of the microscopic surgery, surgical methods, and their probable diverse effects such as hearing loss, facial nerve palsy, and intracranial problems.

  16. Schwannoma of the stomach: a case report

    International Nuclear Information System (INIS)

    Lee, Mi Suk; Lee, Jeong Min; Yun, Yeung Geum; Yang, Kee Hwa

    1995-01-01

    We report a case of exogastric schwannoma of the stomach in 41-years-old male patient with papable mass in left upper abdomen. Upper Gl series revealed extrinsic compression on the greater curvature of the stomach. CT scan showed a low density mass attached to greater curvature of the stomach with inhomogeneous contrast enhancement in the mass lesion. The mass was removed by surgery, and confirmed pathologically as schwannoma arising from the stomach

  17. Sacrality and worldmaking: new categorial perspectives

    OpenAIRE

    William E. Paden

    1999-01-01

    The category of the sacred in particular and the role of transcultural concept-formation in general have undergone an obvious crisis. For the most part, "the sacred," if not an empty label, has been linked with theologism, and transcultural concepts have been condemned for their general non-comparability and colonialist intent. The author approaches the matter of transcultural templates through an analysis of certain concepts of sacrality. With some exceptions, the discourse of sacrality has ...

  18. Fourth Ventricular Schwannoma: Identical Clinicopathologic Features as Schwann Cell-Derived Schwannoma with Unique Etiopathologic Origins

    Directory of Open Access Journals (Sweden)

    Tiffany R. Hodges

    2011-01-01

    Full Text Available Background. To our knowledge, this is the sixth reported case in the literature of fourth ventricular schwannoma. The etiology and natural history of intraventricular schwannomas is not well understood. A thorough review of potential etiopathogenic mechanisms is provided in this case report. Case Description. A 69-year-old man presented with an incidentally found fourth ventricular tumor during an evaluation for generalized weakness, gait instability, and memory disturbance. Magnetic resonance imaging (MRI revealed a heterogeneously enhancing lesion in the fourth ventricle. A suboccipital craniotomy was performed to resect the lesion. Histopathological examination confirmed the diagnosis of schwannoma (WHO grade I. Conclusions. Schwannomas should be considered in the differential diagnosis of intraventricular tumors. Although the embryologic origins may be different from nerve sheath-derived schwannomas, the histologic, clinical, and natural history appear identical and thus should be managed similarly.

  19. Storytelling: Performance, Presentations and Sacral Communication

    Directory of Open Access Journals (Sweden)

    Zoltán Bódis

    2013-12-01

    Full Text Available Various schools of tale research manifested the relationship of tales of the sacred based on their ideological preconceptions: the relationship between tales and the sacred is refused or accepted. In this article tales are investigated not from the perspective of the possible sacral referent(s but rather it looks at them as a kind of communicational subsystem that is part of human culture. The focus is on revealing the specific features of sacral communication in the communication system of tales. Sacral communication is a special form of communication in which the elements of the communication model are transformed. The goal of sacral communication is exactly this kind of identity creation. This may be oriented towards creating a personal or a communal self-identity. Among its characteristics we may find the special type of language forms in which the predominance of linguistic elements pushes the sense conveying possibilities more into the background than usual, and those linguistic forms that restructure consciousness become emphasized. In this communication the tale telling is transformed by a language use characteristic of sacral communication (rhythm, repetition and rhetorical forms. Various examples explain that traditional tale telling creates a complex effect related to the visual, auditory, and kinetic senses: a modification and transformation of the self-understanding and self-identity that connect the world of tale telling to sacral communication.

  20. Obturator nerve schwannoma presenting as an adnexal mass: case report

    Energy Technology Data Exchange (ETDEWEB)

    Mehta, M.; Thurston, W.A.; Merchant, N. [The Toronto Hospital, Dept. of Medical Imaging, Toronto, Ontario (Canada); Murphy, K.J. [The Toronto Hospital, Dept. of Obstetrics and Gynecology, Toronto, Ontario (Canada)

    1999-02-01

    Schwannomas are relatively common, benign nerve-sheath tumours. They arise most commonly from either cranial nerves or the dorsal root of spinal nerves. Schwannomas have also been reported to occur in peripheral nerve-root trunks, although this location is much less common. We report a case of a 45-year-old woman with a large pelvic mass originally believed to be an ovarian tumour. Following surgical excision, the tumour was found to be a schwannoma of the obturator nerve. To our knowledge, there are no reported cases of an obturator nerve schwannoma. The imaging features of schwannomas are reviewed. (author)

  1. EXTRACRANIAL HEAD AND NECK SCHWANNOMA: CASE REPORT

    Directory of Open Access Journals (Sweden)

    Ashok

    2015-03-01

    Full Text Available Schwannoma is a benign nerve sheath tumour composed of Schwan cells which normally produce the insulating myelin sheath covering peripheral nerves. Schwannoma is a homogenous tumour, consisting only of schwan cells. The tumour cells stay outside the nerve, but the tumour itself may either push the nerve aside or up against a bony structure there by producing nerve damage. They arise from peripheral, cranial and autonomic nerves and usually present as solitary well demarcated lesions. Extracranial Head and Neck schwannomas are rare tumours. They may produce secondary symptoms like nasal obstruction, dysphagia, and hoarseness of voice depending upon the location of the tumour. FNAC, Ultra sound, CT, MRI may be of limited help in the diagnosis. Complete surgical excision is the treatment of choice. Post operative histopa thological examination establishes the final diagnosis

  2. MR imaging of sacral and perisacral lesions

    International Nuclear Information System (INIS)

    Wetzel, L.H.; Levine, E.; Murphey, M.D.

    1987-01-01

    This exhibit demonstrates the utility of MR imaging in evaluating sacral and perisacral lesions. Thirty-two lesions were studied using a superconducting 1.0-T MR imager. Eleven primary and 13 metastatic tumors, four congenital lesions, and four arachnoid cysts were evaluated. MR did not usually enable a more specific histologic diagnosis than other imaging techniques. However, extraosseous and proximal spinal extent of tumors was well defined without use of oral or intravenous contrast material. MR imaging is an excellent noninvasive technique for evaluating most sacral and perisacral lesions and is particularly helpful when precise tumor extent must be determined for treatment planning

  3. Sacral-neuromodulation CT-guided

    International Nuclear Information System (INIS)

    Amoroso, Lamberto; Ricci, Stefano; Pelliccioni, Giuseppe; Scarpino, Osvaldo; Ghiselli, Roberto; Saba, Vittorio

    2005-01-01

    Purpose: Sacral neuromodulation is a new treatment for refractory voiding disorders such as urge incontinence, urinary retention, frequency-urgency syndromes and faecal incontinence. The current approach to sacral nerve stimulation consists of a two-stage procedure. The first is a PNE test (Percutaneous Nerve Evaluation) by a provisional electrically stimulated spinal needle, placed percutaneously in the S3 foramina for four of ten days. If successful, the second stage, permanent implantation, is carried out. The PNE test is performed under fluoroscopic control using the palpable bony sacral foramina as referral points. This technique can show some limitations, such as operator Rx exposure, poor visualization of sacral foramina because of bowel gas artefacts or sacral malformation. In order to reduce these inconveniences and to improve efficiency of the test we tried an alternative technique. The purpose of our study was to test the use of CT as an alternative technique in order to evaluate its advantages and possible routine use. Materials and methods: We tested 30 patients with the PNE test under CT guidance (16 males and 14 females) suffering from serious pelvic disorders and not responding to the normal therapeutic regime. Twenty-seven patient showed relative anatomical integrity of the pelvis and the sacrum, the remaining 3 patients presented morphological anormalities of the sacral foramina. With the patient in the prone position the sacral foramina were identified with CT volumetric scanning using a spiral CT scanner equipped with a second console for the three-dimensional reconstructions. Having identified the location of the S3 foramina, a sterile field was prepared and the spiral needle introduced checking correct positioning with a CT control scan. An electrode was inserted after having checked correct muscular contractile response and the precise position with a further CT scan. Results: Thirty patients were subjected to PNE under CT guidance for a

  4. THREE YEARS STUDY OF SCHWANNOMAS OF PERIPHERAL NERVES

    Directory of Open Access Journals (Sweden)

    Subha Dhua

    2017-02-01

    Full Text Available BACKGROUND In this paper authors present three cases of schwannomas including a case of multiple schwannomas without the features of neurofibromatosis (NF. There was no family history of neurofibromatosis. All the patients underwent surgical excision and improved from the symptomatic lesions. Histopathology confirmed these lesions as schwannomas. The authors recommend surgery for symptomatic lesions. Asymptomatic tumours can be monitored. Regular follow up is essential as they may develop fresh lesions at any time. The relevant literature is discussed. • Malignant transformation of the schwannomas is rare and has poor prognosis. It should be considered in the differential diagnosis of schwannomas. • We should distinguish between “ancient schwannoma” and malignant transformation of schwannoma since treatment and prognosis vary. • Imaging is not entirely reliable in differentiating benign from malignant peripheral nerve tumours. MATERIALS AND METHODS All the patients underwent surgical excision and improved from the symptomatic lesions. Histopathology confirmed these lesions as schwannomas. The authors recommend surgery for symptomatic lesions. RESULTS The histopathological studies confirmed the lesion as Flexi Schwannoma and surgery was considered to be the best option. CONCLUSION Schwannomas and meningiomas are usually benign tumours curable by complete removal. They occur either as single sporadic tumors in otherwise healthy individuals in the fourth to sixth decades of life or as multiple tumours at an early age as part of the autosomal dominant genetic disorder neurofibromatosis 2 (NF2. The hallmark feature of NF2 is bilateral vestibular schwannomas. Multiplicity, a lobular growth pattern, and invasiveness are typical features of NF2 schwannomas. The diagnosis of NF2 is difficult in a group of heterogeneous and poorly defined patients who do not have BVSs but present with other features suggestive of NF2, namely (1 multiple

  5. Surgical techniques for lumbo-sacral fusion.

    Science.gov (United States)

    Tropiano, P; Giorgi, H; Faure, A; Blondel, B

    2017-02-01

    Lumbo-sacral (L5-S1) fusion is a widely performed procedure that has become the reference standard treatment for refractory low back pain. L5-S1 is a complex transition zone between the mobile lordotic distal lumbar spine and the fixed sacral region. The goal is to immobilise the lumbo-sacral junction in order to relieve pain originating from this site. Apart from achieving inter-vertebral fusion, the main challenge lies in the preoperative determination of the fixed L5-S1 position that will be optimal for the patient. Many lumbo-sacral fusion techniques are available. Stabilisation can be achieved using various methods. An anterior, posterior, or combined approach may be used. Recently developed minimally invasive techniques are gaining in popularity based on their good clinical outcomes and high fusion rates. The objective of this conference is to resolve the main issues faced by spinal surgeons in their everyday practice. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

    African Journals Online (AJOL)

    Background and Objective: There are various postulated possible causes of surgically symptomatic prolapsed intervertebral discs in the lumbar and sacral regions. They may be acting singularly or collectively. Yet, these factors, which could vary in different environments, have not been satisfactorily confirmed. The intention ...

  7. Complications of Microsurgery of Vestibular Schwannoma

    Directory of Open Access Journals (Sweden)

    Jan Betka

    2014-01-01

    Full Text Available Background. The aim of this study was to analyze complications of vestibular schwannoma (VS microsurgery. Material and Methods. A retrospective study was performed in 333 patients with unilateral vestibular schwannoma indicated for surgical treatment between January 1997 and December 2012. Postoperative complications were assessed immediately after VS surgery as well as during outpatient followup. Results. In all 333 patients microsurgical vestibular schwannoma (Koos grade 1: 12, grade 2: 34, grade 3: 62, and grade 4: 225 removal was performed. The main neurological complication was facial nerve dysfunction. The intermediate and poor function (HB III–VI was observed in 124 cases (45% immediately after surgery and in 104 cases (33% on the last followup. We encountered disordered vestibular compensation in 13%, permanent trigeminal nerve dysfunction in 1%, and transient lower cranial nerves (IX–XI deficit in 6%. Nonneurological complications included CSF leakage in 63% (lateral/medial variant: 99/1%, headache in 9%, and intracerebral hemorrhage in 5%. We did not encounter any case of meningitis. Conclusions. Our study demonstrates that despite the benefits of advanced high-tech equipment, refined microsurgical instruments, and highly developed neuroimaging technologies, there are still various and significant complications associated with vestibular schwannomas microsurgery.

  8. Cellular schwannoma arising from sigmoid mesocolon presenting ...

    African Journals Online (AJOL)

    Schwannomas are a type of peripheral nerve sheath tumors with clinically indolent behavior. Though, they can occur anywhere in body, the incidence in retroperitoneum, mediastinum, and pelvis is exceedingly rare. We present a case of a 58‑year‑old female with a massive twisted tumor arising from sigmoid mesocolon.

  9. Cellular Schwannoma Arising from Sigmoid Mesocolon Presenting ...

    African Journals Online (AJOL)

    Schwannomas are a type of peripheral nerve sheath tumors with clinically indolent behavior. Though, they can occur anywhere in body, the incidence in retroperitoneum, mediastinum, and pelvis is exceedingly rare. We present a case of a 58‑year‑old female with a massive twisted tumor arising from sigmoid mesocolon.

  10. Intralabyrinthine schwannoma shown by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Saeed, S.R.; Birzgalis, A.R.; Ramsden, R.T.

    1994-01-01

    Intralabyrinthine schwannomas are rare benign tumours which present with progressive or fluctuant audiovestibular symptoms and may mimic Menieres disease. The size and position of these lesions make preoperative diagnosis unusual and most are discovered incidentally at labyrinthectomy. A case is reported which was diagnosed on magnetic resonance imaging and confirmed at surgery. (orig.)

  11. Spinal Cord Studies in the African Giant Rat (Cricetomys gambianus ...

    African Journals Online (AJOL)

    olayemitoyin

    J. Physiol. Sci. 30 (2015) 025 – 032 www.njps.com.ng. Spinal Cord Studies in the African Giant Rat (Cricetomys gambianus .... Body and Spinal Cord measurements of the AGR (C. gambianus), Mean ±SEM ... the eighth cervical segment appeared circular in shape. ... other lumbar segments, sacral and coccygeal segments.

  12. Intracranial schwannoma presenting as a subfrontal tumor: case report.

    Science.gov (United States)

    Huang, P P; Zagzag, D; Benjamin, V

    1997-01-01

    Intracerebral schwannomas not associated with cranial nerves account for less than 1% of surgically treated schwannomas of the central and peripheral nervous system. Subfrontal schwannomas are extremely rare, with only 15 cases reported to date. A 33-year-old man presented with a 4-month history of progressive headaches and lethargy. Radiographic studies revealed a large subfrontal tumor thought to be a meningioma preoperatively. The patient underwent a craniotomy for resection of his tumor. Intraoperatively, a large extra-axial tumor arising from the floor of the left frontal fossa was encountered. Microscopic examination of the tumor revealed a schwannoma. Several theories on the possible origin of intracerebral schwannomas have been considered. Because of the age of the patient at presentation, many authors have postulated a developmental origin for these lesions. However, extra-axial schwannomas not associated with cranial nerves often present later in life, suggesting a different pathogenesis for this subgroup.

  13. Laryngeal schwannoma: a case report with emphasis on sonographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Luis Ronan Marquez Ferreira de, E-mail: luisronan@gmail.com [Universidade Federal do Triangulo Mineiro (UFTM), Uberaba, MG (Brazil); De Nicola, Harley; Yamasaki, Rosiane; Pedroso, Jose Eduardo; Brasil, Osiris de Oliveira Campones do; Yamashita, Helio [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina

    2014-05-15

    Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral, cranial and autonomic nerves. Twenty-five to forty-five percent of all schwannomas occur in the head and neck region, but location of such tumors in the larynx is rarely observed. The present report is aimed at describing a clinical case of laryngeal schwannoma, with emphasis on sonographic findings. (author)

  14. Facial Nerve Schwannoma of the Cerebellopontine Angle: A Diagnostic Challenge

    OpenAIRE

    Lassaletta, Luis; Roda, José María; Frutos, Remedios; Patrón, Mercedes; Gavilán, Javier

    2002-01-01

    Facial nerve schwannomas are rare lesions that may involve any segment of the facial nerve. Because of their rarity and the lack of a consistent clinical and radiological pattern, facial nerve schwannomas located at the cerebellopontine angle (CPA) and internal auditory canal (IAC) represent a diagnostic and therapeutic challenge for clinicians. In this report, a case of a CPA/IAC facial nerve schwannoma is presented. Contemporary diagnosis and management of this rare lesion are analyzed.

  15. Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases

    Directory of Open Access Journals (Sweden)

    Varun Sharma Tandra

    2015-01-01

    Full Text Available Giant cell tumour (GCT is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge.

  16. CT findings of esophageal schwannoma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Man Ho; Ryu, Dae Shick; Eom, Dae Woon; Shin, Dong Rock; Choi, Soo Jung; Ahn, Jae Hong; Park, Man Soo; Yoo, Dong Kon [Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung (Korea, Republic of)

    2015-03-15

    Esophageal schwannomas are a relative rare benign neoplasm that usually occurs in the upper esophagus, in the middle aged women. We report a case of a 67-year-old man with a lower esophageal schwannoma. This lesion was composed of homogenous density, iso-attenuating with the chest wall muscle on pre- and post-contrast chest computed tomography (CT). The CT findings of the esophageal schwannoma are similar to those of esophageal leiomyoma. Hense, esophageal schwannoma may be a differential diagnosis with esophageal leiomyoma.

  17. Clinicopathological and Immunohistochemical Characterisation of Gastric Schwannomas in 29 Cases

    Science.gov (United States)

    Zheng, Lijun; Wu, Xiaojiang; Kreis, Martin E.; Yu, Zhen; Feng, Lijin; Chen, Chunqiu; Xu, Bin; Bu, Zhaode; Li, Ziyu; Ji, Jiafu

    2014-01-01

    Schwannomas are tumors arising from the nervous system that also occur infrequently in the gastrointestinal tract, most commonly in the stomach. This report characterizes 29 patients with benign or malignant gastric schwannomas. Surgical data and clinical follow-up information were available for 28 cases with a median postoperative duration of 57 months. Clinicopathological and immunohistochemical characteristics of benign and malignant schwannomas were analysed. Four cases (13.7%) were histologically diagnosed with malignant schwannoma. All tumors were positive for S-100 and CD56 proteins, displaying a diffuse staining pattern. Vimentin was expressed in 100% cases and all schwannomas were negative for smooth muscle actin, c-kit, and HMB-45. A significant difference was observed between the group of benign and malignant schwannomas as regards recurrences and metastasis after complete resection (P = 0.015). The survival time of patients with benign schwannomas was longer than the malignant group (P = 0.013), so gastric malignant schwannomas have a potential for recurrence and metastasis, with subsequently short survival. Complete resection with an attempt to remove all tumor tissue with negative margins is of paramount importance in the management of gastric schwannomas, particularly when they turn out to be malignant. PMID:24688535

  18. Clinicopathological and Immunohistochemical Characterisation of Gastric Schwannomas in 29 Cases

    Directory of Open Access Journals (Sweden)

    Lijun Zheng

    2014-01-01

    Full Text Available Schwannomas are tumors arising from the nervous system that also occur infrequently in the gastrointestinal tract, most commonly in the stomach. This report characterizes 29 patients with benign or malignant gastric schwannomas. Surgical data and clinical follow-up information were available for 28 cases with a median postoperative duration of 57 months. Clinicopathological and immunohistochemical characteristics of benign and malignant schwannomas were analysed. Four cases (13.7% were histologically diagnosed with malignant schwannoma. All tumors were positive for S-100 and CD56 proteins, displaying a diffuse staining pattern. Vimentin was expressed in 100% cases and all schwannomas were negative for smooth muscle actin, c-kit, and HMB-45. A significant difference was observed between the group of benign and malignant schwannomas as regards recurrences and metastasis after complete resection (P=0.015. The survival time of patients with benign schwannomas was longer than the malignant group (P=0.013, so gastric malignant schwannomas have a potential for recurrence and metastasis, with subsequently short survival. Complete resection with an attempt to remove all tumor tissue with negative margins is of paramount importance in the management of gastric schwannomas, particularly when they turn out to be malignant.

  19. Solitary Schwannoma in the breast: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Yun Jung; Kim, Ji Young; Park, Kyeong Mee; Han, Se Hwan; Kim, Soung Hee; Jeong, Myeong Ja; Kim, Soo Hyun [Sanggye Paik Hospital, Inje University, Seoul (Korea, Republic of)

    2006-08-15

    Schwannoma (neurilemoma) is a benign nerve tumor derived from the nerve sheath. The most common locations are the flexor surfaces of the extremities, and the head and the neck. Schwannoma of the breast is unusual. To our knowledge, few studies have reported the radiologic appearance of Schwannoma in the breast and there has been only one report from Korea (1-3). This tumor can be clinically and radiologically considered to be fibroadenoma, which is a common benign tumor of the breast. We describe the mammographic and sonographic findings of a case of Schwannoma in the breast.

  20. MR myelography of sacral meningeal cysts

    International Nuclear Information System (INIS)

    Tsuchiya, K.; Katase, S.; Hachiya, J.

    1999-01-01

    Purpose: To describe the findings of sacral meningeal cysts (SMCs) on MR myelography and assess its value for the diagnosis of SMCs. Material and Methods: We evaluated the MR images and MR myelograms obtained from 10 patients with SMC. MR myelograms were obtained using a 2D or 3D single-shot fast spin-echo sequence. In 5 patients, X-ray myelograms and postmyelographic CT images were compared with the MR myelograms. Results: A total of 33 SMCs were diagnosed within the spinal canal and/or sacral foramen. MR myelograms clearly revealed each cyst as a well-defined mass showing hyperintensity (10 cysts) or isointensity (23 cysts) compared to cerebrospinal fluid. MR myelograms demonstrated SMCs better than X-ray myelograms and postmyelographic CT images in 3 of the 5 patients. Conclusion: MR myelography can be an adjunct to conventional imaging techniques when surgical treatment is indicated, because it can precisely delineate the extent of SMCs. (orig.)

  1. Sacrality and worldmaking: new categorial perspectives

    Directory of Open Access Journals (Sweden)

    William E. Paden

    1999-01-01

    Full Text Available The category of the sacred in particular and the role of transcultural concept-formation in general have undergone an obvious crisis. For the most part, "the sacred," if not an empty label, has been linked with theologism, and transcultural concepts have been condemned for their general non-comparability and colonialist intent. The author approaches the matter of transcultural templates through an analysis of certain concepts of sacrality. With some exceptions, the discourse of sacrality has indeed been dominated by a single model, where "the sacred" became a reified noun—a substantive term for a supernatural reality, a label for the transcendent, or even an epithet for divinity, mystery, the wholly other. As such, the expression has functioned to bestow a sense of unity to the diversity of cultures, link that unity with a transcendent reality, and offer a simple way of making sense of otherwise foreign beliefs and practices by giving them a familiar, generic referent.

  2. Pneumorrhachis Secondary From Sacral Decubitus Ulcer

    OpenAIRE

    Moayedi, Siamak; Babin, Lisa

    2016-01-01

    An elderly woman with a chronic decubitus sacral ulcer presented to the emergency department with sepsis. A computed tomography of her abdomen showed diffuse gas extending throughout the thoracolumbar spinal canal. Pneumorrhachis is a rare radiographic finding defined as gas within the spinal canal. There are many causes of pneumorrhachis ranging from trauma to infection. In this case the pneumorrhachis was caused by direct spread of gas-forming organisms from vertebral osteomyelitis. Emergen...

  3. [Sacral pressure sores and their treatment].

    Science.gov (United States)

    Bielecki, Marek; Skowroński, Rafał; Skowroński, Jan

    2006-01-01

    Sacral bed sores still present a serious problem in most surgery departments. They occur mainly in elderly patients of limited mobility. The treatment of such sores extends over long periods of time and therefore involves considerable costs. The material consisted of 11 sacral pressure ulcers treated surgically. The sores occurred in 4 severely disabled patients suffering from proximal third femur fractures, 4 patients with traumatic brain injury (treated in the Intensive Care Unit), and 3 patients suffering from bed sores after spinal cord injury. In 6 patients a fasciocutaneous flap was applied to the sores and in 5 cases a pedicled musculocutaneous gluteus maximus flap. The end results were assessed using Seiler's criteria. Complications of the "seroma" type were observed in 3 patients, and in 2 marginal necrosis. In all our patients complete healing was achieved within 2-4 weeks. On analysing our experience to date in surgical treatment of bed sores we are of the opinion that even extensive sacral sores can be covered with unilateral pedicled flaps provided that they are appropriately planned. Deep sores of the 4th degree sometimes with concomitant osteomyelitis require pedicled muscle flaps or in some cases musculocutaneous flaps to improve local circulation. The preparation of the patient for reconstruction surgery is just as important as the operation itself and therefore such preparation should never be neglected.

  4. Transcutaneous sacral neurostimulation for irritative voiding dysfunction.

    Science.gov (United States)

    Walsh, I K; Johnston, R S; Keane, P F

    1999-01-01

    Patients with irritative voiding dysfunction are often unresponsive to standard clinical treatment. We evaluated the response of such individuals to transcutaneous electrical stimulation of the third sacral nerve. 32 patients with refractory irritative voiding dysfunction (31 female and 1 male; mean age 47 years) were recruited to the study. Ambulatory transcutaneous electrical neurostimulation was applied bilaterally to the third sacral dermatomes for 1 week. Symptoms of frequency, nocturia, urgency, and bladder pain were scored by each patient throughout and up to 6 months following treatment. The mean daytime frequency was reduced from 11.3 to 7.96 (p = 0.01). Nocturia episodes were reduced from a mean of 2.6 to 1.8 (p = 0.01). Urgency and bladder pain mean symptom scores were reduced from 5.97 to 4.89 and from 1.48 to 0.64, respectively. After stopping therapy, symptoms returned to pretreatment levels within 2 weeks in 40% of the patients and within 6 months in 100%. Three patients who continued with neurostimulation remained satisfied with this treatment modality at 6 months. Transcutaneous third sacral nerve stimulation may be an effective and noninvasive ambulatory technique for the treatment of patients with refractory irritative voiding dysfunction. Following an initial response, patients may successfully apply this treatment themselves to ensure long-term relief.

  5. Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas?

    International Nuclear Information System (INIS)

    Pollock, Bruce E.; Foote, Robert L.; Stafford, Scott L.

    2002-01-01

    Purpose: To review patient outcomes after radiosurgery of nonvestibular schwannomas. Methods and Materials: From April 1992 to February 2000, 23 patients had radiosurgery at our center for nonvestibular schwannomas. Affected cranial nerves included the trochlear (n=1), trigeminal (n=10), jugular foramen region (n=10), and hypoglossal (n=2). Nine patients had undergone one or more prior tumor resections. One patient had a malignant schwannoma; 2 patients had neurofibromatosis. The median prescription isodose volume was 8.9 cc (range, 0.2 to 17.6 cc). The median tumor margin dose was 18 Gy (range, 12 to 20 Gy); the median maximum dose was 36 Gy (range, 24 to 40 Gy). The median follow-up after radiosurgery was 43 months (range, 12 to 111 months). Results: Twenty-two of 23 tumors (96%) were either smaller (n=12) or unchanged in size (n=10) after radiosurgery. One patient with a malignant schwannoma had tumor progression outside the irradiated volume despite having both radiosurgery and fractionated radiation therapy (50.4 Gy); he died 4 years later. Morbidity related to radiosurgery occurred in 4 patients (17%). Three of 10 patients with trigeminal schwannomas suffered new or worsened trigeminal dysfunction after radiosurgery. One patient with a hypoglossal schwannoma had eustachian tube dysfunction after radiosurgery. No patient with a lower cranial nerve schwannoma developed any hearing loss, facial weakness, or swallowing difficulty after radiosurgery. Conclusions: Although the reported number of patients having radiosurgery for nonvestibular schwannomas is limited, the high tumor control rates demonstrated after vestibular schwannoma radiosurgery should apply to these rare tumors. Compared to historical controls treated with surgical resection, radiosurgery appears to have less treatment-associated morbidity for nonvestibular schwannomas, especially for schwannomas involving the lower cranial nerves

  6. Complications of microsurgery of vestibular schwannoma

    Czech Academy of Sciences Publication Activity Database

    Betka, J.; Zvěřina, E.; Balogová, Zuzana; Profant, Oliver; Skřivan, J.; Kraus, J.; Lisý, J.; Syka, Josef; Chovanec, M.

    2014-01-01

    Roč. 2014, May 28 (2014), s. 315952 ISSN 2314-6133 R&D Projects: GA MZd NT12459 Grant - others:GA MZd(CZ) NT11543; GA MŠk(CZ) UNCE 204013; GA UK(CZ) SVV 266513; GA MŠk(CZ) Prvouk-P27/LF1/1 Institutional support: RVO:68378041 Keywords : acoustic neurona surgery * tumor surgery * vestibular schwannomas Subject RIV: FF - HEENT, Dentistry Impact factor: 1.579, year: 2014

  7. Pelvic schwannoma in the right parametrium

    Directory of Open Access Journals (Sweden)

    Machairiotis N

    2013-03-01

    Full Text Available Nikolaos Machairiotis,4 Paul Zarogoulidis,3 Aikaterini Stylianaki,1 Eleni Karatrasoglou,4 Georgia Sotiropoulou,4 Alvin Floreskou,4 Eleana Chatzi,4 Athanasia Karamani,4 Georgia Liapi,5 Eleni Papakonstantinou,5 Nikolaos Katsikogiannis,1 Nikolaos Courcoutsakis,2 Christodoulos Machairiotis4 1Surgery Department, 2Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 3Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 4Obstetric Gynecology Department, 5Pathology Department, Thriasio General Hospital, Athens, Greece Abstract: Neurilemomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells. These tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area (less than 0.5% of reported cases, unless they are combined with von Recklinghausen disease (type 1 neurofibromatosis. We report the case of a 58-year-old female with pelvic schwannoma, 6.5 × 5.5 cm in size, in the right parametrium. This is the first case reported in the literature. Based on the rarity of this tumor and in order to ensure optimum treatment and survival for our patient, we performed laparotomy with total abdominal hysterectomy and en-block tumor excision. A frozen section was taken during the surgery before complete resection of the mass, which was ambiguous. Because of the possibility of malignancy, complete excision of the mass was performed, with pelvic blunt dissection. Histological examination showed a benign neoplasm, originating from the cells of peripheral nerve sheaths; diagnosis was a schwannoma. There were degenerative areas, including cystic degeneration, hemorrhagic infiltrations, ischemic foci with pycnotic cells, and collagen replacement. Pelvic schwannomas are rare neoplasms that can be misdiagnosed. Laparoscopy is a safe

  8. Intraparenchymal schwannoma of the frontal lobe.

    Directory of Open Access Journals (Sweden)

    Deogaonkar M

    1994-10-01

    Full Text Available A 45 year old woman with bifrontal headaches and progressive diminution in vision over 6 months was found to have bilateral papilloedema. CT scan showed large right frontal lesion with surrounding oedema. Right basal frontotemporal craniotomy was performed to excise the multinodular, intraparenchymatous tumor. Hispathology confirmed the diagnosis of schwannoma. Post-operative course was uneventful with disappearance of pre-operative signs and symptoms.

  9. Radiotherapy for Vestibular Schwannomas: A Critical Review

    International Nuclear Information System (INIS)

    Murphy, Erin S.; Suh, John H.

    2011-01-01

    Vestibular schwannomas are slow-growing tumors of the myelin-forming cells that cover cranial nerve VIII. The treatment options for patients with vestibular schwannoma include active observation, surgical management, and radiotherapy. However, the optimal treatment choice remains controversial. We have reviewed the available data and summarized the radiotherapeutic options, including single-session stereotactic radiosurgery, fractionated conventional radiotherapy, fractionated stereotactic radiotherapy, and proton beam therapy. The comparisons of the various radiotherapy modalities have been based on single-institution experiences, which have shown excellent tumor control rates of 91-100%. Both stereotactic radiosurgery and fractionated stereotactic radiotherapy have successfully improved cranial nerve V and VII preservation to >95%. The mixed data regarding the ideal hearing preservation therapy, inherent biases in patient selection, and differences in outcome analysis have made the comparison across radiotherapeutic modalities difficult. Early experience using proton therapy for vestibular schwannoma treatment demonstrated local control rates of 84-100% but disappointing hearing preservation rates of 33-42%. Efforts to improve radiotherapy delivery will focus on refined dosimetry with the goal of reducing the dose to the critical structures. As future randomized trials are unlikely, we suggest regimented pre- and post-treatment assessments, including validated evaluations of cranial nerves V, VII, and VIII, and quality of life assessments with long-term prospective follow-up. The results from such trials will enhance the understanding of therapy outcomes and improve our ability to inform patients.

  10. A Case Report of Schwannoma Presenting as Sciatica

    Directory of Open Access Journals (Sweden)

    A Afshar Fard

    2012-08-01

    The patient underwent operation and sciatic nerve explored via posterior tight and unique neural branch of mass dissociated of sciatic and mass resected. Pathology report confirmed Schwannoma in the patient. Conclusion: In patients with sciatic pain, schwannoma nerve is one of the differential diagnosis and it needs to be considered in assessing of patients.

  11. Molecular characterization of chromosome 22 deletions in schwannomas

    NARCIS (Netherlands)

    Bijlsma, E. K.; Brouwer-Mladin, R.; Bosch, D. A.; Westerveld, A.; Hulsebos, T. J.

    1992-01-01

    Schwannomas are tumors of the cranial, spinal, and peripheral nerve sheaths that originate from Schwann cells. Acoustic neurinomas are the most frequent cranial schwannomas. They might develop sporadically or in the context of neurofibromatosis type 2 (NF2). Loss of part or all of chromosome 22 is

  12. Malignant Transformation of Vagal Nerve Schwannoma in to ...

    African Journals Online (AJOL)

    Schwannomas are benign, rare peripheral nerve sheath tumors that occur in the head and neck region. Some physicians opt to closely observe cases of schwannoma of the neck on an outpatient basis rather than to perform radical surgery. However, there is a possibility, albeit rare, of malignant transformation of a benign ...

  13. Malignant Transformation of Vagal Nerve Schwannoma in to ...

    African Journals Online (AJOL)

    Vagal schwannomas are benign, rare peripheral nerve sheath tumors in the head and neck region. Some physicians opt to closely observe cases of schwannoma of the neck on an outpatient basis rather than to perform radical surgery. However, there is a possibility, albeit rare, of malignant transformation of a.

  14. Translabyrinthine surgery for disabling vertigo in vestibular schwannoma patients

    NARCIS (Netherlands)

    Godefroy, W. P.; Hastan, D.; van der Mey, A. G. L.

    2007-01-01

    To determine the impact of translabyrinthine surgery on the quality of life in vestibular schwannoma patients with rotatory vertigo. Prospective study in 18 vestibular schwannoma patients. The study was conducted in a multispecialty tertiary care clinic. All 18 patients had a unilateral

  15. Long-term hearing preservation in vestibular schwannoma

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Thomsen, Jens; Tos, Mirko

    2010-01-01

    The aim of the present study was to evaluate the long-term hearing during "wait and scan" management of vestibular schwannomas.......The aim of the present study was to evaluate the long-term hearing during "wait and scan" management of vestibular schwannomas....

  16. Tracheal schwannoma: Completely resected with therapeutic bronchoscopic techniques

    Directory of Open Access Journals (Sweden)

    Barney Thomas Jesudason Isaac

    2015-01-01

    Full Text Available Tracheal schwannomas are rare benign tumors of the trachea. There are only a few reported cases in the literature. Surgeons have generally resected these tumors, whereas bronchoscopists have attempted to remove them bronchoscopically. We report a case of tracheal schwannoma which was completely resected using bronchoscopic techniques.

  17. Benign intramural schwannoma of the esophagus ? case report

    OpenAIRE

    Kozak, Katarzyna; Kowalczyk, Mateusz; Jesionek-Kupnicka, Dorota; Kozak, J?zef

    2015-01-01

    Schwannomas of the esophagus are rare peripheral nerve tumors. A 37-year-old woman with dysphagia was found to have an intramural tumor of the upper esophagus. The lesion was revealed on computed tomography. Endoscopic ultrasound biopsy was nondiagnostic. Through right thoracotomy, the mass was enucleated from the wall of the esophagus. Benign schwannoma was diagnosed only after immunological staining examination.

  18. Laparoscopic resection of an obturator schwannoma: a case report

    Institute of Scientific and Technical Information of China (English)

    YI Ke; WANG Yu-mei; CHEN Jie

    2010-01-01

    @@ Schwannomas are usually benign tumors that arise from a nerve supporting the Schwann cells, those are mostly associated with the cranial or main peripheral nerves. The occurrence of retroperitoneal schwannoma is quite rare, and in such a case, surgical excision is the first option for treatment.

  19. Giant Cell Tumors of the Axial Skeleton

    Directory of Open Access Journals (Sweden)

    Maurice Balke

    2012-01-01

    Full Text Available Background. We report on 19 cases of giant cell tumor of bone (GCT affecting the spine or sacrum and evaluate the outcome of different treatment modalities. Methods. Nineteen patients with GCT of the spine (=6 or sacrum (=13 have been included in this study. The mean followup was 51.6 months. Ten sacral GCT were treated by intralesional procedures of which 4 also received embolization, and 3 with irradiation only. All spinal GCT were surgically treated. Results. Two (15.4% patients with sacral and 4 (66.7% with spinal tumors had a local recurrence, two of the letter developed pulmonary metastases. One local recurrence of the spine was successfully treated by serial arterial embolization, a procedure previously described only for sacral tumors. At last followup, 9 patients had no evidence of disease, 8 had stable disease, 1 had progressive disease, 1 died due to disease. Six patients had neurological deficits. Conclusions. GCT of the axial skeleton have a high local recurrence rate. Neurological deficits are common. En-bloc spondylectomy combined with embolization is the treatment of choice. In case of inoperability, serial arterial embolization seems to be an alternative not only for sacral but also for spinal tumors.

  20. Unusually large quiescent ancient schwannoma of hypoglossal nerve

    Directory of Open Access Journals (Sweden)

    Sangeeta P Wanjari

    2013-01-01

    Full Text Available Ancient schwannoma is considered as a variant of schwannoma, comprising about 10% of all schwanommas. Schwannoma is a benign neoplasm derived from the nerve sheath of peripheral motor, sensory and sympathetic nerves and from the cranial nerve pairs. It usually presents as a solitary soft-tissue lesion which is slow growing, encapsulated and is often associated with nerve attached peripherally. Diagnosis is often confirmed with the microscopic examination. The long standing schwannoma attributes to degenerative changes and is termed "ancient" schwannoma. Present case is of a 68-year-old female patient who reported with an asymptomatic large swelling below mandible on the left side since last 23 years. The lesion was surgically excised under general anesthesia.

  1. Laparoscopic mesh explantation and drainage of sacral abscess remote from transvaginal excision of exposed sacral colpopexy mesh.

    Science.gov (United States)

    Roth, Ted M; Reight, Ian

    2012-07-01

    Sacral colpopexy may be complicated by mesh exposure, and the surgical treatment of mesh exposure typically results in minor postoperative morbidity and few delayed complications. A 75-year-old woman presented 7 years after a laparoscopic sacral colpopexy, with Mersilene mesh, with an apical mesh exposure. She underwent an uncomplicated transvaginal excision and was asymptomatic until 8 months later when she presented with vaginal drainage and a sacral abscess. This was successfully treated with laparoscopic enterolysis, drainage of the abscess, and explantation of the remaining mesh. Incomplete excision of exposed colpopexy mesh can lead to ascending infection and sacral abscess. Laparoscopic drainage and mesh removal may be considered in these patients.

  2. MRI findings of giant plasmacytoma of the calvarium

    International Nuclear Information System (INIS)

    Ishii, Norihiro; Suzuki, Yasuo; Ishii, Ryoji

    2007-01-01

    We report two cases of giant plasmacytoma of the calvarium with the dural tail sign. Though the dural tail sign has been reported as a highly specific finding of meningiomas, the recent literature has described its appearance with other tumors, such as schwannomas, lymphomas, and metastatic brain tumors. Therefore, we reviewed 10 cases of plasmacytomas with a dural tail sign including our two cases and discussed the origin of dural tail signs. It was concluded that giant plasmacytoma of the calvarium is one of the entities that produces a dural tail sign. (author)

  3. Bladder compliance after posterior sacral root rhizotomies and anterior sacral root stimulation

    NARCIS (Netherlands)

    Koldewijn, E. L.; van Kerrebroeck, P. E.; Rosier, P. F.; Wijkstra, H.; Debruyne, F. M.

    1994-01-01

    To evaluate the effects of central detrusor denervation on bladder compliance, we studied 27 patients with complete suprasacral spinal cord injury in whom intradural posterior sacral root rhizotomies from S2 to S5 in combination with implantation of an intradural Finetech-Brindley bladder stimulator

  4. Pneumorrhachis Secondary to a Sacral Decubitus Ulcer

    Directory of Open Access Journals (Sweden)

    Siamak Moayedi

    2016-06-01

    Full Text Available An elderly woman with a chronic decubitus sacral ulcer presented to the emergency department with sepsis. A computed tomography of her abdomen showed diffuse gas extending throughout the thoracolumbar spinal canal. Pneumorrhachis is a rare radiographic finding defined as gas within the spinal canal. There are many causes of pneumorrhachis ranging from trauma to infection. In this case the pneumorrhachis was caused by direct spread of gas-forming organisms from vertebral osteomyelitis. Emergency physicians should know about the implication of gas in the spinal canal in the setting of sepsis. [West J Emerg Med. 2016;17(4:466-468.

  5. [Primary genital herpes with sacral meningoradiculitis].

    Science.gov (United States)

    Carron, P-N; Anguenot, J-L; Dubuisson, J-B

    2004-02-01

    Herpetic genital infection is a common sexually transmitted disease, caused in most cases by type 2 Herpes simplex virus (HSV2). This virus is characterized by its neurotropic properties and its ability to establish latency in sacral sensory ganglions. Some cases of genital primo-infection are complicated by viral replication dissemination to neigbhoring nerve structures like meninges and radicular terminations. In such cases muco-cutaneous manifestations are associated with peripheral neurological impairment in the form of meningo-radiculitis. Physicians should be familiar with these neurological symptoms knowing that they always regress completely. The present report illustrates these complications and reviews the potential neurological implications described in the literature.

  6. Postpartum Sacral Stress Fracture: An Atypical Case Report

    Directory of Open Access Journals (Sweden)

    Andrea Speziali

    2015-01-01

    Full Text Available Sacral stress fractures are common in elderly people. However, sacral stress fracture should be always screened in the differential diagnoses of low back pain during the postpartum period. We present a case of sacral fracture in a thirty-six-year-old woman with low back pain and severe right buttock pain two days after cesarean section delivery of a 3.9 Kg baby. The diagnosis was confirmed by MRI and CT scan, while X-ray was unable to detect the fracture. Contribution of mechanical factors during the cesarean section is not a reasonable cause of sacral fracture. Pregnancy and lactation could be risk factors for sacral stress fracture even in atraumatic delivery such as cesarean section. Our patient had no risk factors for osteoporosis except for pregnancy and lactation. Transient or focal osteoporosis is challenging to assess and it cannot be ruled out even if serum test and mineral density are within the normal range.

  7. Peripheral Vestibular System Disease in Vestibular Schwannomas

    DEFF Research Database (Denmark)

    Møller, Martin Nue; Hansen, Søren; Caye-Thomasen, Per

    2015-01-01

    density of the peripheral vestibular nerve branches, and atrophy of the neuroepithelium of the vestibular end organs. In cases with small tumors, peripheral disease occurred only in the tissue structures innervated by the specific nerve from which the tumor originated. CONCLUSION: Vestibular schwannomas...... are associated with distinctive disease of the peripheral vestibular tissue structures, suggesting anterograde degeneration and that dizziness in these patients may be caused by deficient peripheral vestibular nerve fibers, neurons, and end organs. In smaller tumors, a highly localized disease occurs, which...

  8. Schwannoma of the sublingual gland: report of a case

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Sook; Choi, Soon Chul; Park, Tae Won; You, Dong Soo [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1994-08-15

    Schwannoma, also referred to as neurilemmoma, is a solitary, benign and slow growing tumor of nerve sheath origin. This rare lesion originates from Schwann cell of peripheral, autonomic and cranial nerve. Extracranial neurogenic tumor of the head and neck is uncommon. Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumor, with most presenting in the parotid gland originating from a peripheral branch of the facial nerve. In this report, an unusual case of schwannoma in the sublingual region is presented and the literature concerning this subject is reviewed.

  9. Sacral-neuromodulation CT-guided; Nuova tecnica di centraggio TC-assistista nella neuromodulazione sacrale

    Energy Technology Data Exchange (ETDEWEB)

    Amoroso, Lamberto; Ricci, Stefano [INRCA, Ancona (Italy). Dipartimento di radiologia e medicina nucleare; Pelliccioni, Giuseppe; Scarpino, Osvaldo [INRCA, Ancona (Italy). Unita' operativa di radiologia; Ghiselli, Roberto; Saba, Vittorio [INRCA, Ancona (Italy). Dipartimento di chirurgia

    2005-04-01

    Purpose: Sacral neuromodulation is a new treatment for refractory voiding disorders such as urge incontinence, urinary retention, frequency-urgency syndromes and faecal incontinence. The current approach to sacral nerve stimulation consists of a two-stage procedure. The first is a PNE test (Percutaneous Nerve Evaluation) by a provisional electrically stimulated spinal needle, placed percutaneously in the S3 foramina for four of ten days. If successful, the second stage, permanent implantation, is carried out. The PNE test is performed under fluoroscopic control using the palpable bony sacral foramina as referral points. This technique can show some limitations, such as operator Rx exposure, poor visualization of sacral foramina because of bowel gas artefacts or sacral malformation. In order to reduce these inconveniences and to improve efficiency of the test we tried an alternative technique. The purpose of our study was to test the use of CT as an alternative technique in order to evaluate its advantages and possible routine use. Materials and methods: We tested 30 patients with the PNE test under CT guidance (16 males and 14 females) suffering from serious pelvic disorders and not responding to the normal therapeutic regime. Twenty-seven patient showed relative anatomical integrity of the pelvis and the sacrum, the remaining 3 patients presented morphological anormalities of the sacral foramina. With the patient in the prone position the sacral foramina were identified with CT volumetric scanning using a spiral CT scanner equipped with a second console for the three-dimensional reconstructions. Having identified the location of the S3 foramina, a sterile field was prepared and the spiral needle introduced checking correct positioning with a CT control scan. An electrode was inserted after having checked correct muscular contractile response and the precise position with a further CT scan. Results: Thirty patients were subjected to PNE under CT guidance for a

  10. MR imaging of cranial nerve schwannomas

    International Nuclear Information System (INIS)

    Shapiro, M.; Peyster, R.; Cross, R.R.; Charles, J.; Murtagh, R.; Shapiro, R.; Chyatte, D.

    1988-01-01

    One of the major advantages of magnetic resonance (MR) imaging over other imaging modalities is direct visualization of the cranial nerves. This is best accomplished with thin-section, contiguous T1-weighted images. They report a series of 75 cranial nerve neuromas, including 47 of the eighth nerve and a mixture of schwannomas involving all other cranial nerves (excluding the fourth). All tumors demonstrated at least some area of increased signal (equal to or greater than that of cerebrospinal fluid) on T2-weighted images. This fact enabled them to differentiate schwannomas from neoplasms (lymphoma, meningioma, sarcoma) that may be isointense on T2-weighted pulse sequences. Many of the lesions had areas of low signal intermixed with predominantly high signal (on T2-weighted images). The pathologic evaluation of these areas of decreased signal revealed predominant fibrosis. In addition, some of the neuromas had a cystic component. Gadolinium-enhanced MR imaging may permit detection when the nerve is still normal in size

  11. Schwannoma of the left brachial plexus mimicking a ...

    African Journals Online (AJOL)

    Schwannoma of the left brachial plexus mimicking a cervicomediastinal ... Her voice was hoarse but there was no eye signs suggestive of thyrotoxicosis. ... A presumptive diagnosis of thyroid carcinoma with retrosternal extension was made.

  12. Distinct spontaneous shrinkage of a sporadic vestibular schwannoma

    DEFF Research Database (Denmark)

    Huang, Xiaowen; Cayé-Thomasen, Per; Stangerup, Sven-Eric

    2013-01-01

    on "shrinkage" or "negative growth" or "regression" or "involution" of the tumor were selected, and the contents on the rate, extent and mechanism of spontaneous tumor shrinkage were extracted and reviewed. The reported rate of spontaneous shrinkage of vestibular schwannoma is 5-10% of patients managed......We present a case with outspoken spontaneous vestibular schwannoma shrinkage and review the related literature. The patient was initially diagnosed with a left-sided, intrameatal vestibular schwannoma, which subsequently grew into the cerebello-pontine angle (CPA), followed by total shrinkage...... of the CPA component without any intervention over a 12-year observation period. The literature on spontaneous tumor shrinkage was retrieved by searching the subject terms "vestibular schwannoma, conservative management" in PubMed/MEDLINE database, without a time limit. Of the published data, the articles...

  13. Rare presentation of pancreatic schwannoma: a case report

    Directory of Open Access Journals (Sweden)

    Tofigh Arash

    2008-08-01

    Full Text Available Abstract Introduction Schwannoma is a rare tumor among pancreatic neoplasms. Schwannomas vary in size, and most of them are cystic, mimicking pancreatic cystic lesions. Generally, a definitive diagnosis is made at the time of histological analysis. The mainstay treatment is surgical resection. Case presentation We report an unusual presentation of pancreatic schwannoma with abdominal pain and several episodes of cholangitis in a 54-year-old Caucasian (Iranian man. The condition was not diagnosed pre-operatively and Whipple's procedure was performed. Conclusion Pancreatic schwannoma is an important clinical entity to include in the differential diagnosis of pancreatic lesions. Pre-operative diagnosis is difficult but computed tomographic findings may be helpful. The tumor may also have atypical and rare presentations, such as cholangitis and weight loss. For benign tumors, simple enucleation is usually adequate, whereas malignant tumors require standard oncological resection.

  14. Vestibular schwannoma with contralateral facial pain – case report

    Directory of Open Access Journals (Sweden)

    Ghodsi Mohammad

    2003-03-01

    Full Text Available Abstract Background Vestibular schwannoma (acoustic neuroma most commonly presents with ipsilateral disturbances of acoustic, vestibular, trigeminal and facial nerves. Presentation of vestibular schwannoma with contralateral facial pain is quite uncommon. Case presentation Among 156 cases of operated vestibular schwannoma, we found one case with unusual presentation of contralateral hemifacial pain. Conclusion The presentation of contralateral facial pain in the vestibular schwannoma is rare. It seems that displacement and distortion of the brainstem and compression of the contralateral trigeminal nerve in Meckel's cave by the large mass lesion may lead to this atypical presentation. The best practice in these patients is removal of the tumour, although persistent contralateral pain after operation has been reported.

  15. Spinal accessory nerve schwannomas masquerading as a fourth ventricular lesion

    Directory of Open Access Journals (Sweden)

    Shyam Sundar Krishnan

    2015-01-01

    Full Text Available Schwannomas are benign lesions that arise from the nerve sheath of cranial nerves. The most common schwannomas arise from the 8 th cranial nerve (the vestibulo-cochlear nerve followed by trigeminal and facial nerves and then from glossopharyngeal, vagus, and spinal accessory nerves. Schwannomas involving the oculomotor, trochlear, abducens and hypoglossal nerves are very rare. We report a very unusual spinal accessory nerve schwannoma which occupied the fourth ventricle and extended inferiorly to the upper cervical canal. The radiological features have been detailed. The diagnostic dilemma was due to its midline posterior location mimicking a fourth ventricular lesion like medulloblastoma and ependymoma. Total excision is the ideal treatment for these tumors. A brief review of literature with tabulations of the variants has been listed.

  16. Recurrent meningitis in a case of congenital anterior sacral meningocele and agenesis of sacral and coccygeal vertebrae Meningite recorrente em um paciente com meningocele sacral anterior e agenesia sacral e coccigea

    Directory of Open Access Journals (Sweden)

    Carolina A. R. Funayama

    1995-12-01

    Full Text Available A rare case of recurrent meningitis due to congenital anterior sacral meningocele and agenesis of the sacral and coccygeal vertebrae is described. An autosomal dominant inheritance is demonstrated for lower cord malformation, and environmental factors (chromic acid or fumes are discussed.Um caso raro de meningite recorrente devido a meningocele sacral anterior e agenesia das vértebras sacras coccígeas é descrito. Herança autossômica dominante para malformação medular caudal é demonstrada e, possíveis fatores ambientais (ligados ao cromo, são discutidos.

  17. Four Cases of Urinary Dysfunction Associated with Sacral Herpes Zoster

    OpenAIRE

    松尾, 朋博; 大庭, 康司郎; 宮田, 康好; 井川, 掌; 酒井, 英樹

    2014-01-01

    Herpes zoster is caused by the infection of Varicella-Zoster virus. The anatomical distribution of herpes zoster in the sacral area is only6. 9%1). Moreover, the onset rate of herpes zoster with urinary dysfunction is 0.6%1). The lesion sites of herpes zoster which cause urinary dysfunction are almost lumber and sacral areas. We describe four cases of sacral herpes zoster with urinary dysfunction in this report. All patients were elderly people (66-84 years old), and all patients were adminis...

  18. CT and MR features of the intracranial Schwannomas

    International Nuclear Information System (INIS)

    Jung, So Lyung; Ro, Hee Jeong; Lee, Hong Jae; Jung, Seung Eun; Byun, Jae Young; Yang, Il Kwon; Lee, Han Jin; Choi, Kyu Ho; Kim, Jong Woo; Shinn, Kyung Sub

    1996-01-01

    To evaluate CT and MR findings of the intracranial schwannomas arising from variable cranial nerves. The authors retrospectively analyzed CT (n=21) and MR (n=15) findings of 24 cases in 23 patients (M : 7, F : 16) who had suffered from surgically-proven intracranial schwannomas over the previous five years. Schwannomas arose from the acoustic nerve(n=18), the trigeminal nerve(n=2), the glossopha-ryngeal-vagal-accessory nerve complex (n=2), and the olfactory nerve(n=1). Intracranial schwannomas were well defined, ,lobulated and inhomogeneously or homogeneously enhancing masses on CT and MR, and were located along the course of the specific cranial nerve. Acoustic schwannomas involved both the internal auditory canal(IAC) and the cerebellopontive angle(CPA) in 14 case, the IAC in three, and the SPA in two. Two trigeminal schwannomas involved both middle and posterior cranial fossa and were in the shape of a dumbbell. One of the two schwannomas that invelved lower cranial nerve complex(9-11th) was located in the medullary cistern and jugular foramen ; the other was located in the central posterior cranial fossa. A case of olfactory schwannoma was located in the right cribriform plate. The precontrast CT scan showed low density in 13 cases (62%), isodensity in seven(33%) and high density in one(5%). on postcontrast CT scan, enhancement was seen in 20 cases(95%). Of the 15 cases with MR, 2 had low signal intensity on T1 weighted image and 14 had high signal intensity on T2 weighted image. MR imaging after Gd-DTPA infusion showed enhancement in 14 cases. Enhancement was inhomogeneous in 14 cases on CT and in 13 on MR. Of 24 cases, intratumoral necrosis was seen in 19, ring enhancement in five and severe cystic change in one. Other findings were in tratumoral calcification (21%), hemorrhage(8%), pressure bony erosion(70.8%), midline shift(58%), peritumoral edema(29%) and hydrocephalus(33%). On MR, there was in all 15 cases a peritumoral low signal intensity rim on T1-and

  19. Primary atypical sacral meningioma- not always benign

    International Nuclear Information System (INIS)

    Bhadra, A.K.; Casey, A.T.H.; Saifuddin, A.; Briggs, T.W.

    2007-01-01

    We present a case of an atypical recurrent meningioma of the sacrum with pulmonary metastasis in a 31-year-old man. He presented with deep-seated buttock pain and urinary hesitancy for 3 months. MRI revealed a lesion occupying the central and left side of the sacral canal at the S1-S2 level. Surgical excision of the lesion via a posterior approach was undertaken, and the patient became symptom-free post-operatively. Histology confirmed atypical meningioma. Eight months later he re-presented with similar symptoms, and MRI confirmed local recurrence. The patient underwent left hemisacrectomy. Six months later he again presented with low back pain and MRI confirmed a second local recurrence. A CT scan of the chest showed multiple lung metastases. The patient died of a severe chest infection 18 months later. (orig.)

  20. Primary atypical sacral meningioma- not always benign

    Energy Technology Data Exchange (ETDEWEB)

    Bhadra, A.K.; Casey, A.T.H.; Saifuddin, A.; Briggs, T.W. [Royal National Orthopaedic Hospital, Stanmore, London (United Kingdom)

    2007-06-15

    We present a case of an atypical recurrent meningioma of the sacrum with pulmonary metastasis in a 31-year-old man. He presented with deep-seated buttock pain and urinary hesitancy for 3 months. MRI revealed a lesion occupying the central and left side of the sacral canal at the S1-S2 level. Surgical excision of the lesion via a posterior approach was undertaken, and the patient became symptom-free post-operatively. Histology confirmed atypical meningioma. Eight months later he re-presented with similar symptoms, and MRI confirmed local recurrence. The patient underwent left hemisacrectomy. Six months later he again presented with low back pain and MRI confirmed a second local recurrence. A CT scan of the chest showed multiple lung metastases. The patient died of a severe chest infection 18 months later. (orig.)

  1. Sciatica due to Schwannoma at the Sciatic Notch

    Directory of Open Access Journals (Sweden)

    Yavuz Haspolat

    2013-01-01

    Full Text Available Schwannomas are rarely seen on the sciatic nerve and can cause sciatica. In this case report we aimed to present an unusual location of schwannoma along sciatic nerve that causes sciatica. A 60-years-old-man was admitted to us with complaints of pain on his thigh and paresthesia on his foot. Radiography of the patient revealed a solitary lesion on the sciatic nerve. The lesion was excised and the symptoms resolved after surgery.

  2. Sciatica due to Schwannoma at the Sciatic Notch

    Science.gov (United States)

    Haspolat, Yavuz; Ozkan, Feyza Unlu; Turkmen, Ismail; Kemah, Bahattin; Turhan, Yalcin; Sarar, Serhan; Ozkan, Korhan

    2013-01-01

    Schwannomas are rarely seen on the sciatic nerve and can cause sciatica. In this case report we aimed to present an unusual location of schwannoma along sciatic nerve that causes sciatica. A 60-years-old-man was admitted to us with complaints of pain on his thigh and paresthesia on his foot. Radiography of the patient revealed a solitary lesion on the sciatic nerve. The lesion was excised and the symptoms resolved after surgery. PMID:23762699

  3. Liver schwannoma incidentally discovered in a patient with breast cancer.

    Science.gov (United States)

    Akin, Murat; Bozkirli, Bahadir; Leventoglu, Sezai; Unal, Kemal; Kapucu, L Ozlem; Akyurek, Nalan; Sare, Mustafa

    2009-01-01

    Benign schwannomas, also referred to as neurilemomas, neurinomas, and perineural fibroblastomas, are encapsulated nerve sheath tumors. Primary schwannomas of the liver are extremely rare. We present a case of liver schwannoma, incidentally found in a patient with breast cancer. A 66-year-old female consulted her physician for a mass she palpated on her left breast. The abdominal ultrasonography (USG) revealed a 44 x 28 mm mass in the medial segment of the left lobe of her liver suspicious of a metastasis. An USG-guided biopsy was performed and the histo-pathological examination revealed a "peripheral nerve sheath tumor". Positron emission tomography (PET-CT) revealed a pathologic FDG uptake in the lesion that was previously defined in the liver. The tumor resected from the liver was 5 x 4 x 3 cm, yellowish, soft, and capsulated tumor. Microscopic examination revealed that the mass consisted of bundles of spindle cells with hypercellular and hypocellular areas. In immunohistochemistry, there was a strong positive staining for S-100. The tumor was diagnosed as benign liver schwannoma. Schwannomas are benign, encapsulated neoplasms. Symptoms and signs vary depending on the anatomical site and the size of the neoplasm; however, most schwannomas present as an asymptomatic or painless mass. Recurrence is unusual, despite of an incomplete removal, and malignant transformation is exceedingly rare (Fig. 4, Ref. 8). Full Text (Free, PDF) www.bmj.sk.

  4. Plexiform (multinodular) schwannoma of soft palate. Report of a case.

    Science.gov (United States)

    Kapetanakis, Stylianos; Vasileiadis, Ioannis; Petousis, Aristotelis; Fiska, Aliki; Stavrianaki, Anna

    2012-01-01

    Plexiform schwannoma is a rare benign neoplasm of the neural sheath characterized by a multinodular plexiform growth pattern. Only 5% of schwannomas have a plexiform or multinodular growth pattern. Schwannoma apparently derives from the Schwann cells. Extracranially, 25% of all schwannomas are located in the head and neck region, but only 1% show an intraoral origin. The intraoral lesions show a predilection for the tongue, followed by the palate, buccal mucosa, lip and gingival. Microscopic examination is necessary to confirm the diagnosis. Characteristic histological signs are the palisading of the spindle-shaped Schwann cells around the central acellular area, so called Verocay bodies. We report a case of a 21-year-old woman with a smooth mass of the soft palate that was gradually increasing. Surgical excision of the mass was done and the histopathology and immunohistochemistry study of the excised lesion revealed a multinodular plexiform schwannoma of the soft palate. The patient is under regular clinical control, with no signs of recurrence after 17 months. Plexiform schwannomas of the soft palate are mentioned very rarely in the English literature. This rare benign tumor is worthy of recognition because it can be misdiagnosed as plexiform neurofibroma.

  5. Schwannoma originating from lower cranial nerves: report of 4 cases.

    Science.gov (United States)

    Oyama, Hirofumi; Kito, Akira; Maki, Hideki; Hattori, Kenichi; Noda, Tomoyuki; Wada, Kentaro

    2012-02-01

    Four cases of schwannoma originating from the lower cranial nerves are presented. Case 1 is a schwannoma of the vagus nerve in the parapharyngeal space. The operation was performed by the transcervical approach. Although the tumor capsule was not dissected from the vagus nerve, hoarseness and dysphagia happened transiently after the operation. Case 2 is a schwannoma in the jugular foramen. The operation was performed by the infralabyrinthine approach. Although only the intracapsular tumor was enucleated, facial palsy, hoarseness, dysphagia and paresis of the deltoid muscle occurred transiently after the operation. The patient's hearing had also slightly deteriorated. Case 3 is a dumbbell-typed schwannoma originating from the hypoglossal nerve. The hypoglossal canal was markedly enlarged by the tumor. As the hypoglossal nerves were embedded in the tumor, the tumor around the hypoglossal nerves was not resected. The tumor was significantly enlarged for a while after stereotactic irradiation. Case 4 is an intracranial cystic schwannoma originating from the IXth or Xth cranial nerves. The tumor was resected through the cerebello-medullary fissure. The tumor capsule attached to the brain stem was not removed. Hoarseness and dysphagia happened transiently after the operation. Cranial nerve palsy readily occurs after the removal of the schwannoma originating from the lower cranial nerves. Mechanical injury caused by retraction, extension and compression of the nerve and heat injury during the drilling of the petrous bone should be cautiously avoided.

  6. Giant grains

    International Nuclear Information System (INIS)

    Leitch-Devlin, M.A.; Millar, T.J.; Williams, D.A.

    1976-01-01

    Infrared observations of the Orion nebula have been interpreted by Rowan-Robinson (1975) to imply the existence of 'giant' grains, radius approximately 10 -2 cm, throughout a volume about a parsec in diameter. Although Rowan-Robinson's model of the nebula has been criticized and the presence of such grains in Orion is disputed, the proposition is accepted, that they exist, and in this paper situations in which giant grains could arise are examined. It is found that, while a giant-grain component to the interstellar grain density may exist, it is difficult to understand how giant grains arise to the extent apparently required by the Orion nebula model. (Auth.)

  7. Improved results for vestibular schwannoma radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Flickinger, J C; Kondziolka, D; Pollock, B; Lunsford, L D

    1995-07-01

    PURPOSE/OBJECTIVE: Treatment techniques in radiosurgery have changed since 1987. We reviewed patients who received radiosurgery for vestibular schwannoma to identify these changes and to investigate any differences in tumor control and complications. MATERIALS and METHODS: One hundred thirty-eight unilateral vestibular schwannoma patients with a minimum follow-up of two years after treatment with gamma knife radiosurgery between 1987 and 1992 were analyzed. The early treatment group consisted of 55 patients treated between 1987-1989 (median: tumor volume 3.63 cc, Dmin 18.1 Gy, Dmax 35.4 Gy, isocenters 2.3, follow-up 50.4 mos.). The later treatment group consisted of 83 patients treated between 1990-1992 (median: tumor volume 3.81 cc, Dmin 16.0 Gy, Dmax 31.6 Gy, isocenters 4.7, follow-up 35.8 mos.) RESULTS: Clinical tumor recurrence requiring surgical intervention occurred in one patient in each group. The overall actuarial clinical tumor control rate was 98%. Slight increases in tumor size (1 to 2 mm) were identified in five other patients not requiring intervention, because of no further tumor growth (n=4) or shrinkage (n=1). This led to an overall radiologic tumor control rate of 92% (not significantly different in either group). Compared to the early treatment group, the incidence of facial neuropathy (temporary or permanent) decreased in the later group (49% vs. 11%, p < 0.0001), as did trigeminal neuropathy (40% vs. 8%, p < 0.0001). Serviceable hearing preservation improved only slightly in the later group (27% vs. 40%, p = 0.70). CONCLUSION: We document a significant decrease in the morbidity of vestibular schwannoma radiosurgery over this time period with no decrease in the high rate of tumor control. This improvement is attributed to a) better conformal dose-planning with stereotactic MRI rather than CT, b) an increase in the number of isocenters used, and c) a reduction in the average dose administered by 2 Gy.

  8. Proton beam stereotactic radiosurgery of vestibular schwannomas

    International Nuclear Information System (INIS)

    Harsh, Griffith R.; Thornton, Allan F.; Chapman, Paul H.; Bussiere, Marc R.; Rabinov, James D.; Loeffler, Jay S.

    2002-01-01

    Purpose: The proton beam's Bragg peak permits highly conformal radiation of skull base tumors. This study, prompted by reports of transient (30% each) and permanent (10% each) facial and trigeminal neuropathy after stereotactic radiosurgery of vestibular schwannomas with marginal doses of 16-20 Gy, assessed whether proton beam radiosurgery using a marginal dose of only 12 Gy could control vestibular schwannomas while causing less neuropathy. Methods and Materials: Sixty-eight patients (mean age 67 years) were treated between 1992 and 1998. The mean tumor volume was 2.49 cm 3 . The dose to the tumor margin (70% isodose line) was 12 Gy. The prospectively specified follow-up consisted of neurologic evaluation and MRI at 6, 12, 24, and 36 months. Results: After a mean clinical follow-up of 44 months and imaging follow-up of 34 months in 64 patients, 35 tumors (54.7%) were smaller and 25 (39.1%) were unchanged (tumor control rate 94%; actuarial control rate 94% at 2 years and 84% at 5 years). Three tumors enlarged: one shrank after repeated radiosurgery, one remained enlarged at the time of unrelated death, and one had not been imaged for 4 years in a patient who remained asymptomatic at last follow-up. Intratumoral hemorrhage into one stable tumor required craniotomy that proved successful. Thus, 97% of tumors required no additional treatment. Three patients (4.7%) underwent shunting for hydrocephalus evident as increased ataxia. Of 6 patients with functional hearing ipsilaterally, 1 improved, 1 was unchanged, and 4 progressively lost hearing. Cranial neuropathies were infrequent: persistent facial hypesthesia (2 new, 1 exacerbated; 4.7%); intermittent facial paresthesias (5 new, 1 exacerbated; 9.4%); persistent facial weakness (2 new, 1 exacerbated; 4.7%) requiring oculoplasty; transient partial facial weakness (5 new, 1 exacerbated; 9.4%), and synkinesis (5 new, 1 exacerbated; 9.4%). Conclusion: Proton beam stereotactic radiosurgery of vestibular schwannomas at the

  9. Developmental identity versus typology: Lucy has only four sacral segments.

    Science.gov (United States)

    Machnicki, Allison L; Lovejoy, C Owen; Reno, Philip L

    2016-08-01

    Both interspecific and intraspecific variation in vertebral counts reflect the action of patterning control mechanisms such as Hox. The preserved A.L. 288-1 ("Lucy") sacrum contains five fused elements. However, the transverse processes of the most caudal element do not contact those of the segment immediately craniad to it, leaving incomplete sacral foramina on both sides. This conforms to the traditional definition of four-segmented sacra, which are very rare in humans and African apes. It was recently suggested that fossilization damage precludes interpretation of this specimen and that additional sacral-like features of its last segment (e.g., the extent of the sacral hiatus) suggest a general Australopithecus pattern of five sacral vertebrae. We provide updated descriptions of the original Lucy sacrum. We evaluate sacral/coccygeal variation in a large sample of extant hominoids and place it within the context of developmental variation in the mammalian vertebral column. We report that fossilization damage did not shorten the transverse processes of the fifth segment of Lucy's sacrum. In addition, we find that the extent of the sacral hiatus is too variable in apes and hominids to provide meaningful information on segment identity. Most importantly, a combination of sacral and coccygeal features is to be expected in vertebrae at regional boundaries. The sacral/caudal boundary appears to be displaced cranially in early hominids relative to extant African apes and humans, a condition consistent with the likely ancestral condition for Miocene hominoids. While not definitive in itself, a four-segmented sacrum accords well with the "long-back" model for the Pan/Homo last common ancestor. Am J Phys Anthropol 160:729-739, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  10. Sacral Variability in Tailless Species: Homo sapiens and Ochotona princeps.

    Science.gov (United States)

    Tague, Robert G

    2017-05-01

    Homo sapiens is variable in number of sacral vertebrae, and this variability can lead to obstetrical complication. This study uses the comparative method to test the hypothesis that sacral variability in H. sapiens is associated with absence of a tail. Three species of lagomorphs are studied: Ochotona princeps (N = 271), which is tailless, and Lepus californicus (N = 212) and Sylvilagus audubonii (N = 206), which have tails. Results show that O. princeps has (1) higher diversity index for number of sacral vertebrae (0.49) compared to L. californicus (0.25) and S. audubonii (0.26) and (2) significantly higher percentage of individuals with the species-specific nonmodal number of sacral vertebrae (43.9%) compared to L. californicus (14.2%) and S. audubonii (15.5%). Comparison of H. sapiens (N = 1,030; individuals of age 20-39 years) with O. princeps shows similarities between the species in diversity index (also 0.49 in H. sapiens) and percentage of individuals with nonmodal number of sacral vertebrae (37.3% in H. sapiens). Homeotic transformation best explains the results. H. sapiens and O. princeps show propensity for caudal shift at the sacral-caudal border (i.e., homeotic transformation of the first caudal vertebra to a sacral vertebra). Caudal and cranial shift among presacral vertebrae increases or decreases this propensity, respectively. Increase in number of sacral vertebrae in H. sapiens by homeotic transformation reduces pelvic outlet capacity and can be obstetrically hazardous. Anat Rec, 300:798-809, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  11. L5 radiculopathy due to sacral stress fracture

    International Nuclear Information System (INIS)

    Aylwin, Anthony; Saifuddin, Asif; Tucker, Stuart

    2003-01-01

    We report the case of a 70-year-old man who presented with a history of left buttock pain with radiation into the left leg in an L5 distribution. MRI of the lumbar spine revealed a left sacral stress fracture with periosteal reaction involving the left L5 nerve root anterior to the sacral ala. With spontaneous healing of the fracture, the patient's symptoms resolved completely. (orig.)

  12. Outcome after translabyrinthine surgery for vestibular schwannomas

    DEFF Research Database (Denmark)

    Springborg, Jacob Bertram; Fugleholm, Kåre; Poulsgaard, Lars

    2012-01-01

    The objective of this article is to study the outcome after translabyrinthine surgery for vestibular schwannomas, with special focus on the facial nerve function. The study design is a case series from a national centralized database and it is set in two University Hospitals in Denmark....... Participants were 1244 patients who underwent translabyrinthine surgery during a period of 33 years from 1976 to 2009. Main outcome measures were tumor removal, intraoperative facial nerve preservation, complications, and postoperative facial nerve function. In 84% patients, the tumor was totally resected...... and in ~85% the nerve was intact during surgery. During 33 years, 12 patients died from complications to surgery and ~14% had cerebrospinal fluid leakage. Before surgery, 74 patients had facial paresis and 46% of these improved after surgery. In patients with normal facial function, overall ~70% had a good...

  13. Introduction of laparoscopic sacral colpopexy to a fellowship training program.

    Science.gov (United States)

    Kantartzis, Kelly; Sutkin, Gary; Winger, Dan; Wang, Li; Shepherd, Jonathan

    2013-11-01

    Minimally invasive sacral colpopexy has increased over the past decade, with many senior physicians adopting this new skill set. However, skill acquisition at an academic institution in the presence of postgraduate learners is not well described. This manuscript outlines the introduction of laparoscopic sacral colpopexy to an academic urogynecology service that was not performing minimally invasive sacral colpopexies, and it also defines a surgical learning curve. The first 180 laparoscopic sacral colpopexies done by four attending urogynecologists from January 2009 to December 2011 were retrospectively analyzed. The primary outcome was operative time. Secondary outcomes included conversion to laparotomy, estimated blood loss, and intra- and postoperative complications. Linear regression was used to analyze trends in operative times. Fisher's exact test compared surgical complications and counts of categorical variables. Mean total operative time was 250 ± 52 min (range 146-452) with hysterectomy and 222 ± 45 (range 146-353) for sacral colpopexy alone. When compared with the first ten cases performed by each surgeon, operative times in subsequent groups decreased significantly, with a 6-16.3% reduction in overall times. There was no significant difference in the rate of overall complications regardless of the number of prior procedures performed (p = 0.262). Introduction of laparoscopic sacral colpopexy in a training program is safe and efficient. Reduction in operative time is similar to published learning curves in teaching and nonteaching settings. Introducing this technique does not add additional surgical risk as these skills are acquired.

  14. Sacral Stress Fracture following the Bone Union of Lumbar Spondylolysis

    Directory of Open Access Journals (Sweden)

    Tatsuro Sasaji

    2016-01-01

    Full Text Available While 22 articles have reported on sacral stress fractures, it is a rare injury and its etiology is not well known. We present the case of a 16-year-old male who presented with low back pain in 2015. He was a high school soccer player with a previous history of a bilateral L5 lumbar spondylolysis in 2014. The patient refrained from soccer and wore a brace for six months. Two months after restarting soccer, he again complained of low back pain. After 1 year, a lumbar spine computed tomography revealed the bone union of the spondylolysis. At his first visit to our hospital, his general and neurological conditions were normal and laboratory data were within the normal range. Sacral coronal magnetic resonance imaging (MRI of the left sacral ala revealed an oblique lineal signal void surrounding bone marrow edema. Based on his symptoms, sports history, and MRI, he was diagnosed with a sacral stress fracture. He again refrained from soccer; his low back pain soon improved, and, after 1 year, the abnormal signal change had disappeared on sacral MRI. Recurrent low back pain case caused by a sacral stress fracture occurring after the bone union of lumbar spondylolysis is uncommon.

  15. Repeat Gamma Knife surgery for vestibular schwannomas

    Science.gov (United States)

    Lonneville, Sarah; Delbrouck, Carine; Renier, Cécile; Devriendt, Daniel; Massager, Nicolas

    2015-01-01

    Background: Gamma Knife (GK) surgery is a recognized treatment option for the management of small to medium-sized vestibular schwannoma (VS) associated with high-tumor control and low morbidity. When a radiosurgical treatment fails to stop tumor growth, repeat GK surgery can be proposed in selected cases. Methods: A series of 27 GK retreatments was performed in 25 patients with VS; 2 patients underwent three procedures. The median time interval between GK treatments was 45 months. The median margin dose used for the first, second, and third GK treatments was 12 Gy, 12 Gy, and 14 Gy, respectively. Six patients (4 patients for the second irradiation and 2 patients for the third irradiation) with partial tumor regrowth were treated only on the growing part of the tumor using a median margin dose of 13 Gy. The median tumor volume was 0.9, 2.3, and 0.7 cc for the first, second, and third treatments, respectively. Stereotactic positron emission tomography (PET) guidance was used for dose planning in 6 cases. Results: Mean follow-up duration was 46 months (range 24–110). At the last follow-up, 85% of schwannomas were controlled. The tumor volume decreased, remained unchanged, or increased after retreatment in 15, 8, and 4 cases, respectively. Four patients had PET during follow-up, and all showed a significant metabolic decrease of the tumor. Hearing was not preserved after retreatment in any patients. New facial or trigeminal palsy did not occur after retreatment. Conclusions: Our results support the long-term efficacy and low morbidity of repeat GK treatment for selected patients with tumor growth after initial treatment. PMID:26500799

  16. Functional Nerve Preservation in Extracranial Head and Neck Schwannoma Surgery.

    Science.gov (United States)

    Ijichi, Kei; Kawakita, Daisuke; Maseki, Shinichiro; Beppu, Shintaro; Takano, Gaku; Murakami, Shingo

    2016-05-01

    A schwannoma is an uncommon, benign neurogenic tumor of Schwann cells. Tumor enucleation is the recommended surgical method to preserve function of the original nerve, although enucleation does not guarantee completely intact nerve function after the operation. To establish a strategy for functional preservation in extracranial head and neck schwannoma treatment by using an electromyographic (EMG) system during tumor resection. A retrospective cohort study was conducted of 15 patients who underwent surgery for removal of schwannoma tumors between April 1, 2006, and March 31, 2015, at an academic tertiary referral center. Data analysis was conducted from April 3, 2006, to September 15, 2015. Neurogenic tumors were diagnosed according to preoperative findings, and during surgery tumors were exposed and given EMG-controlled electrical stimulation to analyze their origins. In motor nerve cases, the electrical activity of the muscle was measured and recorded by EMG. The tumor was then enucleated by incision along tumor fibers mapped using EMG stimulation. If a nerve bundle was visible, we incised along there and enucleated the tumor. A strategy using electrical stimulation to improve preservation of nerve function in extracranial head and neck schwannoma operations. Frequency and duration of postoperative neurologic complications associated with functional preservation surgery with tumor enucleation was evaluated using EMG monitoring according to tumor origin. Of the 15 patients with extracranial schwannoma, 9 (60%) were women (mean [SD] age, 36.3 [15.3] years). All 15 patients underwent surgery using a transcervical approach. The most common nerves of origin were the vagus nerve and the sympathetic chain. In sensory or sympathetic nerve cases, the EMG response was absent. Two of 5 patients with vagus schwannoma had postoperative temporary vocal nerve palsy. These symptoms showed improvement after 1 year. There was no tumor recurrence during the follow-up period in any

  17. Parasacral Perforator Flaps for Reconstruction of Sacral Pressure Sores.

    Science.gov (United States)

    Lin, Chin-Ta; Chen, Shih-Yi; Chen, Shyi-Gen; Tzeng, Yuan-Sheng; Chang, Shun-Cheng

    2015-07-01

    Despite advances in reconstruction techniques, pressure sores continue to present a challenge to the plastic surgeon. The parasacral perforator flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. We present our experience of using parasacral perforator flaps in reconstructing sacral defects. Between August 2004 and January 2013, 19 patients with sacral defects were included in this study. All the patients had undergone surgical reconstruction of sacral defects with a parasacral perforator flap. The patients' sex, age, cause of sacral defect, flap size, flap type, numbers of perforators used, rotation angle, postoperative complications, and hospital stay were recorded. There were 19 parasacral perforator flaps in this series. All flaps survived uneventfully except for 1 parasacral perforator flap, which failed because of methicillin-resistant Staphylococcus aureus infection. The overall flap survival rate was 95% (18/19). The mean follow-up period was 17.3 months (range, 2-24 months). The average length of hospital stay was 20.7 days (range, 9-48 days). No flap surgery-related mortality was found. Also, there was no recurrence of sacral pressure sores or infected pilonidal cysts during the follow-up period. Perforator-based flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscle. Parasacral perforator flaps are durable and reliable in reconstructing sacral defects. We recommend the parasacral perforator flap as a good choice for reconstructing sacral defects.

  18. Gastric schwannomas: radiological features with endoscopic and pathological correlation

    Energy Technology Data Exchange (ETDEWEB)

    Hong, H.S. [Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seodaemoon-gu, Seoul (Korea, Republic of); Ha, H.K. [Department of Radiology, University of Ulsan College of Medicine, Songpa-gu, Seoul (Korea, Republic of)], E-mail: hkha@amc.seoul.kr; Won, H.J.; Byun, J.H.; Shin, Y.M.; Kim, A.Y.; Kim, P.N.; Lee, M.-G. [Department of Radiology, University of Ulsan College of Medicine, Songpa-gu, Seoul (Korea, Republic of); Lee, G.H. [Internal Medicine, University of Ulsan College of Medicine, Songpa-gu, Seoul (Korea, Republic of); Kim, M.J. [Pathology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul (Korea, Republic of)

    2008-05-15

    Aim: To describe the radiological, endoscopic, and pathological findings of gastric schwannomas in 16 patients. Materials and methods: The radiological, endoscopic, and pathological findings of 16 surgically proven cases of gastric schwannoma were retrospectively reviewed. All patients underwent computed tomography (CT) and four patients were evaluated with upper gastrointestinal series. Two radiologists reviewed the CT and upper gastrointestinal series images by consensus with regard to tumour size, contour, margin, and growth pattern, the presence or absence of ulcer, cystic change, and the CT enhancement pattern. Endoscopy was performed in eight of these 16 patients. Six patients underwent endoscopic ultrasonography. Pathological specimens were obtained from and reviewed in all 16 patients. Immunohistochemistry was performed for c-kit, CD34, smooth muscle actin, and S-100 protein. Results: On radiographic examination, gastric schwannomas appeared as submucosal tumours with the CT features of well-demarcated, homogeneous, and uncommonly ulcerated masses. Endoscopy with endoscopic ultrasonography demonstrated homogeneous, submucosal masses contiguous with the muscularis propria in all six examined cases. On pathological examination, gastric schwannomas appeared as well-circumscribed and homogeneous tumours in the muscularis propria and consisted microscopically of interlacing bundles of spindle cells. Strong positivity for S-100 protein was demonstrated in all 16 cases on immunohistochemistry. Conclusion: Gastric schwannomas appear as submucosal tumours of the stomach and have well-demarcated and homogeneous features on CT, endoscopic ultrasonography, and gross pathology. Immunohistochemistry consistently reveals positivity for S-100 protein in the tumours.

  19. Gastric schwannomas: radiological features with endoscopic and pathological correlation

    International Nuclear Information System (INIS)

    Hong, H.S.; Ha, H.K.; Won, H.J.; Byun, J.H.; Shin, Y.M.; Kim, A.Y.; Kim, P.N.; Lee, M.-G.; Lee, G.H.; Kim, M.J.

    2008-01-01

    Aim: To describe the radiological, endoscopic, and pathological findings of gastric schwannomas in 16 patients. Materials and methods: The radiological, endoscopic, and pathological findings of 16 surgically proven cases of gastric schwannoma were retrospectively reviewed. All patients underwent computed tomography (CT) and four patients were evaluated with upper gastrointestinal series. Two radiologists reviewed the CT and upper gastrointestinal series images by consensus with regard to tumour size, contour, margin, and growth pattern, the presence or absence of ulcer, cystic change, and the CT enhancement pattern. Endoscopy was performed in eight of these 16 patients. Six patients underwent endoscopic ultrasonography. Pathological specimens were obtained from and reviewed in all 16 patients. Immunohistochemistry was performed for c-kit, CD34, smooth muscle actin, and S-100 protein. Results: On radiographic examination, gastric schwannomas appeared as submucosal tumours with the CT features of well-demarcated, homogeneous, and uncommonly ulcerated masses. Endoscopy with endoscopic ultrasonography demonstrated homogeneous, submucosal masses contiguous with the muscularis propria in all six examined cases. On pathological examination, gastric schwannomas appeared as well-circumscribed and homogeneous tumours in the muscularis propria and consisted microscopically of interlacing bundles of spindle cells. Strong positivity for S-100 protein was demonstrated in all 16 cases on immunohistochemistry. Conclusion: Gastric schwannomas appear as submucosal tumours of the stomach and have well-demarcated and homogeneous features on CT, endoscopic ultrasonography, and gross pathology. Immunohistochemistry consistently reveals positivity for S-100 protein in the tumours

  20. Gamma-knife radiosurgery in the treatment of trigeminal schwannomas

    International Nuclear Information System (INIS)

    Peker, S.; Bayrakli, F.; Kilic, T.; Pamir, M.N.

    2007-01-01

    Trigeminal nerve schwannomas account for 0.07 %-0.28 % of all intracranial tumors. Advances in skull base surgery have led to more aggressive resection of these tumors, but surgery may associated with development of new neurological deficits. In this report, we analyse the long-term results 15 patients with newly diagnosed or residual/recurrent trigeminal schwannoma who underwent gamma-knife treatment. During a mean 61 months of follow-up, MRI revealed reduction of tumor size in 13 and no size change in 2 patients. The tumor growth control rate was 100 % and only 1 patient had transient facial numbness and diplopia. For patients with small to moderate size trigeminal schwannomas, gamma-knife radiosurgery is associated with good tumor control and a minimal risk of adverse radiation effects. (author)

  1. Retroperitoneal schwannoma: diagnostic imaging findings in 5 patients

    International Nuclear Information System (INIS)

    Baltazar, Alberto; Santamarina, Mario; Scalise, Gabriela; Ponce de Leon, Valeria; Bello, Lorena

    2003-01-01

    Purpose: To evaluate the different imaging findings (US, CT and MRI) in retroperitoneal schwannoma. Materials and methods: 5 patients (3 male and 2 females) with a diagnosis of retroperitoneal schwannoma were retrospectively evaluated. Ages ranged from 33 to 63 years (means 54 years). The images (US, CT and MR) were analyzed and correlated to histopathologic results. Results: The most frequent clinical finding was abdominal pain (60%). A presumptive diagnosis prior to surgery was suggested in 3/5 cases that had well-defined masses with a predominant cystic appearance. All patients underwent surgery with tumoral resection. Only 2 patients (40%) had recurrence within a three years period of follow-up. Conclusion: Retroperitoneal schwannoma is an infrequent tumor. In our series, no pathognomotic features were observed on US, CT or MRI. However, 3/5 tumors showed high signal intensity on T2-weighted images due to cystic areas. (author)

  2. Retroperitoneal Gastrointestinal Type Schwannoma Presenting as a Renal Mass

    Directory of Open Access Journals (Sweden)

    Susan J. Hall

    2015-11-01

    Full Text Available Retroperitoneal schwannomas are extremely rare, and unreported in Urology. Often thought to be malignant from imaging the diagnosis is often delayed until Histology. We report a case of retroperitoneal schwanoma thought to be a malignant renal mass. Seventy three year old lady presented with abdominal pain. Imaging showed a mass attached to the renal pelvis thus she underwent a radical nephrectomy. Histology reported retroperitoneal schwannoma. Malignant forms are rare however treatment for these is surgical excision. Awareness of the existence of these tumors may help in avoiding unnecessary radical surgeries by opting for biopsy preoperatively.

  3. [Primary malignant schwannoma of the buccal branch of facial nerve].

    Science.gov (United States)

    Moumine, M; Thiery, G; Harroudi, T; Amrani, M; El Othmany, A; Rzin, A

    2012-06-01

    Primary malignant schwannomas are rare neoplasms of nerve sheath origin, especially in the location of the head and neck where few cases are described in the literature. We report the case of a 65-year-old male diagnosed with malignant schwannoma in the left cheek. The patient underwent surgery with wide local excision, reconstruction were made later by skin graft. The treatment of choice is radical excision of the lesion with wide margins. In fact, to reduce local tumor recurrence, the use of adjuvant radiation or chemotherapy is still controversial. Copyright © 2009 Elsevier Masson SAS. All rights reserved.

  4. Stereotactic radiation therapy for large vestibular schwannomas

    International Nuclear Information System (INIS)

    Mandl, Ellen S.; Meijer, Otto W.M.; Slotman, Ben J.; Vandertop, W. Peter; Peerdeman, Saskia M.

    2010-01-01

    Background and purpose: To evaluate the morbidity and tumor-control rate in the treatment of large vestibular schwannomas (VS) after stereotactic radiation therapy in our institution. Material and methods: Twenty-five consecutive patients (17 men, 8 women) with large VS (diameter 3.0 cm or larger), treated with stereotactic radiotherapy (SRT) or stereotactic radiosurgery (SRS) between 1992 and 2007, were retrospectively studied after a mean follow-up period of three years with respect to tumor-control rate and complications. Results: Actuarial 5-year maintenance of pre-treatment hearing level probability of 30% was achieved. Five of 17 patients suffered permanent new facial nerve dysfunction. The actuarial 5-year facial nerve preservation probability was 80%. Permanent new trigeminal nerve neuropathy occurred in two of 15 patients, resulting in an actuarial 5-year trigeminal nerve preservation probability of 85%. Tumor progression occurred in four of 25 (16%) patients. The overall 5-year tumor control probability was 82%. Conclusion: Increased morbidity rates were found in patients with large VS treated with SRT or SRS compared to the published series on regular sized VS and other smaller retrospective studies on large VS.

  5. Magnetic resonance imaging of facial nerve schwannoma.

    Science.gov (United States)

    Thompson, Andrew L; Aviv, Richard I; Chen, Joseph M; Nedzelski, Julian M; Yuen, Heng-Wai; Fox, Allan J; Bharatha, Aditya; Bartlett, Eric S; Symons, Sean P

    2009-12-01

    This study characterizes the magnetic resonance (MR) appearances of facial nerve schwannoma (FNS). We hypothesize that the extent of FNS demonstrated on MR will be greater compared to prior computed tomography studies, that geniculate involvement will be most common, and that cerebellar pontine angle (CPA) and internal auditory canal (IAC) involvement will more frequently result in sensorineural hearing loss (SNHL). Retrospective study. Clinical, pathologic, and enhanced MR imaging records of 30 patients with FNS were analyzed. Morphologic characteristics and extent of segmental facial nerve involvement were documented. Median age at initial imaging was 51 years (range, 28-76 years). Pathologic confirmation was obtained in 14 patients (47%), and the diagnosis reached in the remainder by identification of a mass, thickening, and enhancement along the course of the facial nerve. All 30 lesions involved two or more contiguous segments of the facial nerve, with 28 (93%) involving three or more segments. The median segments involved per lesion was 4, mean of 3.83. Geniculate involvement was most common, in 29 patients (97%). CPA (P = .001) and IAC (P = .02) involvement was significantly related to SNHL. Seventeen patients (57%) presented with facial nerve dysfunction, manifesting in 12 patients as facial nerve weakness or paralysis, and/or in eight with involuntary movements of the facial musculature. This study highlights the morphologic heterogeneity and typical multisegment involvement of FNS. Enhanced MR is the imaging modality of choice for FNS. The neuroradiologist must accurately diagnose and characterize this lesion, and thus facilitate optimal preoperative planning and counseling.

  6. Audiovestibular Function Deficits in Vestibular Schwannoma

    Directory of Open Access Journals (Sweden)

    Constantin von Kirschbaum

    2016-01-01

    Full Text Available Introduction. Vestibular schwannomas (VS are benign tumours of the vestibular nerve and can lead to hearing loss, tinnitus, vertigo, facial palsy, and brainstem compression. Audiovestibular diagnostic tests are essential for detection and treatment planning. Methods. Medline was used to perform a systematic literature review with regard to how audiovestibular test parameters correlate with symptoms, tumour size, and tumour location. Results. The auditory brainstem response can be used to diagnose retrocochlear lesions caused by VS. Since hearing loss correlates poorly with tumour size, a retrocochlear lesion is probably not the only cause for hearing loss. Also cochlear mechanisms seem to play a role. This can be revealed by abnormal otoacoustic emissions, despite normal ABR and new MRI techniques which have demonstrated endolymphatic hydrops of the inner ear. Caloric and head impulse tests show frequency specific dynamics and vestibular evoked myogenic potentials may help to identify the location of the tumour regarding the involved nerve parts. Conclusion. In order to preserve audiovestibular function in VS, it is important to stop the growth of the tumour and to avoid degenerative changes in the inner ear. A detailed neurotological workup helps to diagnose VS of all sizes and can also provide useful prognostic information.

  7. Cost of dressings for prevention of sacral pressure ulcers.

    Science.gov (United States)

    Inoue, Kelly Cristina; Matsuda, Laura Misue

    2016-01-01

    to identify costs of dressings to prevent sacral pressure ulcers in an adult intensive care unit in Paraná, Brazil. secondary analysis study with 25 patients admitted between October 2013 and March 2014, using transparent polyurethane film (n=15) or hydrocolloid dressing (n=10) on the sacral region. The cost of each intervention was based on the unit amount used in each type of dressing, and its purchase price (transparent film = R$15.80, hydrocolloid dressing = R$68.00). the mean cost/patient was R$23.17 for use of transparent film and R$190.40 for use of hydrocolloid dressing. The main reason for changing the dressing was detachment. the transparent film was the most economically advantageous alternative to prevent sacral pressure ulcers in critical care patients. However, additional studies should be carried out including assessment of the effectiveness of both dressings.

  8. [Four cases of urinary dysfunction associated with sacral herpes zoster].

    Science.gov (United States)

    Matsuo, Tomohiro; Oba, Kojiro; Miyata, Yasuyoshi; Igawa, Tsukasa; Sakai, Hideki

    2014-02-01

    Herpes zoster is caused by the infection of Varicella-Zoster virus. The anatomical distribution of herpes zoster in the sacral area is only 6. 9%1). Moreover, the onset rate of herpes zoster with urinary dysfunction is 0.6%1). The lesion sites of herpes zoster which cause urinary dysfunction are almost lumber and sacral areas. We describe four cases of sacral herpes zoster with urinary dysfunction in this report. All patients were elderly people (66-84 years old), and all patients were administered anti-virus drugs and alpha 1-adrenergic receptor blockers. Because of urinary retention, three patients have performed clean intermittent self-catheterization (CIC) for several weeks. As the lesions of herpes zoster healed, each patient recovered from urinary dysfunction.

  9. Sacral Nerve Stimulation for Constipation: Suboptimal Outcome and Adverse Events

    DEFF Research Database (Denmark)

    Maeda, Yasuko; Lundby, Lilli; Buntzen, Steen

    2010-01-01

    Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events.......Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events....

  10. Sacral neuromodulation in the treatment of the unstable bladder.

    Science.gov (United States)

    Bosch, J L

    1998-07-01

    Sacral neuromodulation as a treatment for urge incontinence in patients with an unstable bladder is the subject of ongoing clinical studies. Although approximately 75% of the patients treated with a permanent sacral foramen electrode implant have experienced significant improvements, it is now also clear that there is an initial failure rate of about 25%. Recent studies have pointed out the importance of improved patient selection on the basis of sex differences, urodynamic parameters and psychological factors. Also, newer forms of test stimulation and permanent electrode implantation are being explored in an effort to improve on the present results.

  11. Sacral Ewing's Sarcoma and Challenges in it's Diagnosis on MRI

    Directory of Open Access Journals (Sweden)

    Albert D'Souza

    2009-01-01

    Full Text Available A 15-yr old boy presented with low backache for 4 months associated with weakness of left lower limb. MRI of lumbosacral spine showed a sacral lesion with intraspinal and presacral soft tissue extension with neural compression. A diagnosis of tuberculosis was considered in the view of high prevalence in this part of the world, however biopsy revealed Ewing's sarcoma. Ewing's tumor of sacrum is rare, but should be suspected in low backache in children. Differential diagnosis for a sacral lesion includes tuberculosis, pyogenic osteomyelitis, lymphoma, chordoma, osteosarcoma and Ewing's sarcoma. MRI is sensitive in detecting these lesions but is nonspecific requiring histopathological examination for confirmation.

  12. Varied Presentation of Schwannoma – A Case Study

    Directory of Open Access Journals (Sweden)

    Ruquaya Mir

    2010-10-01

    Full Text Available Schwannomas can occur anywhere in the body with unusual presentation. They are difficult to diagnose preoperatively. Fine needle aspiration biopsy does not appear to provide an accurate preoperative diagnosis. Complete excision of the mass should be the goal of surgical excision.

  13. Retropharyngeal Schwannoma Excised Through a Transoral Approach: A Case Report

    Directory of Open Access Journals (Sweden)

    Chia-Ying Hsieh

    2006-09-01

    Full Text Available The contents of the retropharyngeal space are limited to fat and retropharyngeal nodes. Primary tumors originating from the retropharyngeal space are rare. More than 25% of schwannomas are found in the head and neck region, and they are rarely found in the retropharyngeal space. Here, we report the case of a 44-year-old woman with a schwannoma confined to the left retropharyngeal space, who presented with snoring and a mild lump in the throat sensation. Physical examination revealed anterior bulging of the left oropharyngeal wall, with intact mucosa. Magnetic resonance imaging showed a well-defined, encapsulated tumor in the left retropharyngeal space with bright signal intensity on T2-weighted images and low signal intensity on T1-weighted images, which was strongly enhanced after gadolinium administration. The tumor was removed through a transoral approach, resulting in a short postoperative recovery time without complications. The pathologic diagnosis was schwannoma. The patient has been well and free of tumor recurrence for 2 years. From anatomic and physiologic viewpoints, excision through a transoral approach is a good choice for a confined retropharyngeal schwannoma.

  14. Schwannoma of the Recurrent Laryngeal Nerve : A Rare Entity

    NARCIS (Netherlands)

    de Heer, Linda M; Teding van Berkhout, F; Priesterbach, Loudy; Buijsrogge, Marc P

    Neurogenic tumors are the most common posterior mediastinal tumors in adults. Schwannomas originating from the recurrent laryngeal nerve are rare. The present study describes a 46-year-old man with a tumor in the left superior mediastinum. Because of the narrow relationship with the aorta and the

  15. Imaging characteristics of intraparenchymal schwannoma and the related pathology

    International Nuclear Information System (INIS)

    Liu Shuyong; Geng Daoying; He Huijin

    2007-01-01

    Objective: To Analyze the imaging characteristics of intraparenchymal schwannoma and the related pathology, in order to improve the accuracy of diagnosis and be in favor of the clinics and the prognosis. Methods: Four cases were confirmed to be intraparenchymal schwannoma by pathological and immunohistochemistry examination. One case was examined with precontrast and enhanced CT scanning, one with unenhanced MRI scanning, two with unenhanced and enhanced CT and MRI scanning. Their images were retrospectively analyzed. Results: Of the four cases, three patients were less than 30 years old, with tumors located supratentorially. Cysts were found in all cases, with nodules on the wall in 3 cases. The nodules were enhanced markedly in two cases and moderately in one case. In addition, calcification was detected in one case and prominent peritumoral edema existed in 1 case. The picture of the pathology demonstrated Antoni type A and Antoni type B. Immunostaining showed intense immunoreactivity for S-100 protein and Vim and negative immunoreactivity for GFAP and EMA. Conclusions: Intraparenchymal schwannoma mostly occurred in juvenile, which located supratentorially in most cases. The presence of a cyst and peritumoral edema together with the tumor appears to be characteristic of intraparenchymal schwannoma. Calcification or the enhanced nodule is the helpful sign for the diagnosis. Combining the imaging findings with the pathology and immunohistochemistry results can gain the accurate diagnosis. (authors)

  16. Skull base surgery of non vestibular schwannomas of the posterior ...

    African Journals Online (AJOL)

    Results: Twenty one patients with intracranial schwannomas arising from cranial nerves other than the vestibulocochlear were surgically treated in the Neurosurgery department, Alexandria University, in the period between 2003 and 2008. There were 14 males and 7 females and the mean age was 38 years. Seven of our ...

  17. Neurophysiological intraoperative monitoring during an optic nerve schwannoma removal.

    Science.gov (United States)

    San-Juan, Daniel; Escanio Cortés, Manuel; Tena-Suck, Martha; Orozco Garduño, Adolfo Josué; López Pizano, Jesús Alejandro; Villanueva Domínguez, Jonathan; Fernández Gónzalez-Aragón, Maricarmen; Gómez-Amador, Juan Luis

    2017-10-01

    This paper reports the case of a patient with optic nerve schwannoma and the first use of neurophysiological intraoperative monitoring of visual evoked potentials during the removal of such tumor with no postoperative visual damage. Schwannomas are benign neoplasms of the peripheral nervous system arising from the neural crest-derived Schwann cells, these tumors are rarely located in the optic nerve and the treatment consists on surgical removal leading to high risk of damage to the visual pathway. Case report of a thirty-year-old woman with an optic nerve schwannoma. The patient underwent surgery for tumor removal on the left optic nerve through a left orbitozygomatic approach with intraoperative monitoring of left II and III cranial nerves. We used Nicolet Endeavour CR IOM (Carefusion, Middleton WI, USA) to performed visual evoked potentials stimulating binocularly with LED flash goggles with the patient´s eyes closed and direct epidural optic nerve stimulation delivering rostral to the tumor a rectangular current pulse. At follow up examinations 7 months later, the left eye visual acuity was 20/60; Ishihara score was 8/8 in both eyes; the right eye photomotor reflex was normal and left eye was mydriatic and arreflectic; optokinetic reflex and ocular conjugate movements were normal. In this case, the epidural direct electrical stimulation of optic nerve provided stable waveforms during optic nerve schwannoma resection without visual loss.

  18. Vestibular schwannoma and fitness to fly.

    Science.gov (United States)

    Pons, Yoann; Raynal, Marc; Hunkemöller, Iris; Lepage, Pierre; Kossowski, Michel

    2010-10-01

    When a pilot is referred for vestibular schwannoma (VS), his or her fitness to fly may be questioned. The objective of this retrospective study was to describe a series of VS cases in a pilot population and to discuss their fitness to fly options. Between September 2002 and March 2010, the ENT/Head and Neck Surgery Department of the National Pilot Expertise Center conducted nearly 120,000 expert consultations for 40,000 pilots. We examined the files of 10 pilots who were referred to our 2 national experts for VS. At the time of the expert consultation, hypoacusis was present in nine cases (four with total deafness), tinnitus in one case, and vertigo in nine cases. In our series, only 2 of the 10 pilots experienced a negative impact on their fitness to fly. Decisions on fitness to fly were based on several factors: minimally disturbed audition, i.e., less than a 35-dB hearing loss with a good speech discrimination score; good balance, i.e., no reported difficulties; no spontaneous nystagmus recorded on videonystagmography (VNG); no postural deviation; and a normal head-shaking test. The delay and the VS's evolution between diagnosis and expert consultation are important because the selection of a treatment to control VS is critical in minimizing the possible associated complications. When a pilot is referred for VS, his or her fitness to fly is determined by the size of the tumor, balance, auditory status, and the follow-up results of these findings. The complications that may arise from VS treatments must also be considered.

  19. Lumbosacral osteomyelitis after robot-assisted total laparoscopic hysterectomy and sacral colpopexy.

    Science.gov (United States)

    Muffly, Tyler M; Diwadkar, Gouri B; Paraiso, Marie Fidela R

    2010-12-01

    We report on the transabdominal resection of infected lumbosacral bone, synthetic mesh, and sinus tract following sacral colpopexy. A 45-year-old nulliparous patient who had undergone transvaginal mesh followed by robot-assisted sacral colpopexy presented with increasing back pain and foul-smelling vaginal drainage. An epidural abscess required surgical intervention, including diskectomy, sacral debridement, and mesh removal to drain the abscess and vaginal sinus tract. Recognized complications of open prolapse procedures also manifest following minimally invasive approaches. Osteomyelitis of the sacral promontory following sacral colpopexy may require gynecologic and neurosurgical management.

  20. The application of sacral block anesthesia in pediatric interventional therapy

    International Nuclear Information System (INIS)

    Zhong Liang; Qin Zenghui

    2009-01-01

    Objective: To discuss the management and feasibility of sacral block anesthesia in pediatric interventional therapy. Methods: A total of 80 pediatric patients were randomly and equally divided into two groups. Patients in group A received sacral block anesthesia together with basic anesthesia with propofol, while patients in group B received intravenous anesthesia with propofol. Small amount of ketamine as maintaining dose was used in both groups when needed. Results: The interventional management was successfully completed in all patients. A marked decrease in blood pressure occurred in three patients of group A receiving sacral block anesthesia. In group B receiving intravenous anesthesia, a decrease of SpO 2 to below 90 percent was seen in 8 cases, and obvious bradycardia developed in 12 cases. All these patients were treated with intravenous medication or by reducing the dose of propofol. Additional small dose of ketamine was needed in 4 patients during the procedure. Conclusion: Sacral block anesthesia combined with intravenous anesthesia is one of the effective anesthesia management schemes for pediatric interventional therapy. (authors)

  1. Perineal colostomy prolapse: a novel application of mesh sacral pexy.

    Science.gov (United States)

    Landen, S; Ursaru, D; Delugeau, V; Landen, C

    2018-01-01

    Full thickness colonic prolapse following pseudocontinent perineal colostomy has not been previously reported. Possible contributing factors include a large skin aperture at the site of the perineal stoma, the absence of anal sphincters and mesorectal attachments and the presence of a perineal hernia. A novel application of sacral pexy combined with perineal hernia repair using two prosthetic meshes is described.

  2. Sacral pressure sore reconstruction – the pedicled superior gluteal ...

    African Journals Online (AJOL)

    Pressure sore reconstruction has always been challenging. Immobile patients are prone to develop pressure sores from unre- lieved pressure on tissue over the sacral area, with shear, friction, moisture and malnutrition as contributing factors. Up to one-third of immobilised patients in long-term care facilities will develop.

  3. Acute urinary retention attributable to sacral herpes zoster.

    Science.gov (United States)

    Acheson, J; Mudd, D

    2004-11-01

    Acute urinary retention in women is uncommon. A 63 year old woman presented with suprapubic pain, a palpable bladder, and multiple grouped vesicles on the right buttock. Catheterisation showed a residual of 2000 ml. A case is reported of acute urinary retention secondary to herpes zoster infection of the sacral nerves (S2-4).

  4. Giant Chancroid

    Directory of Open Access Journals (Sweden)

    Bhushan Kumar

    1980-01-01

    Full Text Available A case of giant chancroid following rupture of inguinal bubo and having systemic symptoms is described. Response with sulfa and streptomycin combination was excellent and the lesion healed completely in 3 weeks. Early diagnosis and treatment of chancroid will prevent this debilitating complication.

  5. Giant microelectronics

    International Nuclear Information System (INIS)

    Della Sala, D.; Privato, C.; Di Lazzaro, P.; Fortunato, G.

    1999-01-01

    Giant microelectronics, on which the technology of flat liquid-crystal screens is based, is an example of fruitful interaction among independently-developed technologies, in this case thin film micro devices and laser applications. It typifies the interdisciplinary approach needed to produce innovations in microelectronics [it

  6. Plexiform Schwannoma of the Stomach in Neurofibromatosis Type 2: A Case Report

    International Nuclear Information System (INIS)

    Kim, Hyun Jung; Yeom, Dong Heon; Cho, Hyun Sun; Cho, Woo Ho

    2012-01-01

    Plexiform schwannoma is a relatively rare benign subepithelial tumor arising from the peripheral nerve sheath, and associated with Neurofibromatosis type 2 (NF2). There are a few reports of plexiform schwannomas arising from the gastrointestinal tract, and to our knowledge, there is no report of it arising from the stomach in a patient with NF2. Here we present the first case of a plexiform schwannoma of the stomach in an NF2 patient a submucosal tumor on radiologic finding.

  7. Laryngeal schwannoma in an 8-year-old boy with inspiratory dyspnea.

    Science.gov (United States)

    Rognone, Elisa; Rossi, Andrea; Conte, Massimo; Nozza, Paolo; Tarantino, Vincenzo; Fibbi, Antonio; Saetti, Roberto; Cutrone, Cesare; Tortori-Donati, Paolo

    2007-10-01

    Schwannomas of the larynx are rare lesions in the pediatric age group. In this article, we report on the neuroimaging features of a schwannoma arising from the left aryepiglottic fold in an 8-year-old boy with a 6-month history of inspiratory dyspnea. Neuroimaging showed a well-defined, avoid mass originating from the left aryepiglottic fold. The lesion was removed endoscopically. Complete removal of laryngeal schwannomas is curative, and adjuvant treatment is not required.

  8. Intrinsic brainstem schwannoma – A rare clinical entity and a histological enigma

    Directory of Open Access Journals (Sweden)

    Anil Kumar Sharma

    2016-01-01

    Full Text Available Intraparenchymal schwannomas arising in the brainstem are very rare, and only eight cases have been reported in literature till now. We report an intraparenchymal brainstem schwannoma presenting with the classical clinical presentation of an intrinsic brainstem lesion, and discuss its clinicoradiological characteristics and histological origins. We highlight the importance of an intraoperative frozen section diagnosis in such cases. Intraoperative tissue diagnosis significantly may alter the surgical strategy, which should be aimed at near total intracapsular decompression of the schwannoma.

  9. Clinical results of sacral neuromodulation for chronic voiding dysfunction using unilateral sacral foramen electrodes.

    Science.gov (United States)

    Weil, E H; Ruiz-Cerdá, J L; Eerdmans, P H; Janknegt, R A; Van Kerrebroeck, P E

    1998-01-01

    The aim of this study was to determine the long-term clinical efficacy and complications of neuromodulation with a unilateral sacral foramen electrode in 36 patients with chronic voiding dysfunction. Following a positive effect of a percutaneous nerve evaluation test, patients underwent open surgery. A permanent electrode was implanted in 24 patients with urge incontinence, in 6 with urgency-frequency syndrome, and in 6 with nonobstructive urinary retention. After an average follow-up period of 37.8 months, 19 patients (52.8%) continue to benefit from the neuromodulation with a significant improvement of symptoms and urodynamic parameters. The median duration of the therapeutic effect for the total study population was longer than 60 months. No significant difference in the median duration of therapeutic effect with regard to sex, the type of voiding disorder, or the implant pulse generator was found. However, in patients with previous psychological disorders the median duration of therapeutic effect was only 12 months (P = 0.008). Complications were mild. In the group of patients in whom the therapeutic effect remains, 37 reoperations have had to be performed. We conclude that although reoperations were needed to overcome technical problems, patients can achieve lasting symptomatic improvement. Since technical changes in the equipment have reduced the number of complications, even better results can be expected in terms of the reoperation rate.

  10. Large vestibular schwannomas and hydrocephalus: Lessons learnt from a single centre experience

    Directory of Open Access Journals (Sweden)

    Prakash Nair

    2014-01-01

    Full Text Available Aim: The aim of the following study is to analyze the outcome following surgery in 169 patients with large vestibular schwannoma (VS and to evaluate hydrocephalus as a prognostic factor in patients of the VSs. Subjects and Methods: Retrospective analysis of all cases of VSs admitted to our tertiary neurosurgical center from January 2005 to December 2010 was performed. Comparison of patients who underwent pre-operative cerebrospinal fluid (CSF diversion and those who underwent primary surgery was carried out for post-operative complications and delayed hydrocephalus. Results: A total of 169 patients of VS were seen. The mean age at presentation was 39.03 years (12-72 years. The most common symptom was hearing loss seen in 161 (95.2% cases. Giant VS was seen in 130 (75.5% and hydrocephalus was present in 110 (63.9%. Pre-operative CSF diversion was done in 23 (13.1% patients; 8 (4.6% patients developed gradually symptomatic hydrocephalus following surgery and underwent ventriculoperitoneal shunt. Total surgical excision was done in 92.9% patients and subtotal excision was done in 7% patients. Conclusions: Hydrocephalus occurs in longstanding untreated cases of VS. Hydrocephalus causes no statistically significant increase in post-operative complications like CSF leak and post-operative hematoma. Patients with hydrocephalus presenting with acute symptoms of raised intracranial pressure benefit from CSF diversion. In most patients, tumor resection will restore patency of the CSF pathway and CSF diversion can be avoided.

  11. Spinal CT scan, 2. Lumbar and sacral spines

    Energy Technology Data Exchange (ETDEWEB)

    Nakagawa, Hiroshi (Aichi Medical Univ., Aichi (Japan))

    1982-08-01

    Plain CT described fairly accurately the anatomy and lesions of the lumbar and sacral spines on their transverse sections. Since hernia of the intervertebral disc could be directly diagnosed by CT, indications of myelography could be restricted. Spinal-canal stenosis of the lumbar spine occurs because of various factors, and CT not only demonstrated the accurate size and morphology of bony canals, but also elucidated thickening of the joints and yellow ligament. CT was also useful for the diagnosis of tumors in the lumbar and sacral spines, visualizing the images of bone changes and soft tissues on the trasverse sections. But the diagnosis of intradural tumors required myelography and metrizamide CT. CT has become important for the diagnosis of spinal and spinal-cord diseases and for selection of the route of surgical arrival.

  12. Combined Therapy for Distant Metastasis of Sacral Chordoma

    Directory of Open Access Journals (Sweden)

    Birol Özkal

    2015-01-01

    Full Text Available Chordomas are known as rare primary malign tumours that have formed from primitive notochord remains. Sacral chordomas grow slowly but locally and aggressively. Chordomas are locally invasive and have low tendency to metastasis and have a poor prognosis in long-term follow-up. Metastasis may be seen in a rate of 5–40% of the chordomas. Metastasis of chordomas is common in liver, lung, lymph nodes, peritoneum, and brain. The treatment approaches, including surgery, have been discussed in the literature before. Susceptibility to radiotherapy and chemotherapy is controversial in these tumours. The success of surgical treatment affects survival directly. In this report, we will report a sacral chordoma case in which an intraperitoneal distant metastasis occurred and discuss the surgical approach.

  13. Sacral Stress Fracture in an Amateur Badminton Player

    Directory of Open Access Journals (Sweden)

    Yusuke Yuasa

    2017-01-01

    Full Text Available Sacral stress fractures are rare among athletes but have been reported most frequently in long distance runners. We report herein the first case of a sacral stress fracture in an amateur badminton player. A 16-year-old, left-handed adolescent girl, who had just started to play badminton 3 months previously, complained of acute left buttock pain when she received a shuttlecock. Magnetic resonance imaging revealed a linear lesion of the left sacrum with low signal intensity on T1- and high signal intensity on T2-weighted images, which was consistent with a stress fracture. Conservative treatment with rest relieved her symptoms. Her fracture was considered to have occurred due to repetition of an exercise that caused excessive vertical power.

  14. Painful percutaneous transthoracic needle biopsy of Schwannoma: a case report

    International Nuclear Information System (INIS)

    Kim, Sung Hoon; Chun, Kyung Ah; Kim, Young Joo; Park, Seog Hee; Shin, Kyung Sub; Lee, Eun Jung

    1995-01-01

    Percutaneous aspiration needle biopsy of the intrathoracic disease is a safe, easy, and accurate diagnostic method. It usually causes mild pain or discomfort during the procedure. We had a patient who complained of severe sharp pain, well localized at the biopsy site of the target mass during CT-guided transthoracic aspiration biopsy. It was pathologically confirmed as an intrathoracic schwannoma after special staining. To our knowledge, there has been no published report of such a painful percutaneous needle biopsy in a patient with schwannoma in Korea. Two cases were reported in other radiologic journals. The severe sharp pain developed during the transthoracic aspiration needle biopsy is a reliable sign of neurogenic tumor, therefore the participating radiologist should recommend specific immumochemical stain for neurogenic tumor to pathologist

  15. Esqueleto pré-sacral e sacral dos lagartos teiêdeos (Squamata, Teiidae Pressacral and sacral skeleton of teiids lizards (Squamata, Teiidae

    Directory of Open Access Journals (Sweden)

    Lauren Betina Veronese

    1997-01-01

    Full Text Available The morphology of the axial skeleton -pressacral and sacral regions - of the nine genera of Teiidae Boulenger, 1885 comprising Ameiva Meyer, 1795, Callopistes Gravenhorst, 1838, Cnemidophorus Wagler, 1830, Crocodilurus Spix, 1825, Dicrodon Duméril & Bibron, 1839, Dracaena Daudin, 1802, Kenlropyx Spix, 1825, Teius Merrem, 1820 and Tupinambis Daudin, 1803 is here analysed under a comparative approach. The study is in a generic levei, and the principal conclusions reter to differences on the total number of vertebrae and some aspects of the ribs, especially their insertion and presence.

  16. Sacral root neuromodulation in idiopathic nonobstructive chronic urinary retention.

    Science.gov (United States)

    Shaker, H S; Hassouna, M

    1998-05-01

    Sacral root neuromodulation is becoming a superior alternative to the standard treatment of idiopathic nonobstructive urinary retention. We report results in 20 successive patients who underwent sacral foramen implantation to restore bladder function. After an initial, thorough baseline assessment 20 patients 19.43 to 55.66 years old with idiopathic nonobstructive urinary retention underwent percutaneous nerve evaluation. Response was assessed by a detailed voiding diary. Responders underwent implantation with an S3 foramen implant, and were followed 1, 3 and 6 months postoperatively, and every 6 months thereafter. Sacral root neuromodulation restored voiding capability in these patients. Bladders were emptied with minimal post-void residual urine, which decreased from 78.3 to 5.5 to 10.2% of the total voided volume from baseline to postoperative followup. These results were reflected in uroflowmetry and pressure-flow studies, which were almost normal after implantation. Furthermore, the urinary tract infection rate decreased significantly and associated pelvic pain improved substantially. The Beck depression inventory and SF-36 quality of life questionnaire indicated some improvement but reached significance in only 1 item. In addition, cystometrography showed no significant difference after 6 months of implantation compared with baseline values. Complications were minimal and within expectations. Sacral root neuromodulation is an appealing, successful modality for nonobstructive urinary retention. Only patients who have a good response to percutaneous nerve evaluation are candidates for implantation. The high efficacy in patients who undergo implantation, relative simplicity of the procedure and low complication rate make this a treatment breakthrough in this difficult group.

  17. Computer Navigation-aided Resection of Sacral Chordomas

    Directory of Open Access Journals (Sweden)

    Yong-Kun Yang

    2016-01-01

    Full Text Available Background: Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas. Methods: Between 2007 and 2013, a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old (range: 35-84 years old. Tumors were located above the level of the S3 neural foramen in 23 patients and below the level of the S3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months (range: 18-84 months. Results: Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 mm. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 (7.7% exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 (range: 19-30. Conclusions: Computer-assisted navigation can be safely applied to the resection of the sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill.

  18. [PELVIS/SACRAL syndrome with livedoid haemangioma and amniotic band].

    Science.gov (United States)

    Bourrat, E; Lemarchand-Venencie, F; Jacquemont, M-L; El Ghoneimi, A; Wassef, M; Leger, J; Morel, P

    2008-12-01

    PELVIS or SACRAL syndrome denotes the association of local haemangioma and malformation in the pelvic region. In this paper, we report a case noteworthy on account of the initially livedoid appearance of the haemangioma as well as associated amniotic banding of an upper limb. A newborn male infant underwent left colostomy on the day of birth due to anal imperforation and anomalies of the external genital organs with sexual ambiguity. Examination of the skin and appendages revealed poorly delineated hypopigmentation in the sacrolumbar region and a fibrous groove around the right arm characteristic of amniotic band syndrome. Sacrolumbar and pelvic MRI scans revealed deviation towards the left of the last three sacral vertebrae with no medullary anomalies. Retrograde cystography showed a recto-uretral fistula. Progression of the infant's condition was marked by the appearance during the first month of a flat, violaceous, angiomatous, livedoid lesion in the middle of the buttocks and the perineum and a linear lesion on the rear aspect of the right lower limb. The skin biopsy of this lesion revealed a single capillary lobule at the dermal-hypodermal junction of non-specific appearance but with marked Glut1 expression by endothelial cells highly evocative of infantile haemangioma. Segmented haemangiomas are commonly associated with extracutaneous abnormalities. By analogy with PHACE syndrome, defined as association of segmented facial haemangioma with cerebral, ocular and cardio-aortic abnormalities, PELVIS/SACRAL syndrome denotes the association of segmented haemangioma of the loins (sacrolumbar region, buttocks or perineum=napkin haemangioma) with spinal dysraphia affecting the sacrolumbar spine, the terminal medullary cone, the genitourinary organs and the anal region to different degrees. Diagnosis of haemangioma associated with PELVIS/SACRAL syndrome may be delayed or complicated due to the macular, telangiectasic or livedoid appearance commonly seen. To our

  19. Intratemporal and extratemporal facial nerve schwannoma: CT and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Keum Won [Pohang Medical Center, Pohang (Korea, Republic of); Lee, Ho Kyu; Shin, Ji Hoon; Choi, Choong Gon; Suh, Dae Chul [Asan Medical Center, Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Cheong, Hae Kwan [Dongguk Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-05-01

    To analyze the characteristics of CT and MRI findings of facial nerve schwannoma in ten patients. Ten patients with pathologically confirmed facial nerve schwannoma, underwent physical and radilolgic examination. The latter involved MRI in all ten and CT scanning in six. We analyzed the location (epicenter), extent and number of involved segments of tumors, tuumor morphology, and changes in adjacent bony structures. The major symptoms of facial nerve schwannoma were facial nerve paralysis in seven cases and hearing loss in six. Epicenters were detected at the intraparotid portion in five cases, the intracanalicular portion in two, the cisternal portion in one, and the intratemporal portion in two. The segment most frequently involved was the mastoid (n=6), followed by the parotid (n=5), intracanalicular (n=4), cisternal (n=2), the labyrinthine/geniculate ganglion (n=2) and the tympanic segment (n=1). Tumors affected two segments of the facial nerve in eight cases, only one segment in one, and four continuous segments in one. Morphologically, tumors were ice-cream cone shaped in the cisternal segment tumor (1/1), cone shaped in intracanalicular tumors (2/2), oval shaped in geniculate ganglion tumors (1/1), club shaped in intraparotid tumors (5/5) and bead shaped in the diffuse-type tumor (1/1). Changes in adjacent bony structures involved widening of the stylomastoid foramen in intraparotid tumors (5/5), widening of the internal auditary canal in intracanalicular and cisternal tumors (3/3), bony erosion of the geniculate fossa in geniculate ganglion tumors (2/2), and widening of the facial nerve canal in intratemporal and intraparotid tumors (6/6). The characteristic location, shape and change in adjacent bony structures revealed by facial schwannomas on CT and MR examination lead to correct diagnosis.

  20. Intratemporal and extratemporal facial nerve schwannoma: CT and MRI findings

    International Nuclear Information System (INIS)

    Kim, Keum Won; Lee, Ho Kyu; Shin, Ji Hoon; Choi, Choong Gon; Suh, Dae Chul; Cheong, Hae Kwan

    2001-01-01

    To analyze the characteristics of CT and MRI findings of facial nerve schwannoma in ten patients. Ten patients with pathologically confirmed facial nerve schwannoma, underwent physical and radilolgic examination. The latter involved MRI in all ten and CT scanning in six. We analyzed the location (epicenter), extent and number of involved segments of tumors, tuumor morphology, and changes in adjacent bony structures. The major symptoms of facial nerve schwannoma were facial nerve paralysis in seven cases and hearing loss in six. Epicenters were detected at the intraparotid portion in five cases, the intracanalicular portion in two, the cisternal portion in one, and the intratemporal portion in two. The segment most frequently involved was the mastoid (n=6), followed by the parotid (n=5), intracanalicular (n=4), cisternal (n=2), the labyrinthine/geniculate ganglion (n=2) and the tympanic segment (n=1). Tumors affected two segments of the facial nerve in eight cases, only one segment in one, and four continuous segments in one. Morphologically, tumors were ice-cream cone shaped in the cisternal segment tumor (1/1), cone shaped in intracanalicular tumors (2/2), oval shaped in geniculate ganglion tumors (1/1), club shaped in intraparotid tumors (5/5) and bead shaped in the diffuse-type tumor (1/1). Changes in adjacent bony structures involved widening of the stylomastoid foramen in intraparotid tumors (5/5), widening of the internal auditary canal in intracanalicular and cisternal tumors (3/3), bony erosion of the geniculate fossa in geniculate ganglion tumors (2/2), and widening of the facial nerve canal in intratemporal and intraparotid tumors (6/6). The characteristic location, shape and change in adjacent bony structures revealed by facial schwannomas on CT and MR examination lead to correct diagnosis

  1. Gastric schwannoma presenting as a casual ultrasonographic findings.

    Science.gov (United States)

    Álvarez Higueras, Francisco Javier; Pereñíguez López, Ana; Estrella Díez, Esther; Muñoz Tornero, María; Egea Valenzuela, Juan; Bas Bernal, Águeda; Garre Sánchez, Carmen; Vargas Acosta, Ángel; Sánchez Velasco, Eduardo; Carballo Álvarez, Luis Fernando

    2016-12-01

    We present the case of a patient under study due to ascites in which a mass located on the gastric wall was observed during ultrasonography. Further studies (upper endoscopy and computed tomography) confirmed this finding. After an ultrasound-guided percutaneous biopsy, diagnosis of gastric schwannoma was made as intense S-100 expression was found. Surgery was rejected due to the bad clinical situation of the patient and because the mass was an asymptomatic benign tumor.

  2. Association between vestibular schwannomas and mobile phone use

    OpenAIRE

    Moon, In Seok; Kim, Bo Gyung; Kim, Jinna; Lee, Jong Dae; Lee, Won-Sang

    2013-01-01

    Vestibular schwannomas (VSs) grow in the region where the energy from mobile phone use is absorbed. We examined the associations of VSs with mobile phone use. This study included 119 patients who had undergone surgical tumor removal. We used two approaches in this investigation. First, a case–control study for the association of mobile phone use and incidence of VSs was conducted. Both cases and controls were investigated with questions based on INTERPHONE guidelines. Amount of mobile phone u...

  3. Quality of life in patients after vestibular Schwannoma surgery

    OpenAIRE

    Hajná, Barbora

    2011-01-01

    TVestibular schwannoma is a benign tumor that arises from the Schwann cells of the vestibular nerve. Unilateral hearing loss, tinnitus, facial and trigeminal dysfunction and vertigo are the most common symptoms. Surgical removal of the tumor is one of the treatment modalities of this disease. Surgical excision usually involves the complete vestibular nerve resection and there is also a risk of cochlear and facial nerve lesion. This thesis deals with changes in quality of life in patients afte...

  4. Ligament-induced sacral fractures of the pelvis are possible.

    Science.gov (United States)

    Steinke, Hanno; Hammer, Niels; Lingslebe, Uwe; Höch, Andreas; Klink, Thomas; Böhme, Jörg

    2014-07-01

    Pelvic ring stability is maintained passively by both the osseous and the ligamentous apparatus. Therapeutic approaches focus mainly on fracture patterns, so ligaments are often neglected. When they rupture along with the bone after pelvic ring fractures, disrupting stability, ligaments need to be considered during reconstruction and rehabilitation. Our aim was to determine the influence of ligaments on open-book injury using two experimental models with body donors. Mechanisms of bone avulsion related to open-book injury were investigated. Open-book injuries were induced in human pelves and subsequently investigated by anatomical dissection and endoscopy. The findings were compared to CT and MRI scans of open-book injuries. Relevant structures were further analyzed using plastinated cross-sections of the posterior pelvic ring. A fragment of the distal sacrum was observed, related to open-book injury. Two ligaments were found to be responsible for this avulsion phenomenon: the caudal portion of the anterior sacroiliac ligament and another ligament running along the ventral surface of the third sacral vertebra. The sacral fragment remained attached to the coxal bone by this second ligament after open-book injury. These results were validated using plastination and the structures were identified. Pelvic ligaments are probably involved in sacral avulsion caused by lateral traction. Therefore, ligaments should to be taken into account in diagnosis of open-book injury and subsequent therapy. Copyright © 2014 Wiley Periodicals, Inc.

  5. Sacral Neuromodulation in Patients With a Cardiac Pacemaker

    Directory of Open Access Journals (Sweden)

    Abdullah A. Gahzi

    2016-09-01

    Full Text Available The objective of this study was to describe our experience using sacral neuromodulation to treat urinary urgency, frequency, urge incontinence, and chronic urinary retention in patients with cardiac pacemakers. With the increasingly widespread use of InterStim for bladder function restoration, we are seeing more complex patients with multiple comorbidities, including cardiac conditions. Herein, we report 3 cases of individuals with cardiac pacemakers who underwent InterStim implantation to treat urinary conditions. This study is a case series of 3 patients with cardiac pacemakers who underwent sacral neuromodulation to treat refractory voiding dysfunction. The initial patient screening for InterStim therapy involved percutaneous nerve evaluation (PNE, in which a temporary untined lead wire was placed through the S3 foramen. Patients who did not respond to PNE proceeded to a staged implant. All patients in this study had a greater than 50% improvement of their urinary symptoms during the initial trial and underwent placement of the InterStim implantable pulse generator (IPG. Postoperative programming was done under electrocardiogram monitoring by a cardiologist. No interference was observed between the Inter-Stim IPG and the cardiac pacemaker. In this group of patients, sacral neuromodulation in the presence of a cardiac pacemaker appears to have been safe.

  6. Analysis on CT features of tumor-like gastric schwannomas

    International Nuclear Information System (INIS)

    Zhang Yu; Chen Jie

    2011-01-01

    Objective: To analyze CT imaging features of tumor-like gastric schwannomas. Methods: Ten patients with gastric schwannomas were retrospectively analyzed. All were scanned with pre-and pro-enhanced CT. Analysis of the CT findings included evaluation of the volume, number, location, contour, growth pattern, border, enhancement pattern, and enhancement grade as well as the presence of surface dimpling, integrity of overlying mucosa. All cases were confirmed by pathology. Results: In every case, simple tumor was present. The largest was about 5.7 cm in the diameter, the smallest was 2.3 cm. All tumors were round or oval, and one tumor was slightly lobulated. Endoluminal growth pattern was defined in two cases, exoluminal growth pattern was defined in one case, and a mixed growth pattern was noted in the rest. The borders of tumors were clear. In arterial phase, no visible enhancement was present in eight cases and mild enhancement in two cases. All cases were constantly enhanced in portal phase. Superficial ulcers were present in four cases. Conclusion: CT findings of tumor-like gastric schwannomas are distinctive to a certain degree. It can be used to guide clinical therapy. (authors)

  7. [A Case of Primary Schwannoma of the Urinary Bladder].

    Science.gov (United States)

    Matsumoto, Yoshitaka; Waku, Natsui; Kawai, Koji; Ikeda, Atsushi; Kimura, Tomokazu; Ishitsuka, Ryutaro; Kojima, Takahiro; Suetomi, Takahiro; Joraku, Akira; Miyazaki, Jun; Sakashita, Mai; Nishiyama, Hiroyuki

    2017-08-01

    A 68-year-old woman presented with a bladder tumor. She was asymptomatic, and the tumor was incidentally detected with radiological imaging performed during treatment of cervical cancer. Magnetic resonance imaging and computed tomography revealed a solitary submucosal tumor located in the anterior wall of the urinary bladder, with homogeneous contrast enhancement. Cystoscopy showed a submucosal tumor covered by normal mucosa. A paraganglioma was considered in the differential diagnosis, but symptoms suggesting hypercatecholaminemia were not apparent. Moreover, she did not have a family history or symptoms associated with neurofibromatosis-1 (NF-1). She underwent partial cystectomy with a preliminary diagnosis of submucosal bladder tumor. Histopathological diagnosis confirmed a schwannoma arising from the bladder wall. She was followed up without intravesical recurrence or metastases for 6 months. In the literature, only 12 cases of bladder schwannoma have been reported. There was no reported family history or symptoms associated with NF-1 in any of the cases. Although the number of cases is limited, literature review showed a favorable prognosis for bladder schwannoma with local tumor resection in patients without NF-1.

  8. An evidence-based case of acoustic/vestibular schwannoma

    Directory of Open Access Journals (Sweden)

    Girish Gupta

    2015-01-01

    Full Text Available A vestibular schwannoma, often called an acoustic neuroma/schwannoma, is a benign primary intracranial tumor of the myelin-forming cells of the vestibulo-cochlear nerve (8 th cranial nerve. This tumor arises from the Schwann cells responsible for the myelin sheath that helps keep peripheral nerves insulated. [1] Approximately, 3000 cases are diagnosed each year in the United States with a prevalence of about 1 in 100,000 worldwide. It comprises 5-10% of all intracranial neoplasms in adults. Incidence peaks in the fifth and sixth decades and both sexes are affected equally. Studies in Denmark published in 2004 show the incidence of 17.4/million. Most acoustic neuromas are diagnosed in patients between the ages of 30 and 60, and men and women appear to be affected equally. [2] The case illustrated here is a rare one of acoustic/vestibular schwannoma a surgical conditions, treated with Lycopodium, which produced improvement on both subjective and objective parameters.

  9. Small vestibular schwannomas presenting with facial nerve palsy.

    Science.gov (United States)

    Espahbodi, Mana; Carlson, Matthew L; Fang, Te-Yung; Thompson, Reid C; Haynes, David S

    2014-06-01

    To describe the surgical management and convalescence of two patients presenting with severe facial nerve weakness associated with small intracanalicular vestibular schwannomas (VS). Retrospective review. Two adult female patients presenting with audiovestibular symptoms and subacute facial nerve paralysis (House-Brackmann Grade IV and V). In both cases, post-contrast T1-weighted magnetic resonance imaging revealed an enhancing lesion within the internal auditory canal without lateral extension beyond the fundus. Translabyrinthine exploration demonstrated vestibular nerve origin of tumor, extrinsic to the facial nerve, and frozen section pathology confirmed schwannoma. Gross total tumor resection with VIIth cranial nerve preservation and decompression of the labyrinthine segment of the facial nerve was performed. Both patients recovered full motor function between 6 and 8 months after surgery. Although rare, small VS may cause severe facial neuropathy, mimicking the presentation of facial nerve schwannomas and other less common pathologies. In the absence of labyrinthine extension on MRI, surgical exploration is the only reliable means of establishing a diagnosis. In the case of confirmed VS, early gross total resection with facial nerve preservation and labyrinthine segment decompression may afford full motor recovery-an outcome that cannot be achieved with facial nerve grafting.

  10. Schwannoma extending from the umbilical region to the mid-thigh ...

    African Journals Online (AJOL)

    ... originating from the cells of peripheral nerve sheaths; the diagnosis was a schwannoma. Abdominal schwannomas are rare neoplasms that can be misdiagnosed. Laparoscopy is a safe and efficient option for approaching benign pelvic tumours and may offer the advantage of better visualisation of structures owing to the ...

  11. Multiple schwannomas of cauda equine in the absence of von Recklinghausen's disease

    International Nuclear Information System (INIS)

    Kayaoglu, Cetin R.; Sengul, G.; Aydin, Ismail H.

    2007-01-01

    Multiple schwannomas in the absence of neurofibromatosis is rarely reported in the literature. We present a 56-year-old female with a history of severe leg and back pain on the left side for one year. Magnetic resonance imaging revealed 4 schwannomas located in the cauda equine in the absence of von Recklinghausen's disease. (author)

  12. Schwannoma of the facial nerve involving the middle cranial fossa:case report

    Institute of Scientific and Technical Information of China (English)

    SAI Ke; CHEN Zhong-ping

    2007-01-01

    @@ Facial nerve schwannoma involving the middle cranial fossa is quite rare,and its accurate diagnosis is very difficult before SUrgery.Here we present a case of schwannoma of the facial nerve at the middle cranial fossa that was misdiagnosed previously at a local hospital and then cured in our hospital.

  13. Comparison of Aorta-sacral Promontory Distance with Age and BMI in Female Patients Undergoing CT

    OpenAIRE

    Sneha Mary Varghese; Suresh Sukumar; Abhimanyu Pradhan

    2017-01-01

    Introduction: Sacral colpopexy is the gold standard procedure for pelvic organ prolapse. During sacral colpopexy, various complications such as haemorrhage can occur. Careful dissection of presacral space is essential to minimize complications. Aim: The aim of the study was to compare patient age and Body Mass Index (BMI) with Computed Tomography (CT) measured aorta-sacral promontory distance. Materials and Methods: From 172 samples data such as age and BMI of female patients aged 18 ye...

  14. Association of Genetic Predisposition With Solitary Schwannoma or Meningioma in Children and Young Adults.

    Science.gov (United States)

    Pathmanaban, Omar N; Sadler, Katherine V; Kamaly-Asl, Ian D; King, Andrew T; Rutherford, Scott A; Hammerbeck-Ward, Charlotte; McCabe, Martin G; Kilday, John-Paul; Beetz, Christian; Poplawski, Nicola K; Evans, D Gareth; Smith, Miriam J

    2017-09-01

    Meningiomas and schwannomas are usually sporadic, isolated tumors occurring in adults older than 60 years and are rare in children and young adults. Multiple schwannomas and/or meningiomas are more frequently associated with a tumor suppressor syndrome and, accordingly, trigger genetic testing, whereas solitary tumors do not. Nevertheless, apparently sporadic tumors in young patients may herald a genetic syndrome. To determine the frequency of the known heritable meningioma- or schwannoma-predisposing mutations in children and young adults presenting with a solitary meningioma or schwannoma. Using the database of the Manchester Centre for Genomic Medicine, this cohort study analyzed lymphocyte DNA from young individuals prospectively referred to the clinic for genetic testing between January 1, 1990, and December 31, 2016, on presentation with a single meningioma (n = 42) or schwannoma (n = 135) before age 25 years. Sequencing data were also examined from an additional 39 patients with neurofibromatosis type 2 who were retrospectively identified as having a solitary tumor before age 25 years. Patients with schwannoma were screened for NF2, SMARCB1, and LZTR1 gene mutations, while patients with meningioma were screened for NF2, SMARCB1, SMARCE1, and SUFU. The type of underlying genetic mutation, or lack of a predisposing mutation, was associated with the presenting tumor type and subsequent development of additional tumors or other features of known schwannoma- and meningioma-predisposing syndromes. In 2 cohorts of patients who presented with an isolated meningioma (n = 42; median [range] age, 11 [1-24] years; 22 female) or schwannoma (n = 135; median [range] age, 18 [0.2-24] years; 60 female) before age 25 years, 16 of 42 patients (38%) had a predisposing mutation to meningioma and 27 of 135 patients (20%) to schwannoma, respectively. In the solitary meningioma cohort, 34 of 63 patients (54%) had a constitutional mutation in a known meningioma

  15. Ancient schwannoma at the olfactory groove mimicking meningioma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Young Jin; Jeong, Hae Woong [Dept. of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2015-12-15

    Schwannomas are benign slow-growing nerve sheath tumors, which can develop in any peripheral or central nerve that contains Schwann cells. Schwannomas located near the olfactory groove are extremely rare and radiological diagnosis can be difficult. Moreover, ancient schwannoma is an uncommon variant, and radiologic findings are rarely reported. Herein, we reported a surgically confirmed case of ancient schwannoma at the olfactory groove in a 44-year-old woman presenting with headache and visual disturbance. Brain magnetic resonance imaging (MRI) showed a solid and cystic extra-axial mass located in the subfrontal area mimicking an olfactory groove meningioma. Histopathologic diagnosis of ancient schwannoma was confirmed by immunohistochemical staining for S100, CD56, vimentin, and other markers. Furthermore, we described the clinical manifestations, MRI characteristics, and histopathologic findings of the case, and presented a review of related literature.

  16. Ancient schwannoma of thoracic spine in a schizophrenic patient with somatic delusion

    Directory of Open Access Journals (Sweden)

    Ya-Ting Wen

    2016-03-01

    Full Text Available Ancient schwannoma is a rare variant of schwannoma characterized by histopathologic degenerative changes, which are thought to be the result of long-term tumor growth and aging. However, ancient schwannoma in the spinal canal is particularly rare. We report a case of thoracic spine intradural extramedullary ancient schwannoma in a schizophrenic patient, who kept saying that “something in his back was giving him electric shock” for a long time. Unfortunately, this complaint was misinterpreted as somatic delusion symptoms. A spinal cord tumor was taken into consideration only after paraparesis developed. We have highlighted this case to remind every clinician to remain alert about the possibility of organic disease while treating patients with psychotic disorder history. Thorough neurological examination is required to avoid misdiagnosis. Spinal canal schwannoma can be totally removed successfully with good functional outcome and prognosis.

  17. Magnetic Resonance Imaging Appearance of Schwannomas from Head to Toe: A Pictorial Review

    Directory of Open Access Journals (Sweden)

    Jamie Crist

    2017-01-01

    Full Text Available Schwannomas are benign soft-tissue tumors that arise from peripheral nerve sheaths throughout the body and are commonly encountered in patients with neurofibromatosis Type 2. The vast majority of schwannomas are benign, with rare cases of malignant transformation reported. In this pictorial review, we discuss the magnetic resonance imaging (MRI appearance of schwannomas by demonstrating a collection of tumors from different parts of the body that exhibit similar MRI characteristics. We review strategies to distinguish schwannomas from malignant soft-tissue tumors while exploring the anatomic and histologic origins of these tumors to discuss how this correlates with their imaging findings. Familiarity with the MRI appearance of schwannomas can help aid in the differential diagnosis of soft-tissue masses, especially in unexpected locations.

  18. Rectal motility after sacral nerve stimulation for faecal incontinence

    DEFF Research Database (Denmark)

    Michelsen, H B; Worsøe, J; Krogh, K

    2010-01-01

    Sacral nerve stimulation (SNS) is effective against faecal incontinence, but the mode of action is obscure. The aim of this study was to describe the effects of SNS on fasting and postprandial rectal motility. Sixteen patients, 14 women age 33-73 (mean 58), with faecal incontinence of various...... contractions, total time with cyclic rectal contractions, the number of aborally and orally propagating contractions, the number of anal sampling reflexes or rectal wall tension during contractions. Postprandial changes in rectal tone were significantly reduced during SNS (P

  19. Progressive bilateral anterior sacral meningoceles in Marfan syndrome

    International Nuclear Information System (INIS)

    Scheck, R.J.; Schramm, T.; Gloning, K.P.; Vogl, T.; Ostermayer, E.

    1995-01-01

    Anterior sacral meningoceles (ASM) in Marfan syndrome are rare. They may cause constipation, urinary frequency, dysmenorrhoea, and low back pain or numbness. This report describes bilateral ASM at the level of S1, S2 and S3 in a woman with Marfan syndrome who was admitted to the gynaecology department for evaluation of left lower abdominal pain. The magnetic resonance appearance of the meningoceles is discussed and compared with findings from transvaginal ultrasound and CT. As MRI offers excellent delineation of spinal and pelvic structures, it is the most useful technique available in establishing the diagnosis and planning the treatment of ASM. (orig.)

  20. Progressive bilateral anterior sacral meningoceles in Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Scheck, R J [Dept. of Radiology, Univ. Muenchen (Germany); Schramm, T [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany); Gloning, K P [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany); Vogl, T [Dept. of Radiology, Univ. Muenchen (Germany); Ostermayer, E [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany)

    1995-08-01

    Anterior sacral meningoceles (ASM) in Marfan syndrome are rare. They may cause constipation, urinary frequency, dysmenorrhoea, and low back pain or numbness. This report describes bilateral ASM at the level of S1, S2 and S3 in a woman with Marfan syndrome who was admitted to the gynaecology department for evaluation of left lower abdominal pain. The magnetic resonance appearance of the meningoceles is discussed and compared with findings from transvaginal ultrasound and CT. As MRI offers excellent delineation of spinal and pelvic structures, it is the most useful technique available in establishing the diagnosis and planning the treatment of ASM. (orig.)

  1. Diagnostics and therapy of vestibular schwannomas – an interdisciplinary challenge

    Science.gov (United States)

    Rosahl, Steffen; Bohr, Christopher; Lell, Michael; Hamm, Klaus; Iro, Heinrich

    2017-01-01

    Vestibular schwannomas (VS) expand slowly in the internal auditory canal, in the cerebellopontine angle, inside the cochlear and the labyrinth. Larger tumors can displace and compress the brainstem. With an annual incidence of 1:100,000 vestibular schwannoma represent 6–7% of all intracranial tumors. In the cerebellopontine angle they are by far the most neoplasm with 90% of all lesions located in this region. Magnetic resonance imaging (MRI), audiometry, and vestibular diagnostics are the mainstays of the clinical workup for patients harboring tumors. The first part of this paper delivers an overview of tumor stages, the most common grading scales for facial nerve function and hearing as well as a short introduction to the examination of vestibular function. Upholding or improving quality of life is the central concern in counseling and treating a patient with vestibular schwannoma. Preservation of neuronal function is essential and the management options – watchful waiting, microsurgery and stereotactic radiation – should be custom-tailored to the individual situation of the patient. Continuing interdisciplinary exchange is important to monitor treatment quality and to improve treatment results. Recently, several articles and reviews have been published on the topic of vestibular schwannoma. On the occasion of the 88th annual meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck surgery a special volume of the journal “HNO” will be printed. Hence this presentation has been designed to deviate from the traditional standard which commonly consists of a pure literature review. The current paper was conceptually woven around a series of interdisciplinary cases that outline examples for every stage of the disease that show characteristic results for management options to date. Systematic clinical decision pathways have been deduced from our experience and from results reported in the literature. These pathways are graphically outlined after

  2. Relief of fecal incontinence by sacral nerve stimulation linked to focal brain activation

    DEFF Research Database (Denmark)

    Lundby, Lilli; Møller, Arne; Buntzen, Steen

    2011-01-01

    This study aimed to test the hypothesis that sacral nerve stimulation affects afferent vagal projections to the central nervous system associated with frontal cortex activation in patients with fecal incontinence.......This study aimed to test the hypothesis that sacral nerve stimulation affects afferent vagal projections to the central nervous system associated with frontal cortex activation in patients with fecal incontinence....

  3. Correlation of magnetic resonance imaging findings of spinal intradural extramedullary schwannomas with pathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yeo Ju; Park, In Suh; Yoon, Seung Hwan; Choi, Suk Jin; Kim, Youn Jeong; Kang, Young Hye; Lee, Ha Young; Kim, Woo Chul; Han, Jun Gu; Cho, Soon Gu [Inha University Hospital, Incheon (Korea, Republic of)

    2015-06-15

    To evaluate the magnetic resonance imaging (MRI) findings of spinal intradural extramedullary schwannomas with pathologic correlation and to determine whether these schwannomas share the imaging features of schwannomas in the peripheral nerves. The MRIs of 17 cases of pathologically proven spinal intradural extramedullary schwannomas were reviewed retrospectively, and cystic changes, enhancement, and intratumoral hemorrhage of the tumors were evaluated. Imaging features known to be common findings of schwannoma in the peripheral nerves, such as encapsulation, the target sign, the fascicular sign, and visualization of entering or exiting nerve rootlets, were also evaluated. The histopathology of the tumors was correlated with the MRI findings. Cystic changes were detected in 14 cases by MRI and in 16 cases by pathology. The most common pattern of enhancement was a thick peripheral septal pattern (70.59%). Intratumoral hemorrhage was detected in four cases on MRI, but in all cases on pathology. Encapsulation was observed in all cases. The fascicular sign was seen in only four cases, and thickening of an exiting rootlet was visualized in one case. None of the cases showed the target sign. Spinal intradural extramedullary schwannomas were typical encapsulated cystic tumors and had few imaging features of schwannomas in the peripheral nerves.

  4. Sociodemographic factors and vestibular schwannoma: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Schüz, Joachim; Steding-Jessen, Marianne; Hansen, Søren

    2010-01-01

    Vestibular schwannoma (VS) (or acoustic neuroma) accounts for about 5%-6% of all intracranial tumors; little is known about the etiology. We investigated the association between various sociodemographic indicators and VS in a cohort of 3.26 million Danish residents, with 1087 cases identified in 35...... 308 974 person-years under risk, with data accrued from 1993 to 2006. Complete ascertainment of cases was ensured by using population-based and clinical cancer registries. Information on sociodemographic indicators was obtained on an annually updated individual level from Statistics Denmark. Log...

  5. Anesthetic management of schwannoma of the base of the tongue

    Directory of Open Access Journals (Sweden)

    Upma B Batra

    2011-01-01

    Full Text Available Schwannoma arising from the base of the tongue are very rare and only a few cases have been reported so far. Definitive diagnosis is always made after a histological examination. Apart from an anticipated difficult airway with a risk of airway obstruction upon induction of general anesthesia, anesthetic concerns also include possibility of trauma to the growth and bleeding with attendant risks. We discuss the awake fiberoptic technique used for endotracheal intubation in such a case. This case report highlights the importance of detailed history taking and clinical examination, with emphasis on airway assessment and preoperative planning.

  6. Critical Airway Compromise due to a Massive Vagal Schwannoma

    LENUS (Irish Health Repository)

    McDermott, AM

    2016-05-01

    We describe the case of a 37-year-old man with a slowly enlarging neck lump and compressive symptoms. He presented to a separate institution 10 years prior where an observational approach was advocated. Following preoperative investigations and embolization, an 11cm vagal schwannoma was excised and vagus nerve was sacrificed. Although conservative management is appropriate for a select patient population, surgical excision is treatment of choice for cervical neurogenic tumours and paraganglionomas and must be considered in young patients or rapidly expanding tumours to avoid compressive symptoms, as in this case.

  7. Extraosseous Ewing's sarcoma / primitive neuroectodermal tumor of the sacral nerve plexus

    International Nuclear Information System (INIS)

    Narula, MK; Gupta, Nishant; Anand, Rama; Kapoor, Sudhir

    2009-01-01

    We report an unusual case of Ewing's sarcoma / primitive neuroectodermal tumor (PNET) of the sacral nerve plexus in a 9-year-old boy who presented with a soft tissue swelling and severe piercing pain in the lower back region. MRI of the lumbosacral spine showed a lobulated soft tissue mass with clubbed finger-like projections along the path of the sacral nerves, which had caused widening of the spinal canal and the sacral foramina (S2–S4 level). There was presacral extension and posterior scalloping of the sacral vertebrae. Histopathology of the lesion confirmed Ewing's sarcoma / PNET of the sacral spinal nerve plexus. The patient responded favorably to chemotherapy and radiotherapy, showing clinical and radiological improvement

  8. Clinical results of a brindley procedure: sacral anterior root stimulation in combination with a rhizotomy of the dorsal roots

    NARCIS (Netherlands)

    Martens, F.M.J.; Heesakkers, J.P.F.A.

    2011-01-01

    The Brindley procedure consists of a stimulator for sacral anterior-root stimulation and a rhizotomy of the dorsal sacral roots to abolish neurogenic detrusor overactivity. Stimulation of the sacral anterior roots enables micturition, defecation, and erections. This overview discusses the technique,

  9. Feasibility of Using Ultrasonography to Establish Relationships Among Sacral Base Position, Sacral Sulcus Depth, Body Mass Index, and Sex.

    Science.gov (United States)

    Lockwood, Michael D; Kondrashova, Tatyana; Johnson, Jane C

    2015-11-01

    Identifying relationships among anatomical structures is key in diagnosing somatic dysfunction. Ultrasonography can be used to visualize anatomical structures, identify sacroiliac landmarks, and validate anatomical findings and measurements in relation to somatic dysfunction. As part of the osteopathic manipulative medicine course at A.T. Still University-Kirksville College of Osteopathic Medicine, first-year students are trained to use ultrasonography to establish relationships among musculoskeletal structures. To determine the ability of first-year osteopathic medical students to establish sacral base position (SBP) and sacral sulcus depth (SSD) using ultrasonography and to identify the relationship of SBP and SSD to body mass index (BMI) and sex. Students used ultrasonography to obtain the distance between the skin and the sacral base (the SBP) and the distance between the skin and the tip of the posterior superior iliac spine bilaterally. Next, students calculated the SSD (the distance between the tip of the posterior superior iliac spine and the SBP). Data were analyzed with respect to side of the body, BMI, sex, and age. The BMI data were subdivided into normal (18-25 mg/kg) and overweight (25-30 mg/kg) groups. Ultrasound images of 211 students were included in the study. The SBP was not significantly different between the left and right sides (36.5 mm vs 36.5 mm; P=.95) but was significantly different between normal and overweight BMI categories (33.0 mm vs 40.0 mm; Psex may point to more soft tissue overlaying the sacrum in these groups. Further research is needed on the use of ultrasonography to establish criteria for somatic dysfunction.

  10. Nonvestibular schwannoma tumors in the cerebellopontine angle: A structured approach and management guidelines

    DEFF Research Database (Denmark)

    Springborg, J.B.; Poulsgaard, L.; Thomsen, Jens Christian

    2008-01-01

    The most common cerebellopontine angle (CPA) tumor is a vestibular schwannoma, but one in five CPA tumors are not vestibular schwannomas. These tumors may require different management strategies. Compared with vestibular schwannomas, symptoms and signs from cranial nerve VIII are less frequent......: other cranial nerve and cerebellar symptoms and signs predominate in patients with these less common CPA tumors. Computed tomography and magnetic resonance imaging often show features leading to the correct diagnosis. Treatment most often includes surgery, but a policy of observation or subtotal...

  11. Gastric schwannoma: a benign tumor often misdiagnosed as gastrointestinal stromal tumor

    Directory of Open Access Journals (Sweden)

    Apurva S. Shah

    2015-10-01

    Full Text Available Gastric schwannomas are rare mesenchymal tumors that arise from the nerve plexus of gut wall. They present with nonspecific symptoms and are often detected incidentally. Preoperative investigation is not pathognomic and many are therefore misdiagnosed as gastrointestinal stromal tumors. We report a rare case of a 37-year old woman who underwent laparotomy for complex bilateral ovarian cyst with resection of gastric-gastrointestinal stromal tumor preoperatively, but confirmed to have a gastric schwannomas postoperatively. This case underscores the differential diagnosis of submucosal, exophytic gastric mass as schwannoma.

  12. [Sacral neuromodulation in urology - development and current status].

    Science.gov (United States)

    Schwalenberg, T; Stolzenburg, J-U; Kriegel, C; Gonsior, A

    2012-01-01

    Sacral neuromodulation (SNM) in urology is employed to treat refractory lower urinary tract dysfunction as well as chronic pelvic pain. Electrical stimulation of the sacral afferents (S2 - S4) causes activation and conditioning of higher autonomic and somatic neural structures and thereby influences the efferents controlling the urinary bladder, the rectum and their related sphincter systems. It is therefore possible to treat overactivity as well as hypocontractility and functional bladder neck obstruction. SNM treatment is conducted biphasically. Initially, test electrodes are placed to evaluate changes in micturition and pain parameters. If, in this first phase - called peripheral nerve evaluation (PNE test) - sufficient improvements are observed, the patient progresses to phase two which involves implantation of the permanent electrodes and impulse generator system. In recent years, the "two stage approach" with initial implantation of the permanent electrodes has been favoured as it increases treatment success rates. Long-term success rates of SNM vary significantly in the literature (50 - 80 %) due to heterogeneous patient populations as well as improved surgical approaches. With the introduction of "tined lead electrodes" (2002), tissue damage is reduced to a minimum. Technical innovation, financial feasibility (reimbursed in Germany since 2004) and wider application, especially in otherwise therapy-refractory patients or complex dysfunctions of the pelvis, have established SNM as a potent treatment option in urology. © Georg Thieme Verlag KG Stuttgart · New York.

  13. MRI of occult sacral insufficiency fractures following radiotherapy

    International Nuclear Information System (INIS)

    Mammone, J.F.; Schweitzer, M.E.

    1995-01-01

    Following radiation therapy, marrow abnormalities noted on magnetic resonance imaging (MRI) are frequent and may mimic metastases. Specific radiotherapy changes are usually easily identifiable; however, traumatic lesions cause more interpretive difficulties. We assessed the incidence and MRI characteristics of insufficiency fractures in this population. During a 5-year span (1987-1991), 546 patients received pelvic radiotherapy for primary malignancies. MRI was performed in 25 of these patients at least 3 months after treatment. The mean dose in this group was 53 Gy. These MRI scans were retrospectively reviewed for the appearance of the sacrum with particular attention to the presence of insufficiency fractures. This was correlated with clinical course and scintigraphic findings. Presumed insufficiency fractures on MRI paralleled the sacral side of the sacroiliac joint, enhanced with Gd-DTPA, were most prominent or initially seen anteriorly, and had ill-defined margins on all imaging sequences. The incidence of occult sacral insufficiency fractures was at least 20%. Insufficiency fractures of the sacrum in the post-radiotherapy patient are a relatively frequent occurrence which can mimic metastases. Consideration of this phenomenon and knowledge of differential features may avoid overdiagnosis of osseous metastases. (orig.)

  14. The sacral autonomic outflow is parasympathetic: Langley got it right.

    Science.gov (United States)

    Horn, John P

    2018-04-01

    A recent developmental study of gene expression by Espinosa-Medina, Brunet and colleagues sparked controversy by asserting a revised nomenclature for divisions of the autonomic motor system. Should we re-classify the sacral autonomic outflow as sympathetic, as now suggested, or does it rightly belong to the parasympathetic system, as defined by Langley nearly 100 years ago? Arguments for rejecting Espinosa-Medina, Brunet et al.'s scheme subsequently appeared in e-letters and brief reviews. A more recent commentary in this journal by Brunet and colleagues responded to these criticisms by labeling Langley's scheme as a historical myth perpetuated by ignorance. In reaction to this heated exchange, I now examine both sides to the controversy, together with purported errors by the pioneers in the field. I then explain, once more, why the sacral outflow should remain known as parasympathetic, and outline suggestions for future experimentation to advance the understanding of cellular identity in the autonomic motor system.

  15. Predictors of vertigo in patients with untreated vestibular schwannoma.

    Science.gov (United States)

    Andersen, Jan Fredrik; Nilsen, Kathrin Skorpa; Vassbotn, Flemming Slinning; Møller, Per; Myrseth, Erling; Lund-Johansen, Morten; Goplen, Frederik Kragerud

    2015-04-01

    Previous studies have shown that vertigo is the most powerful negative predictor of quality of life in patients with vestibular schwannomas, but the variability in vertigo symptom severity is still poorly understood. We wanted to find out whether vertigo could be related to objective parameters such as tumor size, location, vestibular nerve function, hearing, and postural stability in patients with untreated vestibular schwannomas. Baseline data from prospective cohort study. Tertiary referral center. Four hundred thirty-four consecutive patients with unilateral VS diagnosed on MRI. Mean age 56 years (range 16-84 yr). Fifty-three percent women. Diagnostic, with a medical history, otolaryngological examination, pure-tone and speech audiometry, MRI, posturography, and videonystagmography with bithermal caloric tests. Dizziness measured on a 100-mm visual analog scale (VAS). Secondary outcome measures were canal paresis and postural imbalance (static and dynamic posturography). Three hundred three patients (70%) completed the VAS. Severe dizziness, defined as VAS 75 or greater, was reported by 9% of the patients. Larger tumors were associated with higher risk of postural instability and canal paresis. Moderate to severe dizziness was associated with postural imbalance and canal paresis, and possibly with small to medium-sized tumors. Postural instability was related to tumor size and canal paresis when measured by dynamic, but not with static, posturography. A minority of VS patients experience severe vestibular symptoms related to canal paresis and postural instability. A curvilinear relationship is hypothesized between tumor size and dizziness.

  16. Transoral Robotic Surgery in Retrostyloid Parapharyngeal Space Schwannomas

    Science.gov (United States)

    Ansarin, Mohssen; Tagliabue, Marta; Chu, Francesco; Zorzi, Stefano; Proh, Michele; Preda, Lorenzo

    2014-01-01

    Parapharyngeal space (PPS) tumors are very rare, representing about 0.5% of head and neck neoplasms. An external surgical approach is mainly used. Several recent papers show how transoral robotic surgery (TORS) excision could be a prospective tool to remove mainly benign lesions in PPS; no cases of neurogenic tumors from the retrostyloid space treated with TORS have been reported. We present two cases which underwent TORS for schwannomas from the retrostyloid compartment of the parapharyngeal space. Clinical diagnosis of schwannoma was performed by magnetic resonance imaging (MRI). In the first case a 6 cm neurogenic tumor arose from the vagus nerve and in the second case a 5 cm mass from the sympathetic chain was observed. Both cases were treated successfully by the TORS approach using a new “J”-shaped incision through the mucosa and superior pharyngeal constrictor muscle. Left vocal cord palsy and the Claude Bernard Horner syndrome, respectively, were observed as expected postsurgical sequelae. In case 1 the first bite syndrome developed after three months, while no complications were observed in case 2. Both patients regained a normal swallowing function. TORS seems to be a feasible mini-invasive procedure for benign PPS masses including masses in the poststyloid space. PMID:25202464

  17. Transoral Robotic Surgery in Retrostyloid Parapharyngeal Space Schwannomas

    Directory of Open Access Journals (Sweden)

    Mohssen Ansarin

    2014-01-01

    Full Text Available Parapharyngeal space (PPS tumors are very rare, representing about 0.5% of head and neck neoplasms. An external surgical approach is mainly used. Several recent papers show how transoral robotic surgery (TORS excision could be a prospective tool to remove mainly benign lesions in PPS; no cases of neurogenic tumors from the retrostyloid space treated with TORS have been reported. We present two cases which underwent TORS for schwannomas from the retrostyloid compartment of the parapharyngeal space. Clinical diagnosis of schwannoma was performed by magnetic resonance imaging (MRI. In the first case a 6 cm neurogenic tumor arose from the vagus nerve and in the second case a 5 cm mass from the sympathetic chain was observed. Both cases were treated successfully by the TORS approach using a new “J”-shaped incision through the mucosa and superior pharyngeal constrictor muscle. Left vocal cord palsy and the Claude Bernard Horner syndrome, respectively, were observed as expected postsurgical sequelae. In case 1 the first bite syndrome developed after three months, while no complications were observed in case 2. Both patients regained a normal swallowing function. TORS seems to be a feasible mini-invasive procedure for benign PPS masses including masses in the poststyloid space.

  18. Prevalence of hydrocephalus in 157 patients with vestibular schwannoma

    Energy Technology Data Exchange (ETDEWEB)

    Rogg, Jeffrey M.; Ahn, S.H.; Tung, G.A. [Rhode Island Hospital, Department of Diagnostic Imaging, Providence, Rhode Island (United States); Reinert, S.E. [Rhode Island Hospital, Lifespan Medical Computing, Providence, Rhode Island (United States); Noren, G. [Rhode Island Hospital, Department of Neurosurgery, Providence, Rhode Island (United States)

    2005-05-01

    The purpose of this study was to determine the prevalence of hydrocephalus in patients with vestibular schwannoma. A second objective was to investigate possible etiologies for hydrocephalus in this population by attempting to correlate the incidence and severity of hydrocephalus with tumor volume and extent of fourth ventricular compression. The MRI examinations of 157 adult patients with vestibular schwannoma were retrospectively reviewed. Tumor size was quantified, and the presence of accompanying hydrocephalus was assessed, categorized as communicating type or non-communicating type and then rated as mild, moderate or severe (grades 1-3). Next, the degree of fourth ventricular distortion caused by tumor mass effect was evaluated and categorized as mild, moderate or severe (grades 1-3). Spearman's rank correlation coefficient was used to test the relationships between tumor volume and (1) the extent of fourth ventricular effacement and (2) severity of hydrocephalus. Hydrocephalus was present in 28/157 (18%) cases and was categorized as mild in 11/28 (39%), moderate in 15/28 (54%) and severe in 2/28 (7%). Communicating-type hydrocephalus was present in 17/28 (61%) and non-communicating type in 11/28 (39%). There was a positive correlation between the grade of non-communicating hydrocephalus and tumor volume (r=0.38; P<0.001) and between the severity of fourth ventricular compression and extent of hydrocephalus in this group(r=0.43; P<0.001). (orig.)

  19. Preoperative predictive factors for hearing preservation in vestibular schwannoma surgery.

    Science.gov (United States)

    Rohit; Piccirillo, Enrico; Jain, Yogesh; Augurio, Angela; Sanna, Mario

    2006-01-01

    We performed a retrospective chart review to evaluate the various predictive factors for postoperative hearing preservation in the surgical management of vestibular schwannoma. Of 792 patients operated on for vestibular schwannoma between April 1987 and July 2002, 107 were candidates for hearing preservation surgery. These patients were divided into group 1 (hearing preserved) and group 2 (hearing not preserved), and both of these groups were evaluated for age, sex, pure tone average, sound discrimination score, tumor size, and auditory brain stem response parameters. A corrected chi2 test and a corrected t-test were used for statistical analysis. Multiple regression analysis was further done to evaluate independent predictive factors, either alone or in combination. The results were evaluated by use of the modified Sanna classification and the guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Preoperative pure tone average and tumor size were the 2 predictive factors in our study. A Pearson correlation test showed that there was no multicollinearity between the factors. On multiple regression analysis by backward elimination of nonsignificant factors, we found that tumor size is an independent predictive factor for postoperative hearing. According to the modified Sanna classification, postoperative hearing was preserved in 11.2% of patients (equivalent to class A of AAO-HNS guidelines). In our series, preoperative pure tone average and tumor size were found to be predictors of postoperative hearing levels.

  20. Transforming giants.

    Science.gov (United States)

    Kanter, Rosabeth Moss

    2008-01-01

    Large corporations have long been seen as lumbering, inflexible, bureaucratic--and clueless about global developments. But recently some multinationals seem to be transforming themselves: They're engaging employees, moving quickly, and introducing innovations that show true connection with the world. Harvard Business School's Kanter ventured with a research team inside a dozen global giants--including IBM, Procter & Gamble, Omron, CEMEX, Cisco, and Banco Real--to discover what has been driving the change. After conducting more than 350 interviews on five continents, she and her colleagues came away with a strong sense that we are witnessing the dawn of a new model of corporate power: The coordination of actions and decisions on the front lines now appears to stem from widely shared values and a sturdy platform of common processes and technology, not from top-down decrees. In particular, the values that engage the passions of far-flung workforces stress openness, inclusion, and making the world a better place. Through this shift in what might be called their guidance systems, the companies have become as creative and nimble as much smaller ones, even while taking on social and environmental challenges of a scale that only large enterprises could attempt. IBM, for instance, has created a nonprofit partnership, World Community Grid, through which any organization or individual can donate unused computing power to research projects and see what is being done with the donation in real time. IBM has gained an inspiring showcase for its new technology, helped business partners connect with the company in a positive way, and offered individuals all over the globe the chance to contribute to something big.

  1. The bony crescent sign - a new sign of facial nerve schwannoma

    International Nuclear Information System (INIS)

    Watts, A.; Fagan, P.

    1992-01-01

    Schwannomas are relatively uncommon intracranial tumours. They most commonly involve the acoustic nerve followed in frequency by the trigeminal nerve. Other cranial nerves are rarely involved. Facial nerve schwannomas occurring within the petrous temporal bone are very rare. Their diagnosis may be missed prospectively even when appropriate computerized tomography (CT) scans are performed. Even in retrospect the site of abnormality may be difficult to identify, especially if there is an associated middle ear mass such as a cholesteatoma. In the 4 cases presented the facial nerve schwannoma was seen on high resolution CT as a soft tissue mass bounded anteriorly by a thin rim of bone. This bony crescent sign is a previously undescribed feature of facial nerve schwannoma which appears to be strongly indicative of the presence of this tumour. Recognition of this sign makes these tumours arising in the region of the geniculate ganglion easy to diagnose prospectively. 12 refs., 6 figs

  2. Subarachnoid Hemorrhage due to Spinal Cord Schwannoma Presenting Findings Mimicking Meningitis.

    Science.gov (United States)

    Zhang, Hong-Mei; Zhang, Yin-Xi; Zhang, Qing; Song, Shui-Jiang; Liu, Zhi-Rong

    2016-08-01

    Subarachnoid hemorrhage (SAH) of spinal origin is uncommon in clinical practice, and spinal schwannomas associated with SAH are even more rarely reported. We report an unusual case of spinal SAH mimicking meningitis with normal brain computed tomography (CT)/magnetic resonance imaging (MRI) and negative CT angiography. Cerebrospinal fluid examination results were consistent with the manifestation of SAH. Spinal MRI performed subsequently showed an intradural extramedullary mass. The patient received surgery and was finally diagnosed with spinal cord schwannoma. A retrospective chart review of the patient was performed. We describe a case of SAH due to spinal cord schwannoma. Our case highlights the importance of careful history taking and complete evaluation. We emphasize that spinal causes should always be ruled out in patients with angionegative SAH and that schwannoma should be considered in the differential diagnosis of SAH etiologies even though rare. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Angiogenesis in vestibular schwannomas: expression of extracellular matrix factors MMP-2, MMP-9, and TIMP-1

    DEFF Research Database (Denmark)

    Møller, Martin Nue; Werther, Kim; Nalla, Amarnadh

    2010-01-01

    Vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs) are potent mediators of tumor angiogenesis. It has been demonstrated that vestibular schwannoma VEGF expression correlates with tumor growth pattern, whereas knowledge on the expression of MMPs is lacking. This study...

  4. Schwannoma in the porta hepatis - laparoscopic excision under laparoscopic ultrasound guidance.

    Science.gov (United States)

    Sebastian, Maciej; Sroczyński, Maciej; Donizy, Piotr; Rudnicki, Jerzy

    2017-09-01

    Schwannomas are usually benign tumors attached to peripheral nerves and are rarely found in the gastrointestinal tract. Schwannomas in the porta hepatis are extremely rare, with only 15 cases described in the literature to date. A 22-year-old female patient presented with colicky upper abdominal pain lasting 3 months. Magnetic resonance imaging of the abdominal cavity revealed a tumor in the porta hepatis. The patient was qualified for laparoscopy. The tumor was totally excised laparoscopically under guidance of laparoscopic ultrasound without intra- or postoperative complications. Postoperative histopathological examination confirmed the porta hepatic schwannoma. The patient recovered uneventfully with very good cosmetic results. In the follow-up period of 5 months we have not observed any abdominal or general health problems. The present case is the first report in the world of laparoscopic ultrasound guided laparoscopic excision of a porta hepatic schwannoma.

  5. Linear accelerator-based stereotactic radiosurgery for bilateral vestibular schwannomas in patients with neurofibromatosis type 2

    NARCIS (Netherlands)

    Meijer, Otto W. M.; Vandertop, W. Peter; Lagerwaard, Frank J.; Slotman, Ben J.

    2008-01-01

    OBJECTIVE: Patients with neurofibromatosis Type 2 (NF2) patients typically have bilateral vestibular schwannomas (VS) and are at risk for developing bilateral deafness, bilateral trigeminal, and bilateral facial nerve function loss. Previous reports suggested that treatment outcomes in these

  6. Clinical experience with Leksell gamma knife in the treatment of trigeminal schwannomas

    Institute of Scientific and Technical Information of China (English)

    WANG En-min; PAN Li; ZHANG Nan; ZHOU Liang-fu; WANG Bing-jiang; DONG Ya-fei; DAI Jia-zhong; CAI Pei-wu

    2005-01-01

    @@ Trigeminal nerve schwannomas, which are rare, slowly growing, benign tumors, account for 0.2% to 1.0% of all intracranial tumors and 0.8% to 8.0% of intracranial schwannomas.1-5 These tumors are treated surgically.1-4 The development of microsurgery and skull base surgery has made complete resection possible in most patients. Nevertheless, cranial nerve sequelae appear after complete resection of these tumors because they are located close to the cavernous sinus and usually adhere to the vital vascular and neural structures. As an alternative to microsurgical resection, Leksell gamma knife (LGK) radiosurgery has been performed for patients with intracranial schwannomas to minimize the treatment-related morbidity and achieve a long-term control of tumor growth.6,7 In this report, we describe our 6-year experience in the treatment of 38 patients with trigeminal schwannomas by LGK.

  7. Imaging-documented repeated intratumoral hemorrhage in vestibular schwannoma: a case report

    NARCIS (Netherlands)

    Mandl, E. S.; Vandertop, W. P.; Meijer, O. W. M.; Peerdeman, S. M.

    2009-01-01

    Intratumoral hemorrhage in vestibular schwannomas is rare. Symptoms often have an acute onset and include headache, nausea, vomiting, vertigo, and depressed consciousness. Intratumoral hemorrhage is probably caused by vascular fragility associated with tumor characteristics and growth. With

  8. Giant Cell Arteritis

    Science.gov (United States)

    Giant cell arteritis is a disorder that causes inflammation of your arteries, usually in the scalp, neck, and arms. ... arteries, which keeps blood from flowing well. Giant cell arteritis often occurs with another disorder called polymyalgia ...

  9. The predictive value of the sacral base pressure test in detecting specific types of sacroiliac dysfunction

    Science.gov (United States)

    Mitchell, Travis D.; Urli, Kristina E.; Breitenbach, Jacques; Yelverton, Chris

    2007-01-01

    Abstract Objective This study aimed to evaluate the validity of the sacral base pressure test in diagnosing sacroiliac joint dysfunction. It also determined the predictive powers of the test in determining which type of sacroiliac joint dysfunction was present. Methods This was a double-blind experimental study with 62 participants. The results from the sacral base pressure test were compared against a cluster of previously validated tests of sacroiliac joint dysfunction to determine its validity and predictive powers. The external rotation of the feet, occurring during the sacral base pressure test, was measured using a digital inclinometer. Results There was no statistically significant difference in the results of the sacral base pressure test between the types of sacroiliac joint dysfunction. In terms of the results of validity, the sacral base pressure test was useful in identifying positive values of sacroiliac joint dysfunction. It was fairly helpful in correctly diagnosing patients with negative test results; however, it had only a “slight” agreement with the diagnosis for κ interpretation. Conclusions In this study, the sacral base pressure test was not a valid test for determining the presence of sacroiliac joint dysfunction or the type of dysfunction present. Further research comparing the agreement of the sacral base pressure test or other sacroiliac joint dysfunction tests with a criterion standard of diagnosis is necessary. PMID:19674694

  10. Bilateral chronic sacral neuromodulation for treatment of lower urinary tract dysfunction.

    Science.gov (United States)

    Hohenfellner, M; Schultz-Lampel, D; Dahms, S; Matzel, K; Thüroff, J W

    1998-09-01

    Chronic sacral neuromodulation aims at functional restoration of selected forms of nonneurogenic and neurogenic bladder dysfunction. The original technique, as described by Tanagho and Schmidt, provides unilateral sacral nerve stimulation via an implanted stimulator powering an electrode inserted into a sacral foramen. Its drawback was that the implant failed unpredictably in some patients despite previous successful percutaneous test stimulation. Therefore, we modified the stimulation technique to improve the efficacy of chronic sacral neuromodulation. Guarded bipolar electrodes powered by an implantable neurostimulator were attached bilaterally directly to the S3 nerves through a sacral laminectomy in 9 women and 2 men (mean age 43.4 years). Of the patients 5 had urinary incontinence due to detrusor hyperactivity and 6 had urinary retention from detrusor hypocontractility. Mean followup with repeated urodynamics was 13 months (range 9 to 28). Four significant complications were encountered in 4 patients. In 10 patients the urological sequelae of the neurological disorder were alleviated significantly (50% or more), including 5 who experienced complete relief of symptoms. The efficacy of chronic sacral neuromodulation can be improved by bilateral attachment of electrodes directly to the sacral nerves.

  11. Contribution of p75NTR to Schwannoma Growth and Therapeutic Responses

    Science.gov (United States)

    2017-05-01

    reducing schwannoma cell growth in culture and in animal models of human schwannoma disease. We find that the NF2 gene product, merlin, regulates p75NTR...treatment period. B. Waterfall plots of change in tumor volume for each tumor. Task 6- Define the ability of simultaneous inhibition of p75NTR and mTOR...mTOR inhibitors in culture, we have not used these compounds in animal models . Changes that had a significant impact on expenditures- None

  12. Case Report: Sciatic nerve schwannoma - a rare cause of sciatica [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Sunil Munakomi

    2017-03-01

    Full Text Available Herein we report a rare case of a sciatic nerve schwannoma causing sciatica in a 69-year-old female. Sciatic nerve schwannoma is a rare entity. It should always be considered as a possible cause of sciatica in patients that present with symptoms of sciatica with no prolapsed disc in the lumbar spine and a negative crossed straight leg raise test. Timely diagnosis and complete excision of the lesion leads to complete resolution of the symptoms of such patients.

  13. A Case of Schwannoma of the Common Peroneal Nerve in the Knee

    Science.gov (United States)

    Öz, Tayyar Taylan; Aktaş, Birol; Özkan, Korhan; Özturan, Burak; Kilic, Bulent; Demiroğlu, Murat

    2017-01-01

    Schwannomas are benign neurogenic tumors of peripheral nerves that originate from neural sheath. The aim of this case report is to bring to mind the schwannoma in the patient with knee pain. A 39-year-old woman presented with a complaint of knee pain of three months history. After surgical intervention, the patient’s complaints completely disappeared in the post-operative period. This should come to mind in the differential diagnosis of knee pain. PMID:28286620

  14. Large Dumbbell-Shaped C1 Schwannoma Presenting as a Foramen Magnum Mass

    OpenAIRE

    Helms, Jody; Michael, Lattimore Madison

    2012-01-01

    Schwannomas involving the foramen magnum commonly originate from the lower cranial nerves, but they are rarely found arising from the first cervical root. To date, very few cases have been described in the literature. The majority involve either the intradural or extradural compartment but not both. We report the second case of a dumbbell-shaped schwannoma arising from the first cervical root. Our patient presented with hemisensory deficits secondary to brainstem compression at the level of t...

  15. A case of schwannoma of the common peroneal nerve in the knee

    Directory of Open Access Journals (Sweden)

    Tayyar Taylan Öz

    2017-02-01

    Full Text Available Schwannomas are benign neurogenic tumors of peripheral nerves that originate from neural sheath. The aim of this case report is to bring to mind the schwannoma in the patient with knee pain. A 39-year-old woman presented with a complaint of knee pain of three months history. After surgical intervention, the patient’s complaints completely disappeared in the post-operative period. This should come to mind in the differential diagnosis of knee pain.

  16. Extracranial Facial Nerve Schwannoma Treated by Hypo-fractionated CyberKnife Radiosurgery

    OpenAIRE

    Sasaki, Ayaka; Miyazaki, Shinichiro; Hori, Tomokatsu

    2016-01-01

    Facial nerve schwannoma is a rare intracranial tumor. Treatment for this benign tumor has been controversial. Here, we report a case of extracranial facial nerve schwannoma treated successfully by hypo-fractionated CyberKnife (Accuray, Sunnyvale, CA) radiosurgery?and discuss the efficacy of this treatment. A 34-year-old female noticed a swelling in her right mastoid process. The lesion enlarged over a seven-month period, and she experienced facial spasm on the right side. She was diagnosed wi...

  17. Preclinical Validation of Anti-Nuclear Factor Kappa B Therapy against Vestibular Schwannoma and Neurofibromatosis Type II

    Science.gov (United States)

    2015-06-01

    Thomsen, J., Nielsen, F.C., 2010. Deregulated genes in sporadic vestibular schwannomas. Otol. Neurotol. 31 (2), 256e266. Cioffi, J.A., Yue, W.Y., Mendolia...Thomas, R., Gope, M.L., Doddaballapur, S.K., Gope, R., 2006. Age dependent phosphorylation and deregulation of p53 in human vestibular schwannomas. Mol...tissue was visualized and imaged using a Carl Zeiss 2000 upright microscope (Carl Zeiss, Jena, Germany ). Schwann and schwannoma cell isolation and

  18. Gamma Knife radiosurgery for vestibular schwannoma: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Fairbanks Robert K

    2009-12-01

    Full Text Available Abstract Vestibular schwannomas, also called acoustic neuromas, are benign tumors of the vestibulocochlear nerve. Patients with these tumours almost always present with signs of hearing loss, and many also experience tinnitus, vertigo, and equilibrium problems. Following diagnosis with contrast enhanced MRI, patients may choose to observe the tumour with subsequent scans or seek active treatment in the form of microsurgery, radiosurgery, or radiotherapy. Unfortunately, definitive guidelines for treating vestibular schwannomas are lacking, because of insufficient evidence comparing the outcomes of therapeutic modalities. We present a contemporary case report, describing the finding of a vestibular schwannoma in a patient who presented with dizziness and a "clicking" sensation in the ear, but no hearing deficit. Audible clicking is a symptom that, to our knowledge, has not been associated with vestibular schwannoma in the literature. We discuss the diagnosis and patient's decision-making process, which led to treatment with Gamma Knife radiosurgery. Treatment resulted in an excellent radiographic response and complete hearing preservation. This case highlights an atypical presentation of vestibular schwannoma, associated with audible "clicks" and normal hearing. We also provide a concise review of the available literature on modern vestibular schwannoma treatment, which may be useful in guiding treatment decisions.

  19. Gamma Knife radiosurgery for vestibular schwannoma: case report and review of the literature.

    Science.gov (United States)

    Arthurs, Benjamin J; Lamoreaux, Wayne T; Giddings, Neil A; Fairbanks, Robert K; Mackay, Alexander R; Demakas, John J; Cooke, Barton S; Lee, Christopher M

    2009-12-18

    Vestibular schwannomas, also called acoustic neuromas, are benign tumors of the vestibulocochlear nerve. Patients with these tumours almost always present with signs of hearing loss, and many also experience tinnitus, vertigo, and equilibrium problems. Following diagnosis with contrast enhanced MRI, patients may choose to observe the tumour with subsequent scans or seek active treatment in the form of microsurgery, radiosurgery, or radiotherapy. Unfortunately, definitive guidelines for treating vestibular schwannomas are lacking, because of insufficient evidence comparing the outcomes of therapeutic modalities.We present a contemporary case report, describing the finding of a vestibular schwannoma in a patient who presented with dizziness and a "clicking" sensation in the ear, but no hearing deficit. Audible clicking is a symptom that, to our knowledge, has not been associated with vestibular schwannoma in the literature. We discuss the diagnosis and patient's decision-making process, which led to treatment with Gamma Knife radiosurgery. Treatment resulted in an excellent radiographic response and complete hearing preservation. This case highlights an atypical presentation of vestibular schwannoma, associated with audible "clicks" and normal hearing. We also provide a concise review of the available literature on modern vestibular schwannoma treatment, which may be useful in guiding treatment decisions.

  20. MRI findings of type II sacral agenesis: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang A; Kim, Myung Soon; Kwon, Woo Cheol [Dept. of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju (Korea, Republic of)

    2016-07-15

    Sacral agenesis (or caudal regression syndrome) is a rare congenital anomaly involving various levels of coccygeal, sacral, and even lumbar or lower thoracic vertebral dysgenesis, as well as spinal cord abnormalities. A few cases have been previously reported in Korea, especially based upon MRI findings. We describe a case of a 4-year-old girl with partially bilateral agenesis of the sacrum (type II), and club-shaped (chisel-shaped) spinal cord disruption. We also review MRI findings of sacral agenesis, focused on classification and radiological findings.

  1. Medium-Term Outcome of Sacral Nerve Modulation for Constipation

    DEFF Research Database (Denmark)

    Govaert, Bastiaan; Maeda, Yasuko; Alberga, Job

    2012-01-01

    was percutaneous nerve evaluation. If this was successful, patients underwent sacral nerve modulation therapy with an implanted device (tined-lead and implantable pulse generator). MAIN OUTCOME MEASURE: Follow-up was performed at 1, 3, 6, and 12 months, and yearly thereafter. Outcome was assessed with the Wexner...... constipation score. RESULTS: A total of 117 patients (13 men, 104 women) with a mean age of 45.6 (SD, 13.0) years underwent percutaneous nerve evaluation. Of these, 68 patients (58%) had successful percutaneous nerve evaluation and underwent implantation of a device. The mean Wexner score was 17.0 (SD, 3.......8) at baseline and 10.2 (SD 5.3) after percutaneous nerve evaluation (p latest follow-up (median, 37 months; range, 4–92) was only 61 (52% of all patients who...

  2. Spatial Narrative As Feature Of Singularity In Sacral Architecture

    Directory of Open Access Journals (Sweden)

    Gytis Oržikauskas

    2014-05-01

    Full Text Available The paper analyses architectural compositions of various religious complexes – historical and contemporary – apart from their stylistic features. The most prominent ensembles under analysis have one noticeably common feature – spatial narrative. The foreseen sequence of forms of experience and spatial structure tell different religious narratives depending on which different aspects of faith were actualized in a given period. The analyzed examples stand in proof that suggestibility of religious aspects in sacral architecture are inseparable from their artistic suggestibility aspects. In some cases, these aspects are less related to architectural stylistic means, but have a direct connection to such components of architectural compositions as foreseen sequence of a visitor’s experience and semantics of particular forms, i.e. architectural narrative, which is achieved not only through the means of perception of space, but also by the relationship to social and cultural meanings and subtext of architecture.

  3. Sacral herpes-zoster infection presenting as sciatic pain.

    Science.gov (United States)

    Ablin, J; Symon, Z; Mevorach, D

    1996-06-01

    Acute herpes-zoster infection is a painful dermatomal lesion that can be manifested by a wide array of neurologic symptoms. We present a 55-year-old female with non-Hodgkin's lymphoma, who developed a left sciatic pain involving the S roots. Two weeks later, the patient developed fever and vesicular rash over the left gluteal area. Herpes-zoster infection was diagnosed and confirmed by the presence of immunoglobulin M (IgM) antibodies against varicella-zoster. The pain and rash resolved, after treatment with acyclovir. In the appropriate clinical setting, sacral herpes-zoster infection ought to be considered in the differential diagnosis of new-onset sciatic pain.

  4. Linear accelerator stereotactic radiosurgery for vestibular schwannomas: a UK series.

    Science.gov (United States)

    Benghiat, H; Heyes, G; Nightingale, P; Hartley, A; Tiffany, M; Spooner, D; Geh, J I; Cruickshank, G; Irving, R M; Sanghera, P

    2014-06-01

    To evaluate non-auditory toxicity and local control after linear accelerator stereotactic radiosurgery (SRS) for the treatment of vestibular schwannomas. The institutional policy was to use SRS for radiologically progressing vestibular schwannomas. Case notes and plans were retrospectively reviewed for all patients undergoing SRS for vestibular schwannomas between September 2002 and June 2012. All patients were surgically immobilised using a BrainLab stereotactic head frame. The treatment plan was generated using BrainLab software (BrainScan 5.03). The aim was to deliver 12 Gy to the surface of the target with no margin. Patients with a minimum of 12 months of follow-up were included for toxicity and local control assessment. Radiological progression was defined as growth on imaging beyond 2 years of follow-up. Overall local control was defined in line with other series as absence of surgical salvage. Ninety-nine patients were identified. Two patients were lost to follow-up. After a median follow-up interval of 2.4 years, the actuarial radiological progression-free survival at 3 years was 100% and overall local control was also 100%. However, two patients progressed radiologically at 3.3 and 4.5 years, respectively. Twenty-one of 97 (22%) evaluable patients suffered trigeminal toxicity and this was persistent in 8/97 (8%). Two of 97 (2%) suffered long-term facial nerve toxicity (one with associated radiological progression causing hemi-facial spasm alone). One of 97 (1%) required intervention for obstructive hydrocephalus. No statistically significant dosimetric relationship could be shown to cause trigeminal or facial nerve toxicity. However, 7/8 patients with persistent trigeminal nerve toxicity had tumours in contact with the trigeminal nerve. SRS delivering 12 Gy using a linear accelerator leads to high local control rates, but only prospective evaluation will fully establish short-term toxicity. In this study, persistent trigeminal toxicity occurred almost

  5. Doença de Paget com acometimento sacral: relato de caso Paget's disease with sacral involvement: a case report

    Directory of Open Access Journals (Sweden)

    Fernanda Nogueira Holanda Ferreira Braga

    2010-10-01

    Full Text Available Os autores relatam o caso de um paciente do sexo masculino, 71 anos de idade, com diagnóstico de doença de Paget óssea sacral. Foi realizado estudo com radiografia, cintilografia, tomografia computadorizada e ressonância magnética, e o diagnóstico foi confirmado por análise histopatológica. O paciente evoluiu com boa resposta ao uso de ibandronato 150 mg, mensalmente, com redução significativa dos marcadores bioquímicos da doença.The authors report a case of a 71-year-old male patient diagnosed with Paget's disease of sacrum. Imaging study was performed with radiography, scintigraphy, computed tomography and magnetic resonance imaging, and the diagnosis was confirmed by biopsy. The patient progressed with a good response to monthly treatment with ibandronate 150 mg, presenting a significant reduction in biochemical markers of disease.

  6. VESTIBULAR SCHWANNOMA (ACOUSTIC NEUROMA) MIMICKING TEMPOROMANDIBULAR DISORDERS: A CASE REPORT

    Science.gov (United States)

    Bisi, Maurício A.; Selaimen, Caio M. P.; Chaves, Karen D.; Bisi, Melissa C.; Grossi, Márcio L.

    2006-01-01

    Approximately 6 to 16% of patients with trigeminal neuralgia symptoms present intracranial tumors, the most common being the vestibular schwannoma (acoustic neuroma). Some symptoms reported by patients include hearing loss, tinnitus, headaches, vertigo and trigeminal disturbances. An increased muscle response in the surrounding head and neck musculature may also be observed, which mimics signs and symptoms of temporomandibular disorders. In these cases, magnetic resonance imaging (MRI) has proved to be a useful tool in tumor diagnosis. The differential diagnosis between myofascial and neuralgic pain is important, as both may present similar characteristics, while being of different origin, and demanding special treatment approaches. The purpose of this paper is to demonstrate the relationship among trigeminal neuralgia symptoms, intracranial tumors and temporomandibular dysfunction by presenting a clinical case. PMID:19089251

  7. [A new case of "olfactory schwannoma"; presentation and literature review].

    Science.gov (United States)

    Martínez-Soto, L; Alfaro-Baca, R; Torrecilla-Sardón, M V; Fernández-Vallejo, B; Ferreira-Muñóz, R; De Diego, T

    2009-06-01

    We report the case of a 54-year-old man who presented at the Emergency Department with intense headache of 6-days duration and sporadic nominal dysphasia. He did not present anosmia and the rest of the examination was normal. The emergency CT and the posterior cerebral MR showed a great subfrontal extra-axial mass of 7 x 6 x 5 cm, over the right side of the cribiform plate, hetereogeneously enhancing after gadolinium administration. Preoperative diagnosis was olfactory groove meningioma. After total removal by bifrontal craniotomy the histopathological diagnosis was schwannoma of the conventional type. Owing to the unusual frequency of this kind of tumors (26 to the date), we review the literature, the possible radiological differences with olfactory groove meningiomas and the different theories about their origin.

  8. CT-guided fixation of sacral fractures and sacrolilac joint disruptions

    International Nuclear Information System (INIS)

    Nelson, D.W.; Duwelius, P.

    1990-01-01

    Placement of sacral fixation screws at surgery is performed blindly (ie, by palpation). The authors of this paper employed CT to localize the screw between the neutral foramina and anterior sacral cortex and to decrease the morbidity associated with general anesthesia and surgery. Six patients underwent CT-guided sacral fixation performed by means of the 7.0 mm A0 cannulated screw system. All patients had reducible vertical sacral fractures or sacroiliac joint disruptions. Following placement of an epidural catheter for anesthesia, patients were scanned in the prone or decubitus position. Measurements for placement of the guide pin were made from the preliminary scans. Following CT confirmation of satisfactory guide pin placement across the fracture, the screw track was drilled, the screw length was determined, and the fixation screw was placed in position. A CT scan was obtained to evaluate the final position of the screw

  9. Selective detrusor activation by electrical sacral nerve root stimulation in spinal cord injury

    NARCIS (Netherlands)

    Rijkhoff, N. J.; Wijkstra, H.; van Kerrebroeck, P. E.; Debruyne, F. M.

    1997-01-01

    Electrical sacral nerve root stimulation can be used in spinal cord injury patients to induce urinary bladder contraction. However, existing stimulation methods activate simultaneously both the detrusor muscle and the urethral sphincter. Urine evacuation is therefore only possible using poststimulus

  10. Sacral root neuromodulation in the treatment of various voiding and storage problems.

    Science.gov (United States)

    Shaker, H; Hassouna, M M

    1999-01-01

    This paper reviews the use of sacral neuromodulation as a treatment modality for patients with bladder dysfunction. The dual functions of the urinary bladder are to act as a reservoir and to evacuate under voluntary control. Bladder dysfunction is a descriptive term describing the loss or the impairment of one or both of these functions. In the first part of the manuscript we describe the different components of sacral neuromodulation: the screening test known as percutaneous nerve evaluation (PNE), which involves screening patients who could potentially benefit from the therapy. Those who show a satisfactory response will have a permanent neuroprosthesis implanted. The technical aspects of both components of neuromodulation are described in detail, as well as the technical difficulties encountered. In the second part we present our long-term results in patients with sacral neuromodulation. Sacral neuromodulation is a safe and efficient therapeutic modality that helps patients with refractory voiding dysfunction restore their bladder function.

  11. Fractionated Stereotactic Radiotherapy of Vestibular Schwannomas Accelerates Hearing Loss

    Energy Technology Data Exchange (ETDEWEB)

    Rasmussen, Rune, E-mail: rune333@gmail.com [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark); Claesson, Magnus [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark); Stangerup, Sven-Eric [Ear, Nose, and Throat Department, Rigshospitalet, Copenhagen (Denmark); Roed, Henrik [Department of Radiation Oncology, Rigshospitalet, Copenhagen (Denmark); Christensen, Ib Jarle [Finsen Laboratory, Rigshospitalet, Copenhagen (Denmark); Caye-Thomasen, Per [Ear, Nose, and Throat Department, Rigshospitalet, Copenhagen (Denmark); Juhler, Marianne [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark)

    2012-08-01

    Objective: To evaluate long-term tumor control and hearing preservation rates in patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (FSRT), comparing hearing preservation rates to an untreated control group. The relationship between radiation dose to the cochlea and hearing preservation was also investigated. Methods and Materials: Forty-two patients receiving FSRT between 1997 and 2008 with a minimum follow-up of 2 years were included. All patients received 54 Gy in 27-30 fractions during 5.5-6.0 weeks. Clinical and audiometry data were collected prospectively. From a 'wait-and-scan' group, 409 patients were selected as control subjects, matched by initial audiometric parameters. Radiation dose to the cochlea was measured using the original treatment plan and then related to changes in acoustic parameters. Results: Actuarial 2-, 4-, and 10-year tumor control rates were 100%, 91.5%, and 85.0%, respectively. Twenty-one patients had serviceable hearing before FSRT, 8 of whom (38%) retained serviceable hearing at 2 years after FSRT. No patients retained serviceable hearing after 10 years. At 2 years, hearing preservation rates in the control group were 1.8 times higher compared with the group receiving FSRT (P=.007). Radiation dose to the cochlea was significantly correlated to deterioration of the speech reception threshold (P=.03) but not to discrimination loss. Conclusion: FSRT accelerates the naturally occurring hearing loss in patients with vestibular schwannoma. Our findings, using fractionation of radiotherapy, parallel results using single-dose radiation. The radiation dose to the cochlea is correlated to hearing loss measured as the speech reception threshold.

  12. Electrical vestibular stimulation after vestibular deafferentation and in vestibular schwannoma.

    Directory of Open Access Journals (Sweden)

    Swee Tin Aw

    Full Text Available BACKGROUND: Vestibular reflexes, evoked by human electrical (galvanic vestibular stimulation (EVS, are utilized to assess vestibular function and investigate its pathways. Our study aimed to investigate the electrically-evoked vestibulo-ocular reflex (eVOR output after bilateral and unilateral vestibular deafferentations to determine the characteristics for interpreting unilateral lesions such as vestibular schwannomas. METHODS: EVOR was recorded with dual-search coils as binocular three-dimensional eye movements evoked by bipolar 100 ms-step at EVS intensities of [0.9, 2.5, 5.0, 7.5, 10.0] mA and unipolar 100 ms-step at 5 mA EVS intensity. Five bilateral vestibular deafferented (BVD, 12 unilateral vestibular deafferented (UVD, four unilateral vestibular schwannoma (UVS patients and 17 healthy subjects were tested with bipolar EVS, and five UVDs with unipolar EVS. RESULTS: After BVD, bipolar EVS elicited no eVOR. After UVD, bipolar EVS of one functioning ear elicited bidirectional, excitatory eVOR to cathodal EVS with 9 ms latency and inhibitory eVOR to anodal EVS, opposite in direction, at half the amplitude with 12 ms latency, exhibiting an excitatory-inhibitory asymmetry. The eVOR patterns from UVS were consistent with responses from UVD confirming the vestibular loss on the lesion side. Unexpectedly, unipolar EVS of the UVD ear, instead of absent response, evoked one-third the bipolar eVOR while unipolar EVS of the functioning ear evoked half the bipolar response. CONCLUSIONS: The bidirectional eVOR evoked by bipolar EVS from UVD with an excitatory-inhibitory asymmetry and the 3 ms latency difference between normal and lesion side may be useful for detecting vestibular lesions such as UVS. We suggest that current spread could account for the small eVOR to 5 mA unipolar EVS of the UVD ear.

  13. Fractionated Stereotactic Radiotherapy of Vestibular Schwannomas Accelerates Hearing Loss

    International Nuclear Information System (INIS)

    Rasmussen, Rune; Claesson, Magnus; Stangerup, Sven-Eric; Roed, Henrik; Christensen, Ib Jarle; Cayé-Thomasen, Per; Juhler, Marianne

    2012-01-01

    Objective: To evaluate long-term tumor control and hearing preservation rates in patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (FSRT), comparing hearing preservation rates to an untreated control group. The relationship between radiation dose to the cochlea and hearing preservation was also investigated. Methods and Materials: Forty-two patients receiving FSRT between 1997 and 2008 with a minimum follow-up of 2 years were included. All patients received 54 Gy in 27-30 fractions during 5.5-6.0 weeks. Clinical and audiometry data were collected prospectively. From a “wait-and-scan” group, 409 patients were selected as control subjects, matched by initial audiometric parameters. Radiation dose to the cochlea was measured using the original treatment plan and then related to changes in acoustic parameters. Results: Actuarial 2-, 4-, and 10-year tumor control rates were 100%, 91.5%, and 85.0%, respectively. Twenty-one patients had serviceable hearing before FSRT, 8 of whom (38%) retained serviceable hearing at 2 years after FSRT. No patients retained serviceable hearing after 10 years. At 2 years, hearing preservation rates in the control group were 1.8 times higher compared with the group receiving FSRT (P=.007). Radiation dose to the cochlea was significantly correlated to deterioration of the speech reception threshold (P=.03) but not to discrimination loss. Conclusion: FSRT accelerates the naturally occurring hearing loss in patients with vestibular schwannoma. Our findings, using fractionation of radiotherapy, parallel results using single-dose radiation. The radiation dose to the cochlea is correlated to hearing loss measured as the speech reception threshold.

  14. Probabilistic Tractography of the Cranial Nerves in Vestibular Schwannoma.

    Science.gov (United States)

    Zolal, Amir; Juratli, Tareq A; Podlesek, Dino; Rieger, Bernhard; Kitzler, Hagen H; Linn, Jennifer; Schackert, Gabriele; Sobottka, Stephan B

    2017-11-01

    Multiple recent studies have reported on diffusion tensor-based fiber tracking of cranial nerves in vestibular schwannoma, with conflicting results as to the accuracy of the method and the occurrence of cochlear nerve depiction. Probabilistic nontensor-based tractography might offer advantages in terms of better extraction of directional information from the underlying data in cranial nerves, which are of subvoxel size. Twenty-one patients with large vestibular schwannomas were recruited. The probabilistic tracking was run preoperatively and the position of the potential depictions of the facial and cochlear nerves was estimated postoperatively by 3 independent observers in a blinded fashion. The true position of the nerve was determined intraoperatively by the surgeon. Thereafter, the imaging-based estimated position was compared with the intraoperatively determined position. Tumor size, cystic appearance, and postoperative House-Brackmann score were analyzed with regard to the accuracy of the depiction of the nerves. The probabilistic tracking showed a connection that correlated to the position of the facial nerve in 81% of the cases and to the position of the cochlear nerve in 33% of the cases. Altogether, the resulting depiction did not correspond to the intraoperative position of any of the nerves in 3 cases. In a majority of cases, the position of the facial nerve, but not of the cochlear nerve, could be estimated by evaluation of the probabilistic tracking results. However, false depictions not corresponding to any nerve do occur and cannot be discerned as such from the image only. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Clinical, radiological, surgical, and pathological determinants of olfactory groove schwannoma

    Directory of Open Access Journals (Sweden)

    Andi Sadayandi Ramesh

    2014-01-01

    Full Text Available Background: Olfactory groove schwannomas (OGS are rare anterior cranial fossa base tumors with only 41 cases reported in literature. Olfactory ensheathing cell schwannoma (OECS has similar clinico-radiological features as OGS, but a different cell of origin. In recent years, there is growing interest in OECS as more cases are being reported. Aims: The objective was to study the clinico-radiological features of OGS and define the histological differentiation from OECS. Materials and Methods: We retrospectively analyzed clinical, radiological, surgical and histopathological picture of all cases of OGS managed in our institute. Immuno histochemical studies were performed in these tumors for differentiating from OECS. A comprehensive review of articles published until date describing the operative treatment was done. Results: All three cases had presented with seizures, two had anosmia and papilledema. Gross-total resection was achieved in all our patients. One patient expired in the postoperative period due to septicemia. Positive expression to newer immuno histochemical biomarker CD57 (Leu7, with negative staining to smooth muscle α-actin (SMA was helpful in confirming the diagnosis of OGS and differentiating it from OECS in all our cases. Conclusions: OECS, though rare has to be differentiated from OGS using immuno histochemistry. Gross-total resection of OGS with preservation of olfactory function is often possible and curative. Although these tumors are commonly treated with microsurgical skull base approaches, an endoscopic endonasal approach can be considered in some cases, with repair using mucoperiosteal pedicled flap to prevent cerebrospinal fluid leak.

  16. Improving patient knowledge about sacral nerve stimulation using a patient based educational video.

    Science.gov (United States)

    Jeppson, Peter Clegg; Clark, Melissa A; Hampton, Brittany Star; Raker, Christina A; Sung, Vivian W

    2013-10-01

    We developed a patient based educational video to address the information needs of women considering sacral nerve stimulation for overactive bladder. Five semistructured focus groups were used to identify patient knowledge gaps, information needs, patient acceptable terminology and video content preferences for a patient based sacral nerve stimulation educational video. Each session was transcribed, independently coded by 2 coders and examined using an iterative method. A 16-minute educational video was created to address previously identified knowledge gaps and information needs using patient footage, 3-dimensional animation and peer reviewed literature. We developed a questionnaire to evaluate participant sacral nerve stimulation knowledge and therapy attitudes. We then performed a randomized trial to assess the effect of the educational video vs the manufacturer video on patient knowledge and attitudes using our questionnaire. We identified 10 patient important domains, including 1) anatomy, 2) expectations, 3) sacral nerve stimulation device efficacy, 4) surgical procedure, 5) surgical/device complications, 6) post-procedure recovery, 7) sacral nerve stimulation side effects, 8) postoperative restrictions, 9) device maintenance and 10) general sacral nerve stimulation information. A total of 40 women with overactive bladder were randomized to watch the educational (20) or manufacturer (20) video. Knowledge scores improved in each group but the educational video group had a greater score improvement (76.6 vs 24.2 points, p <0.0001). Women who watched the educational video reported more favorable attitudes and expectations about sacral nerve stimulation therapy. Women with overactive bladder considering sacral nerve stimulation therapy have specific information needs. The video that we developed to address these needs was associated with improved short-term patient knowledge. Copyright © 2013 American Urological Association Education and Research, Inc

  17. Presacral abscess as a rare complication of sacral nerve stimulator implantation.

    Science.gov (United States)

    Gumber, A; Ayyar, S; Varia, H; Pettit, S

    2017-03-01

    A 50-year-old man with intractable anal pain attributed to proctalgia fugax underwent insertion of a sacral nerve stimulator via the right S3 vertebral foramen for pain control with good symptomatic relief. Thirteen months later, he presented with signs of sepsis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large presacral abscess. MRI demonstrated increased enhancement along the pathway of the stimulator electrode, indicating that the abscess was caused by infection introduced at the time of sacral nerve stimulator placement. The patient was treated with broad spectrum antibiotics, and the sacral nerve stimulator and electrode were removed. Attempts were made to drain the abscess transrectally using minimally invasive techniques but these were unsuccessful and CT guided transperineal drainage was then performed. Despite this, the presacral abscess progressed, developing enlarging gas locules and extending to the pelvic brim to involve the aortic bifurcation, causing hydronephrosis and radiological signs of impending sacral osteomyelitis. MRI showed communication between the rectum and abscess resulting from transrectal drainage. In view of the progressive presacral sepsis, a laparotomy was performed with drainage of the abscess, closure of the upper rectum and formation of a defunctioning end sigmoid colostomy. Following this, the presacral infection resolved. Presacral abscess formation secondary to an infected sacral nerve stimulator electrode has not been reported previously. Our experience suggests that in a similar situation, the optimal management is to perform laparotomy with drainage of the presacral abscess together with simultaneous removal of the sacral nerve stimulator and electrode.

  18. Restoration of bladder function in spastic neuropathic bladder using sacral deafferentation and different techniques of neurostimulation.

    Science.gov (United States)

    Schumacher, S; Bross, S; Scheepe, J R; Alken, P; Jünemann, K P

    1999-01-01

    Conventional sacral anterior root stimulation (SARS) results in simultaneous activation of both the detrusor muscle and the external urethral sphincter. We evaluated the possibilities of different neurostimulation techniques to overcome stimulation induced detrusor-sphincter-dyssynergia and to achieve a physiological voiding. The literature was reviewed on different techniques of sacral anterior root stimulation of the bladder and the significance of posterior rhizotomy in patients with supraconal spinal cord injury suffering from the loss of voluntary bladder control, detrusor hyperreflexia and sphincter spasm. The achievement of selective detrusor activation would improve current sacral neurostimulation of the bladder, including the principle of "poststimulus voiding". This is possible with the application of selective neurostimulation in techniques of anodal block, high frequency block, depolarizing prepulses and cold block. Nowadays, sacral deafferentation is a standard therapy in combination with neurostimulation of the bladder because in conclusion advantages of complete rhizotomy predominate. The combination of sacral anterior root stimulation and sacral deafferentation is a successful procedure for restoration of bladder function in patients with supraconal spinal cord injury. Anodal block technique and cryotechnique are excellent methods for selective bladder activation to avoid detrusor-sphincter-dyssynergia and thus improve stimulation induced voiding.

  19. Current practices in vestibular schwannoma management: a survey of American and Canadian neurosurgeons.

    Science.gov (United States)

    Fusco, Matthew R; Fisher, Winfield S; McGrew, Benjamin M; Walters, Beverly C

    2014-12-01

    Comprehensive therapy for vestibular schwannomas has changed dramatically over the past fifty years. Previously, neurosurgeons were most likely to treat these tumors via an independent surgical approach. Currently, many neurosurgeons treat vestibular schwannomas employing an interdisciplinary team approach with neuro-otologists and radiation oncologists. This survey aims to determine the current treatment paradigm for vestibular schwannomas among American and Canadian neurosurgeons, with particular attention to the utilization of a team approach to the surgical resection of these lesions. A seventeen part survey questionnaire was sent by electronic mail to residency trained members of the American Association of Neurological Surgeons currently practicing in Canada or the United States. Questions were divided into groups regarding physician background, overall practice history, recent practice history, opinions on treatment paradigms, and experience with an interdisciplinary team approach. Seven hundred and six responses were received. The vast majority of neurosurgeons surgically resect vestibular schwannomas as part of an interdisciplinary team (85.7%). Regional variations were observed in the use of an interdisciplinary team: 52.3% of responding neurosurgeons who surgically treat vestibular schwannomas without neuro-otologists currently practice in the South (no other region represented more than 15.4% of this group, p=0.02). Surgeons who have treated >50 vestibular schwannomas show a trend towards more frequent utilization of an interdisciplinary approach than less experienced surgeons, but this did not reach statistical significance. The majority of neurosurgeons in the United States and Canada surgically resect vestibular schwannomas via an interdisciplinary approach with the participation of a neuro-otologist. Neurosurgeons in the South appear more likely to surgically treat these tumors alone than neurosurgeons in other regions of the U.S. and Canada

  20. Naso-ethmoid schwannoma with intracranial extension: case report Schwannoma naso-etmoidal com extensão intracraniana: relato de caso

    Directory of Open Access Journals (Sweden)

    Mario G. Siqueira

    2001-06-01

    Full Text Available Intranasal schwannomas are rare lesions, specially when they present with an intracranial extension. The fifth case in the medical literature of a naso-ethmoid schwannoma with extension into the anterior cranial fossa is presented. The magnetic resonance findings and the details of the combined intracranial / transfacial operative approach used are described. The possible origin and the clinical characteristics of this rare lesion are reviewed.Schwannomas intranasais são lesões raras, principalmente quando apresentam um extensão intracraniana. Estamos apresentando o quinto caso da literatura médica de um schwannoma naso-etmoidal com extensão para o interior da fossa craniana anterior. São descritos os achados da ressonância magnética e os detalhes da via de acesso cirúrgico combinada intracraniana/transfacial. A possível origem e as características clínicas dessa lesaõ rara são revistas.

  1. Long-term mobile phone use and the risk of vestibular schwannoma: a Danish nationwide cohort study.

    Science.gov (United States)

    Schüz, Joachim; Steding-Jessen, Marianne; Hansen, Søren; Stangerup, Sven-Eric; Cayé-Thomasen, Per; Poulsen, Aslak Harbo; Olsen, Jørgen H; Johansen, Christoffer

    2011-08-15

    Vestibular schwannomas grow in the region within the brain where most of the energy by radiofrequency electromagnetic fields from using mobile phones is absorbed. The authors used 2 Danish nationwide cohort studies, one a study of all adult Danes subscribing for a mobile phone in 1995 or earlier and one on sociodemographic factors and cancer risk, and followed subjects included in both cohorts for occurrence of vestibular schwannoma up to 2006 inclusively. In this study including 2.9 million subjects, a long-term mobile phone subscription of ≥11 years was not related to an increased vestibular schwannoma risk in men (relative risk estimate = 0.87, 95% confidence interval: 0.52, 1.46), and no vestibular schwannoma cases among long-term subscribers occurred in women versus 1.6 expected. Vestibular schwannomas did not occur more often on the right side of the head, although the majority of Danes reported holding their mobile phone to the right ear. Vestibular schwannomas in long-term male subscribers were not of larger size than expected. Overall, no evidence was found that mobile phone use is related to the risk of vestibular schwannoma. Because of the usually slow growth of vestibular schwannoma and possible diagnostic delay, further surveillance is indicated.

  2. Long-term socio-economic impact of vestibular schwannoma for patients under observation and after surgery

    DEFF Research Database (Denmark)

    Tos, Tina; Caye-Thomasen, Per; Stangerup, Sven-Eric

    2003-01-01

    This study describes and compares the long-term socio-economic impact for patients diagnosed with a vestibular schwannoma and either operated on or observed. A consecutive sample of patients diagnosed with vestibular schwannoma in Denmark and either operated on (748 patients) or observed...

  3. Frontoethmoidal Schwannoma with Exertional Cerebrospinal Fluid Rhinorrhea: Case Report and Review of Literature.

    Science.gov (United States)

    Yoneoka, Yuichiro; Akiyama, Katsuhiko; Seki, Yasuhiro; Hasegawa, Go; Kakita, Akiyoshi

    2018-03-01

    Frontoethmoidal schwannomas are rare. No case manifesting exertional cerebrospinal fluid (CSF) rhinorrhea has ever been reported to the best of our knowledge. In this report, we describe an extremely rare case of frontoethmoidal schwannoma extending through the olfactory groove with exertional CSF rhinorrhea as the initial symptom. A 50-year-old woman was presented to our clinic for frequent nasal discharge on exertion. A postcontrast computed tomographic scan demonstrated heterogeneously enhanced tumor from the anterior cranial fossa to the anterior ethmoid sinus. A gadolinium-enhanced T1-weighted magnetic resonance image revealed a well-defined heterogeneously enhanced tumor situated in the midline anterior cranial fossa and anterior ethmoid sinus. After the resection, the defect of the right anterior skull base was reconstructed with a fascia graft and adipose tissue taken from the abdomen, as well as a pedicle periosteum flap. A histologic examination revealed the tumor as schwannoma. Her rhinorrhea completely resolved. She regained her sense of smell and taste 1 month after the operation. According to previous reports, olfactory groove, and paraolfactory groove/periolfactory groove schwannomas can be divided into 4 types: subfrontal, nasoethmoidal, frontoethmoidal, and ethmofrontal. Among them, a frontoethmoidal schwannoma can manifest exertional CSF rhinorrhea as an initial symptom. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Natural history of vestibular schwannomas and hearing loss in NF2 patients.

    Science.gov (United States)

    Peyre, M; Bernardeschi, D; Sterkers, O; Kalamarides, M

    2015-07-13

    Bilateral vestibular schwannomas are the hallmark of neurofibromatosis 2 (NF2), occurring in 95% of patients. These tumors are associated with significant morbidity due to hearing loss, tinnitus, imbalance and facial weakness. As radiosurgery and chemotherapy have been recently introduced in the treatment armamentarium in addition to surgery, a thorough evaluation of vestibular schwannoma natural history is mandatory to determine the role and timing of each treatment modality. An exhaustive review of the literature was performed using the PubMed database concerning the natural history of tumor growth and hearing loss in NF2 patients with vestibular schwannomas. Although some aspects of vestibular schwannoma natural history remain uncertain (pattern of tumor growth, mean tumor growth rate), factors influencing growth such as age at presentation and paracrine factors are well established. Studies focusing on the natural history of hearing have highlighted different patterns of hearing loss and the possible role of intralabyrinthine tumors. The polyclonality of vestibular schwannomas in NF2 was recently unveiled, giving a new perspective to their growth mechanisms. An uniform evaluation of tumor growth using volumetric evaluation and hearing with standard classifications will ensure the use of common endpoints and should improve the quality of clinical trials as well as foster comparison among studies while ensuring more consistency in decision-making. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. A neurofibromatosis type 2 case with vestibular, trigeminal and facial schwannomas together: magnetic resonance imaging findings

    International Nuclear Information System (INIS)

    Akay, S.; Hamcan, S.; Kara, K.; Battal, B.; Tasar, M.

    2012-01-01

    Full text: Introduction: Neurofibromatosis type 2 (NF2) is characterized by the development of multiple nervous system tumors. This disorder is also called multiple inherited schwannomas (MIS), meningiomas (M), and ependymomas (E) (MISME) syndrome. Objectives and tasks: To discuss the magnetic resonance (MR) imaging findings of a NF2 case who has bilateral vestibular and trigeminal schwannomas, unilateral facial schwannoma, multiple meningiomas and cervical intramedullary spinal cord tumors. Materials and methods: A 23-year-old male patient complaining of tinnitus and imbalance for 3 years, came to Neck-Nose-Throat department of our hospital. After the physical examination, the patient was referred to our department for the further work up with MR imaging. Results: Brain MR imaging showed bilateral acoustic schwannoma which reach through the internal acoustic canals. Bilateral symmetric homogeneously enhanced masses were also detected in Meckel's caves. Similarly, one milimetric enhancing lesion was seen at the right facial nerve. Eight meningiomas in various locations were observed, as well. Additionally, two enhancing intramedullary well-defined small foci were detected in the proximal cervical spinal cord. Ependymomas or intraparanchimal schwannomas were primarily suspected. Conclusion: This case includes all the probable intracranial and spinal mass lesions which may be associated with NF2. Enhanced MR is very reliable imaging modality for the detailed evaluation of NF2 patients

  6. Laryngeal Schwannoma: A Case Presentation and Review of the Mayo Clinic Experience.

    Science.gov (United States)

    Romak, Jonathan J; Neel, H Bryan; Ekbom, Dale C

    2017-01-01

    The aim of this study was to clarify the nature of laryngeal schwannomas through review of the experience of a single institution during a 104-year period. This is a retrospective case series. The Mayo Clinic, Rochester, Minnesota clinical and surgical pathology database was reviewed for the years 1985-2011. Four cases of laryngeal schwannoma were identified. These cases were pooled with a previously published series of laryngeal schwannomas treated at our institution between 1907 and 1986. The characteristics of all 11 cases were studied, and relevant literature was reviewed. A total of 11 cases of schwannoma of the larynx were identified. The mean age at presentation was 48 years (range 12-73 years). The most common presenting symptoms were dysphonia and dysphagia. The most frequently involved primary site was the false vocal fold (six patients), followed by the aryepiglottic fold (three), epiglottis (two), subglottis (two), ventricle (one), true vocal fold (one) and postcricoid region (one). The mean maximal tumor diameter was 2.5 cm. In all but one case, surgical excision was curative with no recurrence during recorded follow up ranging from 1 to 17 years. Laryngeal schwannomas, although rare, should be considered in the differential diagnosis of laryngeal tumors. They occur most frequently in the false vocal fold and present most commonly with dysphonia and/or dysphagia. Surgical excision is the treatment of choice. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  7. Laryngeal schwannoma excised under a microlaryngoscope without tracheotomy: A case report

    Science.gov (United States)

    WANG, BAOXIN; DONG, PIN; SHEN, BIN; XU, HONGMING; ZHENG, JIN

    2014-01-01

    Schwannomas are benign encapsulated tumors arising from Schwann cells in the peripheral nervous system. Between 25 and 45% of schwannomas occur in the head and neck region. Schwannomas of the larynx are extremely rare with an incidence of 0.1–1.5% in all benign laryngeal tumors. Laryngeal schwannomas usually occur in females aged between their 4th and 5th decades. The most successful curative method is surgical resection. When selecting the surgical method, the size and location of the tumor, as well as the requests of the patient, should be considered. The present case report describes a 29-year-old female patient with symptoms of hoarseness and dyspnea on exertion. Through endoscopic biopsy, histopathology revealed a schwannoma. Considering the symptoms, age and preferences of the patient, the method of trans-oral microlaryngoscopic excision without tracheotomy was used to excise the tumor located in the aryepiglottic fold. Results from a short-term follow-up showed the postoperative result to be satisfactory. PMID:24669270

  8. A neurofibromatosis type 2 case with vestibular, trigeminal and facial schwannomas together: magnetic resonance imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Akay, S; Hamcan, S; Kara, K; Battal, B; Tasar, M

    2012-07-01

    Full text: Introduction: Neurofibromatosis type 2 (NF2) is characterized by the development of multiple nervous system tumors. This disorder is also called multiple inherited schwannomas (MIS), meningiomas (M), and ependymomas (E) (MISME) syndrome. Objectives and tasks: To discuss the magnetic resonance (MR) imaging findings of a NF2 case who has bilateral vestibular and trigeminal schwannomas, unilateral facial schwannoma, multiple meningiomas and cervical intramedullary spinal cord tumors. Materials and methods: A 23-year-old male patient complaining of tinnitus and imbalance for 3 years, came to Neck-Nose-Throat department of our hospital. After the physical examination, the patient was referred to our department for the further work up with MR imaging. Results: Brain MR imaging showed bilateral acoustic schwannoma which reach through the internal acoustic canals. Bilateral symmetric homogeneously enhanced masses were also detected in Meckel's caves. Similarly, one milimetric enhancing lesion was seen at the right facial nerve. Eight meningiomas in various locations were observed, as well. Additionally, two enhancing intramedullary well-defined small foci were detected in the proximal cervical spinal cord. Ependymomas or intraparanchimal schwannomas were primarily suspected. Conclusion: This case includes all the probable intracranial and spinal mass lesions which may be associated with NF2. Enhanced MR is very reliable imaging modality for the detailed evaluation of NF2 patients.

  9. Management of vestibular schwannomas with linear accelerator-based stereotactic radiosurgery: a single center experience.

    Science.gov (United States)

    Sager, Omer; Beyzadeoglu, Murat; Dincoglan, Ferrat; Demiral, Selcuk; Uysal, Bora; Gamsiz, Hakan; Oysul, Kaan; Dirican, Bahar; Sirin, Sait

    2013-01-01

    The primary goal of treatment for vestibular schwannoma is to achieve local control without comprimising regional cranial nerve function. Stereotactic radiosurgery has emerged as a viable therapeutic option for vestibular schwannoma. The aim of the study is to report our 15-year single center experience using linear accelerator-based stereotactic radiosurgery in the management of patients with vestibular schwannoma. Between July 1998 and January 2013, 68 patients with unilateral vestibular schwannoma were treated using stereotactic radiosurgery at the Department of Radiation Oncology, Gulhane Military Medical Academy. All patients underwent high-precision stereotactic radiosurgery using a linear accelerator with 6-MV photons. Median follow-up time was 51 months (range, 9-107). Median age was 45 years (range, 20-77). Median dose was 12 Gy (range, 10-13) prescribed to the 85%-95% isodose line encompassing the target volume. Local tumor control in patients with periodic follow-up imaging was 96.1%. Overall hearing preservation rate was 76.5%. Linear accelerator-based stereotactic radiosurgery offers a safe and effective treatment for patients with vestibular schwannoma by providing high local control rates along with improved quality of life through well-preserved hearing function.

  10. Long-term mobile phone use and the risk of vestibular schwannoma: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Schüz, Joachim; Steding-Jessen, Marianne; Hansen, Søren

    2011-01-01

    Vestibular schwannomas grow in the region within the brain where most of the energy by radiofrequency electromagnetic fields from using mobile phones is absorbed. The authors used 2 Danish nationwide cohort studies, one a study of all adult Danes subscribing for a mobile phone in 1995 or earlier...... and one on sociodemographic factors and cancer risk, and followed subjects included in both cohorts for occurrence of vestibular schwannoma up to 2006 inclusively. In this study including 2.9 million subjects, a long-term mobile phone subscription of =11 years was not related to an increased vestibular...... reported holding their mobile phone to the right ear. Vestibular schwannomas in long-term male subscribers were not of larger size than expected. Overall, no evidence was found that mobile phone use is related to the risk of vestibular schwannoma. Because of the usually slow growth of vestibular schwannoma...

  11. Long-term mobile phone use and the risk of vestibular schwannoma: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Schüz, Joachim; Steding-Jessen, Marianne; Hansen, Søren

    2011-01-01

    Vestibular schwannomas grow in the region within the brain where most of the energy by radiofrequency electromagnetic fields from using mobile phones is absorbed. The authors used 2 Danish nationwide cohort studies, one a study of all adult Danes subscribing for a mobile phone in 1995 or earlier...... and one on sociodemographic factors and cancer risk, and followed subjects included in both cohorts for occurrence of vestibular schwannoma up to 2006 inclusively. In this study including 2.9 million subjects, a long-term mobile phone subscription of ≥11 years was not related to an increased vestibular...... reported holding their mobile phone to the right ear. Vestibular schwannomas in long-term male subscribers were not of larger size than expected. Overall, no evidence was found that mobile phone use is related to the risk of vestibular schwannoma. Because of the usually slow growth of vestibular schwannoma...

  12. Sacral neuromodulation effects on periurethral sensation and urethral sphincter activity.

    Science.gov (United States)

    Gleason, Jonathan L; Kenton, Kimberly; Greer, W Jerod; Ramm, Olga; Szychowski, Jeff M; Wilson, Tracey; Richter, Holly E

    2013-06-01

    To characterize the effect of sacral neuromodulation (SNM) on urethral neuromuscular function. Following IRB approval, women with refractory overactive bladder (OAB) underwent standardized urethral testing prior to and after Stage 1 SNM implantation. Periurethral sensation was measured using current perception thresholds (CPT). Striated urethral sphincter activity was quantified using concentric needle electromyography (CNE) and Multi-Motor Unit Action Potential (MUP) analysis software. Nonparametric analyses were used to characterize pre/post changes with intervention. Baseline CPT and CNE findings were compared between SNM responders and non-responders. Twenty-seven women were enrolled in this pilot study with a mean age of 61 ± 13 years. Twenty of 26 women (76.9%) responded to SNM and went to Stage 2 permanent implantation. Four (14.8%) withdrew after Stage 1 implantation; three of the four withdrawals had not had therapeutic responses to SNM. CPT and CNE parameters did not significantly differ from baseline 2 weeks after SNM. Pre-SNM urethral sensation was not significantly different between responders and non-responders. However, responders had larger amplitude, longer duration and more turns and phases at baseline approaching significance, reflecting more successful urethral reinnervation, than non-responders. SNM does not alter urethral neuromuscular function 2 weeks post Stage 1 implantation. Copyright © 2012 Wiley Periodicals, Inc.

  13. Pregnancy in women with Fowler's syndrome treated with sacral neuromodulation.

    Science.gov (United States)

    Khunda, Azar; Karmarkar, Roopali; Abtahi, Bahareh; Gonzales, Gwen; Elneil, Sohier

    2013-07-01

    Our aim was to determine the impact of pregnancy on sacral neuromodulation (SNM) and vice versa in patients with Fowler's syndrome (FS), which is typified by chronic urinary retention (CUR). We performed a retrospective study of pregnancy in patients with FS who underwent a two-stage SNM implantation. Data were obtained using a standard questionnaire and clinical interview. There were a total of ten patients with 13 pregnancies. The SNM was switched off in ten of the 13 pregnancies, with CUR recurring in nine of the ten pregnancies and recurrent urinary tract infections (UTI) occurring in four of these pregnancies (more than three UTI in the pregnancy). Those in whom the device was left on continued to void normally. One woman had a first trimester miscarriage, eight pregnancies went to term, and four deliveries were premature. Caesarean section was performed in eight pregnancies for obstetric reasons. Four pregnancies resulted in a vaginal delivery. There were no congenital anomalies reported. Following delivery, four of nine women experienced dysfunction of their SNM device when it was switched back on. Turing off the SNM during pregnancy results in recurrence of CUR, with an increased risk of recurrent UTI associated with preterm delivery. This did not impact foetal well-being. The option of keeping the SNM on during pregnancy should therefore be considered, and as caesarean section affects the SNM device, we advise that caesarean section should only be performed for obstetric reasons.

  14. Sacral colpopexy versus transvaginal mesh colpopexy in obese patients.

    Science.gov (United States)

    McDermott, Colleen D; Park, Jean; Terry, Colin L; Woodman, Patrick J; Hale, Douglass S

    2013-05-01

    Obesity can predispose women to pelvic organ prolapse and can also affect the success of pelvic organ prolapse surgery. The purpose of this study was to compare the postoperative anatomical outcomes following sacral colpopexy (SC) and transvaginal mesh colpopexy in a group of obese women with pelvic organ prolapse. We conducted a retrospective cohort study of obese women who underwent SC (n = 56) or transvaginal mesh colpopexy (n = 35). Follow-up ranged from 6 to 12 months. Preoperative, perioperative, and postoperative variables were compared using Student t, Mann-Whitney U, and Fisher exact tests, and by analysis of covariance. The women in the SC group had significantly higher mean apical vaginal measurements (P transvaginal mesh colpopexy group. There were no significant differences between the groups for other postoperative outcomes, including mesh erosion, recurrent prolapse symptoms, dyspareunia, and surgical satisfaction (P > 0.05). In these 91 obese patients with pelvic organ prolapse, SC resulted in better anatomical outcomes than transvaginal mesh colpopexy. However, the two procedures had similar outcomes with regard to recurrent symptoms and surgical satisfaction.

  15. [An adult case of intradural lumbo-sacral lipoma].

    Science.gov (United States)

    Hatayama, T; Sakoda, K; Tokuda, Y; Uozumi, T

    1992-10-01

    A rare case of lumbo-sacral lipoma in an adult case is reported. A 55-year-old male was admitted to the Department of Neurosurgery, Mazda Hospital, after a history of one year of urinary incontinence. Neurologically, no motor or sensory disturbance of the lower extremities was found in this patient. MRI showed a mass with high signal intensity on T2-weighted image, located between L3 to S2 vertebral segments. Metrizamide-CT scan demonstrated the outline of this hypodense mass at the same location as shown on MRI image. A L3 through L5 laminectomy was performed and the tumor was subtotally removed. Microscopic examination revealed that the tumor mass was made up of mature lipoma cells. Postoperative course of the patient was uneventful. The urinary incontinence was improved slightly. No motor or sensory deficit was found. We thought that MRI was useful for the correct diagnosis of lumbosacral lipoma. And it is best managed by operative removal of the tumor as early as possible after it is diagnosed.

  16. STATE ANXIETY, SUBJECTIVE IMBALANCE AND HANDICAP IN VESTIBULAR SCHWANNOMA

    Directory of Open Access Journals (Sweden)

    Yougan Saman

    2016-07-01

    Full Text Available ABSTRACTEvidence is emerging of a significant clinical and neuro-anatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety and there is a relationship between increased state anxiety and worsening balance function. Aims1.To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit.2.To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap. MethodsTwo separate cohorts Vestibular Schwannoma (VS patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials and caloric responses and questionnaire assessment (Vertigo handicap Questionnaire, Vertigo Symptom Scale, State Trait Anxiety InventoryFifteen post resection Vestibular schwannoma patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1. Forty-five patients with VS in-situ and with preserved vestibular function formed the cohort for Experiment 2 (Aim 2. Experiment 1: VS subjects (N=15 with a complete post-resection unilateral vestibular deafferentation completed a State anxiety questionnaire before caloric assessment and again afterwards with the point of maximal vertigo as the reference (Aim 1. Experiment 2: State anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of presenting with balance symptoms (Group 1 N=26 and without balance symptoms (Group 2 N=11 (Aim 2. The presence of balance symptoms was defined as having a positive score on the VSS-VER.ResultsIn experiment 1, a significant difference (p<0.01 was found when comparing

  17. Resection of cervical vagal schwannoma via a post-auricular approach.

    Science.gov (United States)

    Roh, Jong-Lyel

    2006-03-01

    Cervical vagal schwannomas are extremely rare and gross total resection is the standard treatment modality. However, because the conventional cervical approach leaves an incision scar in a visible area, other approaches need to be developed for young women who want the postoperative scar to be invisible. A 28-year-old female underwent complete resection of a 4x4 cm tumor in her right upper neck via a post-auricular approach using an inverted V-shaped incision along the post-auricular sulcus and hairline. The tumor was a schwannoma originating from the right cervical vagus nerve. Postoperatively, right vocal cord paralysis developed despite careful dissection but completely recovered within 6 months after surgery. The patient was satisfied with an invisible external scar which was hidden by her auricle and hair. A cervical vagal schwannoma can be successfully removed by making an incision in a potentially invisible area.

  18. Acute necrosis after Gamma Knife surgery in vestibular schwannoma leading to multiple cranial nerve palsies.

    Science.gov (United States)

    Kapitza, Sandra; Pangalu, Athina; Horstmann, Gerhard A; van Eck, Albert T; Regli, Luca; Tarnutzer, Alexander A

    2016-08-01

    We discuss a rare acute complication after Gamma Knife therapy (Elekta AB, Stockholm, Sweden) in a single patient. A 52-year-old woman presented with vertigo, facial weakness and hearing loss emerging 48hours following Gamma Knife radiosurgery for a right-sided vestibular schwannoma. Neurological examination 6days after symptom onset showed right-sided facial palsy, spontaneous left-beating nystagmus and pathologic head-impulse testing to the right. Pure-tone audiogram revealed right-sided sensorineural hearing loss. A diagnosis of acute vestibulocochlear and facial neuropathy was made. Brain MRI demonstrated focal contrast sparing within the schwannoma, likely related to acute radiation necrosis. Acute multiple cranial neuropathies of the cerebellopontine angle after Gamma Knife treatment should raise suspicion of acute tissue damage within the schwannoma and should result in urgent MRI. Treatment with steroids may be considered based on accompanying swelling and edema. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Cellular schwannoma arising from the gastric wall misdiagnosed as a gastric stromal tumor: A case report.

    Science.gov (United States)

    Wang, Guangyao; Chen, Ping; Zong, Liang; Shi, Lei; Zhao, Wei

    2014-02-01

    Cellular schwannomas have been previously described at almost every anatomic location of the human body, but reports in the gastric wall are rare. The current study presents a rare case of cellular schwannoma originating from the gastric wall. Computed tomography revealed a 5.6×5.3×4.0-cm 3 solid mass located in the posterior wall of the stomach. Open laparotomy confirmed its mesenchymal origin. Microscopically, the tissue was composed of spindle-shaped and fascicularly-arranged cells, but mitotic figures were rare. Immunohistochemical staining showed that the tumor was negative for cluster of differentiation (CD)117, CD34, smooth muscle actin and desmin, but positive for S-100 and Ki67. The patient presented no evidence of recurrence and metastasis during follow-up. Gastric cellular schwannomas may be diagnosed by clinical characteristics, histological observations and immunohistochemical markers.

  20. Nanodielectrics with giant permittivity

    Indian Academy of Sciences (India)

    Following the prediction, during the last couple of years we have investigated the effect of giant permittivity in one-dimensional systems of conventional metals and conjugated polymer chains. In this article, we have tried to summarize the works on giant permittivity and finally the fabrication of nanocapacitor using metal ...

  1. Reporting success rates in the treatment of vestibular schwannomas: are we accounting for the natural history?

    Science.gov (United States)

    Miller, Timothy; Lau, Tsz; Vasan, Rohit; Danner, Christopher; Youssef, A Samy; van Loveren, Harry; Agazzi, Siviero

    2014-06-01

    Stereotactic radiosurgery is generally accepted as one of the best treatment options for vestibular schwannomas. We question whether growth control is an accurate measure of success in vestibular schwannoma treatment. We aim to clarify the success rate of stereotactic radiosurgery and adjust the reported results to the benign natural history of untreated tumors. All articles were taken from a PubMed search of the English literature from the years 2000-2011. Inclusion criteria were articles containing the number of patients treated, radiation technique, average tumor size, follow-up time, and percentage of tumors growing during follow-up. Data were extracted from 19 articles. Success rates were adjusted using published data that 17% to 30% of vestibular schwannomas grow. The average reported success rate for stereotactic radiosurgery across all articles was 95.5%. When considering 17% or 30% natural growth without intervention, the adjusted success rates became 78.2% and 86.9% respectively. These rates were obtained by applying the natural history growth percentages to any tumors not reported to be growing before radiosurgical intervention. Success in the treatment of vestibular schwannomas with stereotactic radiosurgery is often defined as lack of further growth. Recent data on the natural growth history of vestibular schwannomas raise the question of whether this is the best definition of success. We have identified a lack of continuity regarding the reporting of success and emphasize the importance of the clarification of the success of radiosurgery to make informed decisions regarding the best treatment options for vestibular schwannoma. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Safe Zone Quantification of the Third Sacral Segment in Normal and Dysmorphic Sacra.

    Science.gov (United States)

    Hwang, John S; Reilly, Mark C; Shaath, Mohammad K; Changoor, Stuart; Eastman, Jonathan; Routt, Milton Lee Chip; Sirkin, Michael S; Adams, Mark R

    2018-04-01

    To quantify the osseous anatomy of the dysmorphic third sacral segment and assess its ability to accommodate internal fixation. Retrospective chart review of a trauma database. University Level 1 Trauma Center. Fifty-nine patients over the age of 18 with computed tomography scans of the pelvis separated into 2 groups: a group with normal pelvic anatomy and a group with sacral dysmorphism. The sacral osseous area was measured on computed tomography scans in the axial, coronal, and sagittal planes in normal and dysmorphic pelves. These measurements were used to determine the possibility of accommodating a transiliac transsacral screw in the third sacral segment. In the normal group, the S3 coronal transverse width averaged 7.71 mm and the S3 axial transverse width averaged 7.12 mm. The mean S3 cross-sectional area of the normal group was 55.8 mm. The dysmorphic group was found to have a mean S3 coronal transverse width of 9.49 mm, an average S3 axial transverse width of 9.14 mm, and an S3 cross-sectional area of 77.9 mm. The third sacral segment of dysmorphic sacra has a larger osseous pathway available to safely accommodate a transiliac transsacral screw when compared with normal sacra. The S3 segment of dysmorphic sacra can serve as an additional site for screw placement when treating unstable posterior pelvic ring fractures.

  3. Critical Anatomy Relative to the Sacral Suture: A Postoperative Imaging Study After Robotic Sacrocolpopexy.

    Science.gov (United States)

    Crisp, Catrina C; Herfel, Charles V; Pauls, Rachel N; Westermann, Lauren B; Kleeman, Steven D

    2016-01-01

    This study aimed to characterize pertinent anatomy relative to the sacral suture placed at time of robotic sacrocolpopexy using postoperative computed tomography and magnetic resonance imaging. A vascular clip was placed at the base of the sacral suture at the time of robotic sacrocolpopexy. Six weeks postoperatively, subjects returned for a computed tomography scan and magnetic resonance imaging. Ten subjects completed the study. The middle sacral artery and vein coursed midline or to the left of midline in all the subjects. The left common iliac vein was an average of 26 mm from the sacral suture. To the right of the suture, the right common iliac artery was 18 mm away. Following the right common iliac artery to its bifurcation, the right internal iliac was on average 10 mm from the suture. The bifurcations of the inferior vena cava and the aorta were 33 mm and 54 mm further cephalad, respectively.The right ureter, on average, was 18 mm from the suture. The thickness of the anterior longitudinal ligament was 2 mm.The mean angle of descent of the sacrum was 70 degrees. Lastly, we found that 70% of the time, a vertebral body was directly below the suture; the disc was noted in 30%. We describe critical anatomy surrounding the sacral suture placed during robotic sacrocolpopexy. Proximity of both vascular and urologic structures within 10 to 18 mm, as well as anterior ligament thickness of only 2 mm highlights the importance of adequate exposure, careful dissection, and surgeon expertise.

  4. The analysis of the effective of preserving sacral nerve root during surgical treatment of chordoma

    International Nuclear Information System (INIS)

    Ji Yiming; Chen Kangwu; Yang Huilin; Zhu Lifan

    2010-01-01

    Objective: To analyze the effective of preserving sacral nerve root during surgical treatment of sacral chordoma. Methods: This retrospective study included 30 cases of sacral chordomas. All the cases were operated with posterior approach. The blood loss and blood transfusion during operation, the drainged blood after operation were reviewed. The sphincter muscle function of bladder and bowl were observed. Results: Tremendous reduction of blood loss during surgery was found in all cases, the blood loss was 1280 ml in average, the blood transfusion was 1080 ml in average, the drainged blood after ope-ration was 650 ml. Nine patients whose sacral nerve roots had been reserved bilaterally at and above S 3 level, the sphincter muscle function of bladder and bowl was good, whereas the function of sphincter muscle impaired in the other 21 patients and in one case colostomy and ureterocutaneostomy were used. Conclusion: Preoperative arterial embolization is effective method and can lead to excellent results. Even if the tumor is relatively huge and the upper resection margin is as high as at S 1 or S 2 level, the tumor can be removed successfully by posterior approach. Sacral nerve should be preserved as possible. (authors)

  5. Sacral nerve stimulation can be an effective treatment for low anterior resection syndrome.

    Science.gov (United States)

    Eftaiha, S M; Balachandran, B; Marecik, S J; Mellgren, A; Nordenstam, J; Melich, G; Prasad, L M; Park, J J

    2017-10-01

    Sacral nerve stimulation has become a preferred method for the treatment of faecal incontinence in patients who fail conservative (non-operative) therapy. In previous small studies, sacral nerve stimulation has demonstrated improvement of faecal incontinence and quality of life in a majority of patients with low anterior resection syndrome. We evaluated the efficacy of sacral nerve stimulation in the treatment of low anterior resection syndrome using a recently developed and validated low anterior resection syndrome instrument to quantify symptoms. A retrospective review of consecutive patients undergoing sacral nerve stimulation for the treatment of low anterior resection syndrome was performed. Procedures took place in the Division of Colon and Rectal Surgery at two academic tertiary medical centres. Pre- and post-treatment Cleveland Clinic Incontinence Scores and Low Anterior Resection Syndrome scores were assessed. Twelve patients (50% men) suffering from low anterior resection syndrome with a mean age of 67.8 (±10.8) years underwent sacral nerve test stimulation. Ten patients (83%) proceeded to permanent implantation. Median time from anterior resection to stimulator implant was 16 (range 5-108) months. At a median follow-up of 19.5 (range 4-42) months, there were significant improvements in Cleveland Clinic Incontinence Scores and Low Anterior Resection Syndrome scores (P syndrome and may therefore be a viable treatment option. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

  6. Intrapartum sacral stress fracture due to pregnancy-related osteoporosis: a case report.

    Science.gov (United States)

    Oztürk, Gülcan; Külcü, Duygu Geler; Aydoğ, Ece

    2013-01-01

    Low back pain (LBP) and hip pain frequently occur during pregnancy and postpartum period. Although pelvic and mechanic lesions of the soft tissues are most responsible for the etiology, sacral fracture is also one of the rare causes. A 32-year-old primigravid patient presented with LBP and right hip pain which started 3 days after vaginal delivery. Although direct radiographic examination was normal, magnetic resonance imaging of the sacrum revealed sacral stress fracture. Lumbar spine and femoral bone mineral density showed osteoporosis as a risk factor. There were no other risk factors such as trauma, excessive weight gain, and strenuous physical activity. It is considered that the patient had sacral fatigue and insufficiency fracture in intrapartum period. The patient's symptoms subsided in 3 months after physical therapy and rest. In conclusion, sacral fractures during pregnancy and postpartum period, especially resulting from childbirth, are very rare. To date, there are two cases in the literature. In cases who even do not have risk factors related to vaginal delivery such as high birth weight infant and the use of forceps, exc., sacral fracture should be considered in the differential diagnosis of LBP and hip pain started soon after child birth. Pregnancy-related osteoporosis may lead to fracture during vaginal delivery.

  7. Extradural spinal schwannoma at cervical spine in 12 year old child

    Directory of Open Access Journals (Sweden)

    Madoori Srinivas

    2016-10-01

    Full Text Available Spinal schwannomas are benign tumors arising from spinal nerve root sheaths. It is a primary spinal tumor which are rare in children. We report a case of a 12 year old girl who presented with weakness of all limbs and unable to walk. Imaging studies demonstrated an extradural spinal tumor at cervical spine. The patient was operated and tumor was totally removed. The postoperative course was uneventful. Histology confirmed the diagnosis of schwannoma. After surgery there was improvement in signs and symptoms. After two months of operation, child could able to walk normally.

  8. Facial Nerve Schwannoma: A Case Report, Radiological Features and Literature Review.

    Science.gov (United States)

    Pilloni, Giulia; Mico, Barbara Massa; Altieri, Roberto; Zenga, Francesco; Ducati, Alessandro; Garbossa, Diego; Tartara, Fulvio

    2017-12-22

    Facial nerve schwannoma localized in the middle fossa is a rare lesion. We report a case of a facial nerve schwannoma in a 30-year-old male presenting with facial nerve palsy. Magnetic resonance imaging (MRI) showed a 3 cm diameter tumor of the right middle fossa. The tumor was removed using a sub-temporal approach. Intraoperative monitoring allowed for identification of the facial nerve, so it was not damaged during the surgical excision. Neurological clinical examination at discharge demonstrated moderate facial nerve improvement (Grade III House-Brackmann).

  9. Association between vestibular schwannomas and mobile phone use.

    Science.gov (United States)

    Moon, In Seok; Kim, Bo Gyung; Kim, Jinna; Lee, Jong Dae; Lee, Won-Sang

    2014-01-01

    Vestibular schwannomas (VSs) grow in the region where the energy from mobile phone use is absorbed. We examined the associations of VSs with mobile phone use. This study included 119 patients who had undergone surgical tumor removal. We used two approaches in this investigation. First, a case-control study for the association of mobile phone use and incidence of VSs was conducted. Both cases and controls were investigated with questions based on INTERPHONE guidelines. Amount of mobile phone use according to duration, daily amount, and cumulative hours were compared between two groups. We also conducted a case-case study. The location and volume of the tumors were investigated by MRI. Associations between the estimated amount of mobile phone use and tumor volume and between the laterality of phone use and tumor location were analyzed. In a case-control study, the odds ratio (OR) of tumor incidence according to mobile phone use was 0.956. In the case-case study, tumor volume and estimated cumulative hours showed a strong correlation (r(2) = 0.144, p = 0.002), and regular mobile phone users showed tumors of a markedly larger volume than those of non-regular users (p mobile phones and tumor volume that showed strong correlation with amount of mobile phone use, thus there is a possibility that mobile phone use may affect tumor growth.

  10. Selection of treatment and surgical approach for vestibular schwannomas

    International Nuclear Information System (INIS)

    Eguchi, Kuniki; Yamaguchi, Satoshi; Sakoda, Eiichiro

    2007-01-01

    Described are the present state of selection of stereotactic radiotherapy or surgical treatment and their combination for schwannomas in the title, and authors' policy of surgery as a first choice treatment. The policy stands on the concept that surgery is useful for the controllability thereafter of the tumor, of which size is at first larger than 25 mm diameter, and radiotherapy like a gamma-knife is applicable to the residual tissue grown after operation and to the tissue with less than the size before surgery because the smaller the size, the better is thought the control by the knife (reportedly 100% for the tissue of <14 mm diameter). The basis of authors' selection of two surgical approaches of through-lower lateral occiput and trans-labyrinthine, and their outcomes like hearing loss are described and discussed in details for 24 patients (two underwent radiotherapy before surgery) during the period Sep. 2003-Aug. 2006 of authors' hospital. Radiotherapy is thought essentially useful for the control of the tumor with a small or surgically reduced size. (R.T.)

  11. What is the real incidence of vestibular schwannoma?

    DEFF Research Database (Denmark)

    Tos, Mirko; Stangerup, Sven-Eric; Cayé-Thomasen, Per

    2004-01-01

    tumors was small in 104; medium in 194; large in 68; and giant (>40 mm) in 10. Compared with incidences of 7.8 VS/1 million inhabitants per year in the first, 9.4 VS/1 million inhabitants in the second, and 12.4 VS/1 million inhabitants in the third periods, the incidence for the 1996-2001 period...

  12. Increasing annual incidence of vestibular schwannoma and age at diagnosis

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Tos, Mirko; Caye-Thomasen, Per

    2004-01-01

    in 2001. In the first years large and giant tumours dominated, in contrast to recent years in which intrameatal and small tumours dominated. The median age at the time of diagnosis has been almost unchanged through the period (median 55 years). If the decreasing size of the tumour and the increasing...

  13. Transsacral colon fistula: late complication after resection, irradiation and free flap transfer of sacral chondrosarcoma

    Directory of Open Access Journals (Sweden)

    Schildhauer Thomas A

    2008-11-01

    Full Text Available Abstract Background Primary sacral tumors are rare and experience related to accompanying effects of these tumors is therefore limited to observations on a small number of patients. Case presentation In this case report we present a patient with a history of primary sacral chondrosarcoma, an infection of an implanted spinal stabilization device and discuss the challenges that resulted from a colonic fistula associated with large, life threatening abscesses as late complications of radiotherapy. Conclusion In patients with sacral tumors enterocutaneous fistulas after free musculotaneous free flaps transfer are rare and can occur in the setting of surgical damage followed by radiotherapy or advanced disease. They are associated with prolonged morbidity and high mortality. Identification of high-risk patients and management of fistulas at an early stage may delay the need for subsequent therapy and decrease morbidity.

  14. Retention of urine and sacral paraesthesia in anogenital herpes simplex infection.

    Science.gov (United States)

    Edis, R H

    1981-01-01

    Two definite and 2 probable cases of anogenital herpes simplex and sacral radiculitis are described. Symptoms were typical and consisted of paraesthesia and neuralgic pain in the perineum and legs, urinary retention and constipation occurring within several days to a week after an anogenital herpetic eruption. However, at presentation only 1 case had an obvious history of anogenital herpes simplex. Neurological signs were not striking and consisted of a reduced appreciation of light touch and pin prick over the sacral dermatomes and in 2 cases reduced anal sphincter tone. CSF examination in 3 patients showed a lymphocytosis. Bladder catheterisation was required for up to 2 weeks in 2 patients. The paraesthesia persisted for weeks to months. It should be more widely recognised that anogenital herpes simplex, with sacral radiculitis, is probably the commonest cause of acute retention of urine in young sexually active people.

  15. Effect of spinal anterior root stimulation and sacral deafferentation on bladder and sexual dysfunction in spinal cord injury

    DEFF Research Database (Denmark)

    Zaer, Hamed; Rasmussen, Mikkel Mylius

    2018-01-01

    Spinal cord injury (SCI) is a highly devastating injury with a variety of complications; among them are neurogenic bladder, bowel, and sexual dysfunction. We aimed to evaluate the effect of sacral anterior root stimulation with sacral deafferentation (SARS-SDAF) on neurogenic bladder and sexual d...

  16. Detection of neurological deficits by computed tomography in sacral fracture patients

    International Nuclear Information System (INIS)

    Nakai, Daisuke; Numazaki, Shin; Katsumura, Tetsu; Tamaru, Tomohiko; Sugiyama, Mitsugi; Nakamura, Jun-ichiro; Saitoh, Tomoyuki

    2006-01-01

    The purpose of this study is to evaluate the correlation between sacral fractures and neurological deficits as complications. From November 2002 to February 2005, 12 patients (15 fractures) were found to have sacral fractures without other spinal injuries or brain injuries and were evaluated by plain CT scans immediately after trauma. This group included 6 males and 6 females, whose age ranged from 17 to 67 years with mean of 39.9±17.4. All patients were classified according to AO (Arbeitsgemeinschaft fuer Osteosynthesefragen) classification (pelvic ring fracture) and Denis's classification. Displacements of sacral fractures were evaluated by plain CT scans for all patients. We defined displacements using the key slice in CT scans that included the first foramen in the sacrum. Five cases, including 2 with bi-lateral sacral fractures, were complicated with neurological deficits. There was one case with a neurological deficit of 7 Type B fractures (14%) and 4 cases with neurological deficits of 5 Type C fractures (80%) in the AO classification. There were 6 fractures with neurological deficits of 12 Zone II fractures (50%) and one fracture with neurological deficits of one Zone III fractures (100%) in Denis's classification. There was a significant correlation between the extent in the displacement of the sacral fractures and neurological deficits. For more than 3 mm displacements in the medial or lateral or anterior directions, neurological deficits increased significantly. In emergency medicine, it is difficult to evaluate the neurological findings of patients with impaired consciousness. Our evaluation using CT scan is valuable as a predictor of neurological deficits and for an optimal reduction in sacral fractures in patients with in impaired consciousness. (author)

  17. Jogger's fracture and other stress fractures of the lumbo-sacral spine

    International Nuclear Information System (INIS)

    Abel, M.S.

    1985-01-01

    The posterior rings of the lower lumbo-sacral vertebrae are subject to stress fractures at any part - pedicle, pars, or lamina. The site of fracture is apparently determined by the axis of weight bearing. The three illustrative clinical examples cited include a jogger with a laminar fracture, a ballet dancer with pedicle fractures, and a nine-year-old boy with fractures of pars and lamina. Chronic low back pain is the typical complaint with stress fractures of the lower lumbo-sacral spine. Special imaging techniques are usually needed to demonstrate these lesions, including vertebral arch views, multi-directional tomography, and computed tomography (CT). (orig.)

  18. Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED.

    LENUS (Irish Health Repository)

    Galbraith, John G

    2011-03-01

    Sacral insufficiency fractures are an important and treatable cause of severe back pain. Despite publication of several case reports since its original description in 1982, awareness of these injuries remains inadequate in emergency medicine. Most patients are elderly women presenting with intractable lower back pain. Postmenopausal osteoporosis is the most significant risk factor. Marked sacral tenderness is common. Neurologic impairment is rarely detectable. Routine radiography of the spine and pelvis is usually inconclusive. Computed tomography remains the diagnostic modality of choice. Treatment is usually conservative.

  19. Diffusion tensor MRI and fiber tractography of the sacral plexus in children with spina bifida

    DEFF Research Database (Denmark)

    Haakma, Wieke; Dik, Pieter; ten Haken, Bennie

    2014-01-01

    anatomical and microstructural properties of the sacral plexus of patients with spina bifida using diffusion tensor imaging and fiber tractography. MATERIALS AND METHODS: Ten patients 8 to 16 years old with spina bifida underwent diffusion tensor imaging on a 3 Tesla magnetic resonance imaging system...... diffusivity values at S1-S3 were significantly lower in patients. CONCLUSIONS: To our knowledge this 3 Tesla magnetic resonance imaging study showed for the first time sacral plexus asymmetry and disorganization in 10 patients with spina bifida using diffusion tensor imaging and fiber tractography...

  20. Rectal ulcer in a patient with VZV sacral meningoradiculitis (Elsberg syndrome).

    Science.gov (United States)

    Matsumoto, Hideyuki; Shimizu, Takahiro; Tokushige, Shin-ichi; Mizuno, Hideo; Igeta, Yukifusa; Hashida, Hideji

    2012-01-01

    This report describes the case of a 55-year-old woman with varicella-zoster virus (VZV) sacral meningoradiculitis (Elsberg syndrome) who presented with herpes zoster in the left S2 dermatome area, urinary retention, and constipation. Lumbar magnetic resonance imaging showed the left sacral nerve root swelling with enhancement. Thereafter, she suddenly showed massive hematochezia and hemorrhagic shock because of a rectal ulcer. To elucidate the relation between Elsberg syndrome and rectal ulcer, accumulation of similar cases is necessary. To avoid severe complications, attention must be devoted to the possibility of rectal bleeding in the early stage of Elsberg syndrome.

  1. Late malignant transformation of vestibular schwannoma in the absence of irradiation

    DEFF Research Database (Denmark)

    Bashir, Asma; Poulsgaard, Lars; Broholm, Helle

    2016-01-01

    Late malignant transformation of vestibular schwannoma (VS) following irradiation has previously been reported 29 times in the literature. Here, the authors report the first late malignant transformation of VS unrelated to neurofibromatosis or radiation exposure. After undergoing a near-total exc...

  2. Late Malignant Transformation of a Vestibular Schwannoma without Association to NFII or Radiotherapy

    DEFF Research Database (Denmark)

    Bashir, Asma; Poulsgaard, Lars; Broholm, Helle

    Late malignant transformation of vestibular schwannoma (VS) following irradiation has previously been reported 29 times in the literature. Here, the authors report the first late malignant transformation of VS unrelated to neurofibromatosis or radiation exposure. After undergoing a near-total exc...

  3. Pontine extension of a tentorial schwannoma without cranial nerve involvement: a case report

    Directory of Open Access Journals (Sweden)

    D'Urso Pietro

    2011-12-01

    Full Text Available Abstract Introduction Intracranial schwannomas unrelated to the cranial nerves are uncommon. We report a new case of tentorial schwannoma unrelated to the cranial nerves, with extension into the pons. A literature review with discussion of the most relevant pathogenetic aspects is also performed. Case presentation A 42-year-old Caucasian man was admitted with right-sided paresthesias and weakness of his upper and lower extremities. The neurological examination revealed right hemiparesis and hemi-hypoesthesia. A brain magnetic resonance imaging scan revealed a cerebellopontine lesion, arising from the left free edge of the tentorium, and extending into his pons. A piecemeal removal was performed through a retrosigmoid approach. The lesion was not found to be associated with any cranial nerves. The histological examination revealed a schwannoma Antoni type A. His postoperative course was uneventful. At one year follow-up, the patient was neurologically intact and the magnetic resonance imaging of his brain performed at that time showed complete removal without signs of recurrence. Conclusion Tentorial schwannomas are rare clinical entities. Knowledge of their clinical, radiological and anatomical characteristics is very important for the correct diagnosis and management.

  4. Therapeutic profile of single-fraction radiosurgery of vestibular schwannoma: unrelated malignancy predicts tumor control

    Science.gov (United States)

    Wowra, Berndt; Muacevic, Alexander; Fürweger, Christoph; Schichor, Christian; Tonn, Jörg-Christian

    2012-01-01

    Radiosurgery has become an accepted treatment option for vestibular schwannomas. Nevertheless, predictors of tumor control and treatment toxicity in current radiosurgery of vestibular schwannomas are not well understood. To generate new information on predictors of tumor control and cranial nerve toxicity of single-fraction radiosurgery of vestibular schwannomas, we conducted a single-institution long-term observational study of radiosurgery for sporadic vestibular schwannomas. Minimum follow-up was 3 years. Investigated as potential predictors of tumor control and cranial nerve toxicity were treatment technology; tumor resection preceding radiosurgery; tumor size; gender; patient age; history of cancer, vascular disease, or metabolic disease; tumor volume; radiosurgical prescription dose; and isodose line. Three hundred eighty-six patients met inclusion criteria. Treatment failure was observed in 27 patients. History of unrelated cancer (strongest predictor) and prescription dose significantly predicted tumor control. The cumulative incidence of treatment failure was 30% after 6.5 years in patients with unrelated malignancy and 10% after ≥15 years in patients without such cancer (P making in ambiguous cases. PMID:22561798

  5. Long-term quality of life and tumour control following gamma knife radiosurgery for vestibular schwannoma

    DEFF Research Database (Denmark)

    Wangerid, Theresa; Bartek, Jiri; Svensson, Mikael

    2014-01-01

    Gamma knife radiosurgery (GKRS) has for the last decades been an established treatment option for patients with small- or medium-sized vestibular schwannomas (VS), although little data is reported on long-term outcome regarding quality of life (QOL) and tumour control in this patient category...

  6. Cervical Vestibular Evoked Myogenic Potential in Hypoglossal Nerve Schwannoma: A Case Report.

    Science.gov (United States)

    Rajasekaran, Aravind Kumar; Savardekar, Amey Rajan; Shivashankar, Nagaraja Rao

    2018-02-01

    Schwannoma of the hypoglossal nerve is rare. This case report documents an atypical abnormality of the cervical vestibular evoked myogenic potential (cVEMP) in a patient with schwannoma of the hypoglossal nerve. The observed abnormality was attributed to the proximity of the hypoglossal nerve to the spinal accessory nerve in the medullary cistern and base of the skull. To report cVEMP abnormality in a patient with hypoglossal nerve schwannoma and provide an anatomical correlation for this abnormality. Case report. A 44-yr-old woman. Pure-tone and speech audiometry, tympanometry, acoustic stapedial reflex, auditory brainstem response, and cVEMP testing were performed. The audiological test results were normal except for the absence of cVEMP on the lesion side (right). A cVEMP abnormality indicating a compromised spinal accessory nerve was observed in a patient with hypoglossal nerve schwannoma. This case report highlights the importance of recording cVEMP in relevant neurological conditions and provides clinical proof for the involvement of the spinal accessory nerve in the vestibulocollic reflex pathway. American Academy of Audiology

  7. The Middle Fossa Approach for the Removal of a Trochlear Schwannoma

    Science.gov (United States)

    Boucher, Andrew B.; Michael, L. Madison

    2014-01-01

    Objectives. Schwannomas originating from the trochlear nerve are extremely rare; only 30 cases have been reported in the literature. Many operative approaches have been utilized for lesion resection, but the advantages of the anterior transpetrosal approach are numerous and include excellent exposure, minimal extradural retraction of the temporal lobe, and minimal cerebrospinal fluid leaks. We report the second case of a trochlear schwannoma resected via the anterior transpetrosal approach. Setting. A 64-year-old male presented with 3-month history of diplopia and headaches. On physical examination, he was found to have a right fourth nerve palsy. Brain magnetic resonance imaging revealed a mass within the right ambient cistern compressing the adjacent midbrain. A right-sided anterior transpetrosal approach was used—which confirmed that the trochlear nerve entered the mass—to achieve gross total resection. Pathological examination confirmed diagnosis of schwannoma. The patient was discharged on postoperative day 3. He experienced a persistent fourth nerve palsy postoperatively with an otherwise normal neurological examination. Follow-up imaging confirmed complete removal of the tumor. Conclusion. The anterior transpetrosal approach is an excellent approach for removal of trochlear schwannomas involving the cisternal course of the trochlear nerve. It affords complete visualization of this anatomical region while introducing minimal morbidity. PMID:24716021

  8. The imaging manifestation of intracranial schwannomas not arising from cranial nerves

    International Nuclear Information System (INIS)

    Luo Boning; Sun Gengxi; Liang Kangfu

    2003-01-01

    Objective: To report 4 cases of operation-confirmed intracranial schwannomas not arising from cranial nerves, and to discuss the histogenesis and CT and MRI manifestation combining with the literature. Methods: CT and MRI findings of these 4 intracranial schwannomas were analyzed retrospectively and their pathologic characteristics were reviewed. Results: The tumors demonstrated low-iso mixed density with necrotic and cystic areas. Large degeneration even became the prominent characteristics on CT scan. Low-signal to iso-signal intensity on T 1 -weighted images and heterogeneous high-signal intensity on T 2 -weighted images were revealed. The solid portion and the wall of the tumors were moderately enhanced on enhanced CT and MRI scans. Hematoxylin and eosin-stained sections showed two corresponding histological patterns: Antoni Type A and Antoni Type B pattern. The tumor cells exhibited a strong positive staining pattern for s-100 protein. Conclusion: The imaging manifestations of these tumors were similar to that of cranial nerve schwannomas except that the former had higher cystic degeneration rate. We should take that diagnosis into consideration when the mass is not located on cranial nerve but its image feature resembles schwannomas

  9. The Middle Fossa Approach for the Removal of a Trochlear Schwannoma

    Directory of Open Access Journals (Sweden)

    Andrew B. Boucher

    2014-01-01

    Full Text Available Objectives. Schwannomas originating from the trochlear nerve are extremely rare; only 30 cases have been reported in the literature. Many operative approaches have been utilized for lesion resection, but the advantages of the anterior transpetrosal approach are numerous and include excellent exposure, minimal extradural retraction of the temporal lobe, and minimal cerebrospinal fluid leaks. We report the second case of a trochlear schwannoma resected via the anterior transpetrosal approach. Setting. A 64-year-old male presented with 3-month history of diplopia and headaches. On physical examination, he was found to have a right fourth nerve palsy. Brain magnetic resonance imaging revealed a mass within the right ambient cistern compressing the adjacent midbrain. A right-sided anterior transpetrosal approach was used—which confirmed that the trochlear nerve entered the mass—to achieve gross total resection. Pathological examination confirmed diagnosis of schwannoma. The patient was discharged on postoperative day 3. He experienced a persistent fourth nerve palsy postoperatively with an otherwise normal neurological examination. Follow-up imaging confirmed complete removal of the tumor. Conclusion. The anterior transpetrosal approach is an excellent approach for removal of trochlear schwannomas involving the cisternal course of the trochlear nerve. It affords complete visualization of this anatomical region while introducing minimal morbidity.

  10. Trigeminal Schwannoma with intra- and extracranial portions - a case report and review of the literature

    International Nuclear Information System (INIS)

    Souza, Ricardo Pires de; Setubal, Roger; Florencio, Filipe Toledo; Gomes, Marcio Rogerio Alcala; Mayo, Suzete Varela; Leiro, Luis Carlos Filgueira; Soares, Aldemir Humberto

    1997-01-01

    The authors report a case of a 40-year-old male patient presenting a mandibular branch Schwannoma of the trigeminal nerve with intra-and extracranial portions. The radiologic, computed tomographic and magnetic resonance imaging findings are discussed and a review of the literature is presented. (author)

  11. Schwannoma of the upper lip: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Peediackel Antony George

    2017-01-01

    Full Text Available Introduction. Schwannomas or neurilemmomas are well demarcated, benign neurogenic lesions arising by a fibroblastic proliferation of the nerve sheath cell (Schwann cell. They usually present as solitary encapsulated lesions with rare occurrence in the upper lip. Non-diagnosed or misdiagnosed schwannomas present a high risk for the tumor to continue growing and exerting pressure on surrounding nerves. These tumours based on their location could lead to facial weakness and paralysis, pressure in ears, tinnitus, hearing loss, balance loss, and could lead to a life-threatening situation. Case Outline. This case is a rare presentation of a schwannoma located in the upper lip of a 21-year-old male patient of Indian origin. The patient complained of a swelling in the mouth with a difficulty in keeping the mouth closed. The swelling was surgically excised and the patient healed completely. Conclusion. This case of occurrence of tumor on the upper lip points to the possibility of considering schwannoma as a possibility in the diagnosis of oral tumors in the future, as the location of the tumor was rare and had a high chance of misdiagnosis.

  12. Extracranial Facial Nerve Schwannoma Treated by Hypo-fractionated CyberKnife Radiosurgery.

    Science.gov (United States)

    Sasaki, Ayaka; Miyazaki, Shinichiro; Hori, Tomokatsu

    2016-09-21

    Facial nerve schwannoma is a rare intracranial tumor. Treatment for this benign tumor has been controversial. Here, we report a case of extracranial facial nerve schwannoma treated successfully by hypo-fractionated CyberKnife (Accuray, Sunnyvale, CA) radiosurgery and discuss the efficacy of this treatment. A 34-year-old female noticed a swelling in her right mastoid process. The lesion enlarged over a seven-month period, and she experienced facial spasm on the right side. She was diagnosed with a facial schwannoma via a magnetic resonance imaging (MRI) scan of the head and neck and was told to wait until the facial nerve palsy subsides. She was referred to our hospital for radiation therapy. We planned a fractionated CyberKnife radiosurgery for three consecutive days. After CyberKnife radiosurgery, the mass in the right parotid gradually decreased in size, and the facial nerve palsy disappeared. At her eight-month follow-up, her facial spasm had completely disappeared. There has been no recurrence and the facial nerve function has been normal. We successfully demonstrated the efficacy of CyberKnife radiosurgery as an alternative treatment that also preserves neurofunction for facial nerve schwannomas.

  13. Lipase polystyrene giant amphiphiles.

    Science.gov (United States)

    Velonia, Kelly; Rowan, Alan E; Nolte, Roeland J M

    2002-04-24

    A new type of giant amphiphilic molecule has been synthesized by covalently connecting a lipase enzyme headgroup to a maleimide-functionalized polystyrene tail (40 repeat units). The resulting biohybrid forms catalytic micellar rods in water.

  14. Metaphyseal giant cell tumor

    International Nuclear Information System (INIS)

    Pereira, L.F.; Hemais, P.M.P.G.; Aymore, I.L.; Carmo, M.C.R. do; Cunha, M.E.P.R. da; Resende, C.M.C.

    1986-01-01

    Three cases of metaphyseal giant cell tumor are presented. A review of the literature is done, demostrating the lesion is rare and that there are few articles about it. Age incidence and characteristics of the tumor are discussed. (Author) [pt

  15. Giant CP stars

    International Nuclear Information System (INIS)

    Loden, L.O.; Sundman, A.

    1989-01-01

    This study is part of an investigation of the possibility of using chemically peculiar (CP) stars to map local galactic structure. Correct luminosities of these stars are therefore crucial. CP stars are generally regarded as main-sequence or near-main-sequence objects. However, some CP stars have been classified as giants. A selection of stars, classified in literature as CP giants, are compared to normal stars in the same effective temperature interval and to ordinary 'non giant' CP stars. There is no clear confirmation of a higher luminosity for 'CP giants', than for CP stars in general. In addition, CP characteristics seem to be individual properties not repeated in a component star or other cluster members. (author). 50 refs., 5 tabs., 3 figs

  16. Prediction of Balance Compensation After Vestibular Schwannoma Surgery.

    Science.gov (United States)

    Parietti-Winkler, Cécile; Lion, Alexis; Frère, Julien; Perrin, Philippe P; Beurton, Renaud; Gauchard, Gérome C

    2016-06-01

    Background Balance compensation after vestibular schwannoma (VS) surgery is under the influence of specific preoperative patient and tumor characteristics. Objective To prospectively identify potential prognostic factors for balance recovery, we compared the respective influence of these preoperative characteristics on balance compensation after VS surgery. Methods In 50 patients scheduled for VS surgical ablation, we measured postural control before surgery (BS), 8 (AS8) days after, and 90 (AS90) days after surgery. Based on factors found previously in the literature, we evaluated age, body mass index and preoperative physical activity (PA), tumor grade, vestibular status, and preference for visual cues to control balance as potential prognostic factors using stepwise multiple regression models. Results An asymmetric vestibular function was the sole significant explanatory factor for impaired balance performance BS, whereas the preoperative PA alone significantly contributed to higher performance at AS8. An evaluation of patients' balance recovery over time showed that PA and vestibular status were the 2 significant predictive factors for short-term postural compensation (BS to AS8), whereas none of these preoperative factors was significantly predictive for medium-term postoperative postural recovery (AS8 to AS90). Conclusions We identified specific preoperative patient and vestibular function characteristics that may predict postoperative balance recovery after VS surgery. Better preoperative characterization of these factors in each patient could inform more personalized presurgical and postsurgical management, leading to a better, more rapid balance recovery, earlier return to normal daily activities and work, improved quality of life, and reduced medical and societal costs. © The Author(s) 2015.

  17. A Xenograft Model of Vestibular Schwannoma and Hearing Loss.

    Science.gov (United States)

    Dinh, Christine T; Bracho, Olena; Mei, Christine; Bas, Esperanza; Fernandez-Valle, Cristina; Telischi, Fred; Liu, Xue-Zhong

    2018-03-19

    Microsurgical implantation of mouse merlin-deficient Schwann cells (MD-SC) into the cerebellopontine angle of immunodeficient rats will initiate tumor formation, hearing loss, and vestibular dysfunction. The progress in identifying effective drug therapies for treatment of Neurofibromatosis type II (NF2) is limited by the availability of animal models of VS that develop hearing loss and imbalance. A microsurgical technique for implanting MD-SCs onto the cochleovestibular nerve of rats was developed. Ten Rowett Nude rats were implanted with either ∼10 MD-SCs expressing luciferase (N = 5) or vehicle (N = 5). Rats received bioluminescence imaging, auditory brainstem response testing, and were observed for head tilt every 2 weeks after surgery, for a total of 6 weeks. Tumors were harvested and processed with hematoxylin & eosin staining and immunohistochemistry was performed for S100. Rats implanted with MD-SCs developed significantly higher tumor bioluminescence measurements and hearing threshold shifts at multiple frequencies by the 4th and 6th weeks post-implantation, compared with control rats. Rats implanted with MD-SCs also developed gross tumor. The tumor volume was significantly greater than nerve volumes obtained from rats in the control group. All rats with tumors developed a head tilt, while control rats had no signs of vestibular dysfunction. Tumors demonstrated histological features of schwannoma and express S100. Using this microsurgical technique, this xenograft rat model of VS develops tumors involving the cochleovestibular nerve, shifts in hearing thresholds, and vestibular dysfunction. This animal model can be used to investigate tumor-mediated hearing loss and perform preclinical drug studies for NF2.

  18. Predictors of Trigeminal Neuropathy After Radiosurgery for Vestibular Schwannomas

    Energy Technology Data Exchange (ETDEWEB)

    Senova, Suhan [Unité de Radiochirurgie Gamma Knife, Region Ile De France, Paris (France); Service de Neurochirurgie, Centre Hospitalier Universitaire (CHU) La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (France); Inserm, U955, Equipe 14, Université Paris Est, Faculté de médecine, Créteil (France); Aggad, Mourad [Unité de Radiochirurgie Gamma Knife, Region Ile De France, Paris (France); Service de Neurochirurgie, Centre Hospitalier Universitaire (CHU) La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (France); Golmard, Jean-Louis [Service de Biostatistiques, CHU La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (France); Hasboun, Dominique [Service de Neuroanatomie, CHU La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (France); Lamproglou, Ioannis [Unité de Radiochirurgie Gamma Knife, Region Ile De France, Paris (France); and others

    2016-06-01

    Purpose: To analyze the relationship between dosimetric characteristics and symptoms related to trigeminal neuropathy (TN) observed after radiosurgery (RS) for vestibular schwannomas (VS); to propose guidelines to optimize planification in VS RS regarding TN preservation; and to detail the mechanism of TN impairment after VS RS. Methods and Materials: One hundred seventy-nine patients treated between 2011 and 2013 for VS RS and without trigeminal impairment before RS were included in a retrospective study. Univariate and multivariate analyses were performed to determine predictors of TN among characteristics of the patients, the dosimetry, and the VS. Results: There were 20 Koos grade 1, 99 grade 2, 57 grade 3, and 3 grade 4. Fourteen patients (7.8%) presented a transitory or permanent TN. Between the patients with and without TN after VS RS, there was no significant difference regarding dosimetry or VS volume itself. Significant differences (univariate analysis P<.05, Mann-Whitney test) were found for parameters related to the cisternal portion of the trigeminal nerve: total integrated dose, maximum dose, mean dose, volume of the Vth nerve (Vol{sub v}), and volume of the Vth nerve receiving at least 11 Gy (Vol{sub Vcist>11Gy}), but also for maximal dose to the Vth nerve nucleus and intra-axial portion (Dose max{sub Vax}). After multivariate analysis, the best model predicting TN included Vol{sub Vcist>11Gy} (P=.0045), Dose max{sub Vax} (P=.0006), and Vol{sub v} (P=.0058). The negative predictive value of this model was 97%. Conclusions: The parameters Vol{sub Vcist>11Gy}, Dose max{sub Vax}, and Vol{sub v} should be checked when designing dosimetry for VS RS.

  19. Magnetic resonance imaging surveillance following vestibular schwannoma resection.

    Science.gov (United States)

    Carlson, Matthew L; Van Abel, Kathryn M; Driscoll, Colin L; Neff, Brian A; Beatty, Charles W; Lane, John I; Castner, Marina L; Lohse, Christine M; Link, Michael J

    2012-02-01

    To describe the incidence, pattern, and course of postoperative enhancement within the operative bed using serial gadolinium-enhanced magnetic resonance imaging (MRI) following vestibular schwannoma (VS) resection and to identify clinical and radiologic variables associated with recurrence. Retrospective cohort study. All patients who underwent microsurgical resection of VS between January 2000 and January 2010 at a single tertiary referral center were reviewed. Postoperative enhancement patterns were characterized on serial MRI studies. Clinical follow-up and outcomes were recorded. During the last 10 years, 350 patients underwent microsurgical VS resection, and of these, 203 patients met study criteria (mean radiologic follow-up, 3.5 years). A total of 144 patients underwent gross total resection (GTR), 32 received near-total resection (NTR), and the remaining 27 underwent subtotal resection (STR); 98.5% of patients demonstrated enhancement within the operative bed following resection (58.5% linear, 41.5% nodular). Stable enhancement patterns were seen in 24.5% of patients, regression in 66.0%, and resolution in only 3.5% of patients on the most recent postoperative MRI. Twelve patients recurred a mean of 3.0 years following surgery. The average maximum linear diameter growth rate among recurrent tumors was 2.3 mm per year. Those receiving STR were more than nine times more likely to experience recurrence compared to those undergoing NTR or GTR (P assist the clinician in determining an appropriate postoperative MRI surveillance schedule. Future studies using standardized terminology and consistent study metrics are needed to further refine surveillance recommendations. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  20. Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy

    Institute of Scientific and Technical Information of China (English)

    CHEN Ling; CHEN Li-hua; LING Feng; LIU Yun-sheng; Madjid Samii; Amir Samii

    2010-01-01

    Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation.Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgicaily removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed.Results Total tumor resection was achieved in 140 cases (96.6%) and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% (132/145) of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients (Grade Ⅰ and Grade Ⅱ, 79.3%). No patient died in this series. Preservation of nerves and vessels were as important as tumor removal dudng the operation. CT thinner scan could show the relationship between the posterior wall of the internal

  1. Quality of Life in 807 Patients with Vestibular Schwannoma: Comparing Treatment Modalities.

    Science.gov (United States)

    Soulier, Géke; van Leeuwen, Bibian M; Putter, Hein; Jansen, Jeroen C; Malessy, Martijn J A; van Benthem, Peter Paul G; van der Mey, Andel G L; Stiggelbout, Anne M

    2017-07-01

    Objective In vestibular schwannoma treatment, the choice among treatment modalities is controversial. The first aim of this study was to examine the quality of life of patients with vestibular schwannoma having undergone observation, radiation therapy, or microsurgical resection. The second aim was to examine the relationship between perceived symptoms and quality of life. Last, the association between quality of life and time since treatment was studied. Study Design Cross-sectional study. Setting Tertiary referral center. Subjects and Methods A total of 1208 patients treated for sporadic vestibular schwannoma between 2004 and 2014 were mailed the disease-specific Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire and additional questions on symptoms associated with vestibular schwannoma. Total and domain scores were calculated and compared among treatment groups. Propensity scores were used, and results were stratified according to tumor size to control for potential confounders. Correlations were calculated to examine the relationship between self-reported symptoms and quality of life, as well as between quality of life and time since treatment. Results Patients with small tumors (≤10 mm) under observation showed a higher PANQOL score when compared with the radiation therapy and microsurgical resection groups. A strong negative correlation was found between self-reported symptoms and quality of life, with balance problems and vertigo having the largest impact. No correlation was found between PANQOL score and time since treatment. Conclusion This study suggests that patients with small vestibular schwannomas experience better quality of life when managed with observation than do patients who have undergone active treatment.

  2. Long-Term Results for Trigeminal Schwannomas Treated With Gamma Knife Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Hasegawa, Toshinori, E-mail: h-toshi@komakihp.gr.jp; Kato, Takenori; Iizuka, Hiroshi; Kida, Yoshihisa

    2013-12-01

    Purpose: Surgical resection is considered the desirable curative treatment for trigeminal schwannomas. However, complete resection without any complications remains challenging. During the last several decades, stereotactic radiosurgery (SRS) has emerged as a minimally invasive treatment modality. Information regarding long-term outcomes of SRS for patients harboring trigeminal schwannomas is limited because of the rarity of this tumor. The aim of this study was to evaluate long-term tumor control and functional outcomes in patients harboring trigeminal schwannomas treated with SRS, specifically with gamma knife surgery (GKS). Methods and Materials: Fifty-three patients harboring trigeminal schwannomas treated with GKS were evaluated. Of these, 2 patients (4%) had partial irradiation of the tumor, and 34 patients (64%) underwent GKS as the initial treatment. The median tumor volume was 6.0 cm{sup 3}. The median maximum and marginal doses were 28 Gy and 14 Gy, respectively. Results: The median follow-up period was 98 months. On the last follow-up image, 7 patients (13%) had tumor enlargement, including the 2 patients who had partial treatment. Excluding the 2 patients who had partial treatment, the actuarial 5- and 10-year progression-free survival (PFS) rates were 90% and 82%, respectively. Patients with tumors compressing the brainstem with deviation of the fourth ventricle had significantly lower PFS rates. If those patients with tumors compressing the brainstem with deviation of the fourth ventricle are excluded, the actuarial 5- and 10-year PFS rates increased to 95% and 90%, respectively. Ten percent of patients had worsened facial numbness or pain in spite of no tumor progression, indicating adverse radiation effect. Conclusions: GKS can be an acceptable alternative to surgical resection in patients with trigeminal schwannomas. However, large tumors that compress the brainstem with deviation of the fourth ventricle should be surgically removed first and then

  3. Hearing outcomes of vestibular schwannoma patients managed with 'wait and scan': predictive value of hearing level at diagnosis

    DEFF Research Database (Denmark)

    Stangerup, S-E; Tos, M; Thomsen, J

    2010-01-01

    This study aimed to evaluate the predictive value of both hearing level (at various frequencies) and speech discrimination for forecasting hearing outcome after a period of observation, in patients with vestibular schwannoma....

  4. U-shaped sacral fractures: Surgical treatment and quality of life

    NARCIS (Netherlands)

    Gribnau, A. J. G.; Boele van Hensbroek, P.; Haverlag, R.; Ponsen, K. J.; Been, H. D.; Goslings, J. C.

    2009-01-01

    Background: U-shaped sacral fractures are rare and highly unstable pelvic ring fractures. They are not recognised in the standard classification systems of these fractures. The fracture pattern is associated with significant neurological injury and can lead to progressive deformity and chronic pain

  5. The influence of sacral nerve stimulation on gastrointestinal motor function in patients with fecal incontinence

    DEFF Research Database (Denmark)

    Damgaard, M; Thomsen, F G; Sørensen, Michael

    2011-01-01

    Sacral nerve stimulation (SNS) is a well-established treatment for fecal incontinence of various etiologies. However, the mechanism of action remains unclear. The aim of the present study was to determine whether SNS affects gastric emptying, small intestinal transit or colonic transit times....

  6. Sacral pseudotumor complicating iliac bone harvest: radiographic, CT and MRI appearances

    Energy Technology Data Exchange (ETDEWEB)

    Kavanagh, E.; Roth, C.; O' Connell, M.; Eustace, S. [Dept. of Radiology, Mater Misericordiae Hospital, Dublin (Ireland)

    2003-12-01

    We present the imaging appearances of a lytic pseudotumor in the right sacral ala presenting with referred pain to the right thigh. Subsequent imaging revealed the presence of a cystic lesion arising at the site of previous bone graft harvest; CT-guided aspiration yielded synovial fluid presumed to arise from the contiguous sacroiliac joint. (orig.)

  7. Subarachnoid and basal cistern navigation through the sacral hiatus with guide wire assistance.

    Science.gov (United States)

    Layer, Lauren; Riascos, Roy; Firouzbakht, Farhood; Amole, Adewumi; Von Ritschl, Rudiger; Dipatre, Pier; Cuellar, Hugo

    2011-07-01

    Intraspinal navigation with catheters and fiberscopes has shown feasible results for diagnosis and treatment of intraspinal and intracranial lesions. The most common approach, lumbar puncture, has allowed access to the spinal cord, however, coming with the difficulties of fiberscope damage and decreased torque for guidance. Our objective in this study is to allow an alternate access, the sacral hiatus, with guide wire assistance into the subarachnoid and intracranial structures, while easing the angle of entry and increasing torque. We advanced catheters with guide wire and fluoroscopy assistance into the sacral hiatus of three cadavers. After entry, the thecal sac was punctured and the catheter with guide wire was advanced rostrally until positioned in the basal cisterns of the brain. We confirmed catheter placement with contrast injection, autopsy, and dissection. In our study, the sacral hiatus was easily accessed, but resistance was found when attempting to puncture the thecal sac. The advancement of the catheter with guide wire assistance glided easily rostrally until some mild resistance was discovered at entry into the foramen magnum. With redirection, all catheters passed with ease into the basal cisterns. Positioning was confirmed with contrast injection with fluoroscopy evidence, autopsy, and dissection. There was no macroscopic or microscopic evidence of damage to the spinal roots, spinal cord, or cranial nerves. The sacral hiatus with guide wire assistance is an accessible conduit for uncomplicated entry into the subarachnoid and basal cistern space without damaging surrounding structures.

  8. Selective stimulation of sacral nerve roots for bladder control: a study by computer modeling

    NARCIS (Netherlands)

    Rijkhoff, N. J.; Holsheimer, J.; Koldewijn, E. L.; Struijk, J. J.; van Kerrebroeck, P. E.; Debruyne, F. M.; Wijkstra, H.

    1994-01-01

    The aim of this study was to investigate theoretically the conditions for the activation of the detrusor muscle without activation of the urethral sphincter and afferent fibers, when stimulating the related sacral roots. Therefore, the sensitivity of excitation and blocking thresholds of nerve

  9. Dual-dermal-barrier fashion flaps for the treatment of sacral pressure sores.

    Science.gov (United States)

    Hsiao, Yen-Chang; Chuang, Shiow-Shuh

    2015-02-01

    The sacral region is one of the most vulnerable sites for the development of pressure sores. Even when surgical reconstruction is performed, there is a high chance of recurrence. Therefore, the concept of dual-dermal-barrier fashion flaps for sacral pressure sore reconstruction was proposed. From September 2007 to June 2010, nine patients with grade IV sacral pressures were enrolled. Four patients received bilateral myocutaneous V-Y flaps, four patients received bilateral fasciocutaneous V-Y flaps, and one patient received bilateral rotation-advanced flaps for sacral pressure reconstruction. The flaps were designed based on the perforators of the superior gluteal artery in one patient's reconstructive procedure. All flaps' designs were based on dual-dermal-barrier fashion. The mean follow-up time was 16 months (range = 12-25). No recurrence was noted. Only one patient had a complication of mild dehiscence at the middle suture line, occurring 2 weeks after the reconstructive surgery. The dual-dermal fashion flaps are easily duplicated and versatile. The study has shown minimal morbidity and a reasonable outcome.

  10. Surface localization of sacral foramina for neuromodulation of bladder function. An anatomical study.

    Science.gov (United States)

    Hasan, S T; Shanahan, D A; Pridie, A K; Neal, D E

    1996-01-01

    A method is described for percutaneous localization of the sacral foramina, for neuromodulation of bladder function. We carried out an anatomical study of 5 male and 5 female human cadaver pelves. Using the described surface markings, needles were placed percutaneously into all sacral foramina from nine different angles. Paths of needle entry were studied by subsequent dissection. We observed that although it was possible to enter any sacral foramen at a wide range of insertion angles, the incidence of nerve root/vascular penetration increased with increasing angle of needle entry. Also, the incidence of nerve root penetration was higher with the medial approach compared with lateral entry. The insertion of a needle into the S1 foramen was associated with a higher incidence of nerve root penetration and presents a potential for arterial haemorrhage. On the other hand the smaller S3 and S4 nerve roots were surrounded by venous plexuses, presenting a potential source of venous haemorrhage during procedures. Our study suggests a new method for identifying the surface markings of sacral foramina and it describes the paths of inserted needles into the respective foramina. In addition, it has highlighted some potential risk factors secondary to needle insertion.

  11. Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction.

    Science.gov (United States)

    Grünewald, Volker; Höfner, Klaus; Thon, Walter F.; Kuczyk, Markus A.; Jonas, Udo

    1999-01-01

    Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives.

  12. Neurological presentations, imaging, and associated anomalies in 50 patients with sacral agenesis.

    Science.gov (United States)

    Emami-Naeini, Parisa; Rahbar, Ziba; Nejat, Farideh; Kajbafzadeh, Abdolmohammad; El Khashab, Mostafa

    2010-10-01

    Sacral agenesis is an uncommon congenital disorder that involves multiple organs. We studied neurological manifestations of the disease, common associated disorders, and their relation with extent of bony malformation. We investigated neurological manifestations of 50 patients with sacral agenesis. Patients were evaluated for previous procedures, ambulation, limb abnormalities, vertebral alignment, recurrent urinary tract infection, urinary incontinence, dribbling, dimple, lower extremities weakness, myelomeningocele (MMC), and lipomyelomenangocele. Weakness of lower extremities was seen in 37 (74%) patients. Concurrent weakness of proximal and distal muscles of the lower limb was statistically associated with a type of bony aplasia (P = .001). However, paraplegia was seen in only 2 of 44 children over the age of 1, and the rest could walk. Myelodysplastic syndromes were seen in 21 patients. Sacral agenesis is diagnosed in children with concomitant MMC at younger ages and reveals more severe symptoms. Progression of neurological disorders was seen in 19 patients, in all of whom MRI showed tethering of the spinal cord. Urinary disorders including diurnal urinary incontinence (in 30 of 35 children over age 4) and recurrent urinary tract infections (in 37) were also common. Imperforate anus was seen in 11 patients. Twelve children over age 4 reported fecal incontinence, a problem that had statistically significant association with imperforate anus (P = .013). Different disorders can concurrently affect patients with sacral agenesis that may have profound impressions on patients and their families. Early diagnosis, thorough evaluation, and proper intervention are of utmost importance as they can prevent or lessen future complications.

  13. MR imaging of a malignant schwannoma and an osteoblastoma with fluid-fluid levels. Report of two new cases

    International Nuclear Information System (INIS)

    Vilanova, J.C.; Dolz, J.L.; Aldoma, J.; Capdevila, A.; Maestro de Leon, J.L.; Aparicio, A.

    1998-01-01

    One case of malignant schwannoma of the sacrum and another of occipital osteoblastoma were evaluated by MR imaging. Both tumors showed fluid-fluid levels with different signal intensities in the sequences performed. Pathologic examination revealed hemmorhagic fluid in both tumors. Malignant schwannoma and osteoblastoma should be included in the list of bone and soft-tissue with fluid-fluid levels. Our data confirm the non-specificity of this finding, which only suggests the presence of previous intratumoral hemorrhage. (orig.) (orig.)

  14. Indications of Gamma knife radiosurgery for vestibular schwannomas

    International Nuclear Information System (INIS)

    Fukuoka, Seiji; Takanashi, Masami; Hojyo, Atsufumi; Tanaka, Chiharu; Konishi, Masanori; Nakamura, Hirohiko

    2007-01-01

    The purpose of this study was to investigate the indication of gamma knife radiosurgery for vestibular schwannomas by analyzing tumor control and possible complications using low marginal doses and conformal multiple shots to fit irregular tumor shapes. The authors evaluated 223 patients with followed-up periods ranging from 5 years to 15 years (mean 7.7 years, median 7.4 years). Marginal doses were 9 to 15 Gy (mean 12.5 Gy, median 12 Gy) with corresponding treatment volumes being between 0.1 and 18.7 cm 3 (mean 2.6 cm 3 , median 1.8 cm 3 ). The number of isocenters varied from 2 to 24 shots (mean 9, median 9.2). The actuarial tumor control rates were 95% at 5 years and 94% at 7 years, respectively. Larger tumors (p=0.0068) and those in younger patients (p=0.093) tended to recur significantly. The preservation rates of useful hearing were 84%, 71%, and 64% at 2, 4, and 7 years, respectively. The most deterioration seemed to occur in cases with elderly patients (p=0.0048). Facial and trigeminal functions were preserved at 100%, and 97.8%, respectively. Amongst all patients, 20.6% developed transient dizziness, with persistent dizziness remaining in 1.5% of the total. Fifty-six other patients not in the long-term evaluation consecutively underwent caloric testing and static stabilometry as well as neurological examinations to evaluate vestibular function in detail, both before and after gamma knife radiosurgery (GKRS). The results showed that 90% of the patients had already developed vestibular dysfunction before the treatment despite reported symptoms of dizziness. GKRS did not significantly affect vestibular function. Hydrocephalus was recognized in 5.5% of all patients, and seemed to occur primarily in cases with larger tumors (p=0.0189). GKRS provides a safe and effective therapy for small to medium sized tumors up to 8 cm 3 . Long-term hearing preservation rate may be affected by presbycusis in elderly patients. (author)

  15. Predictors of Preoperative Tinnitus in Unilateral Sporadic Vestibular Schwannoma

    Directory of Open Access Journals (Sweden)

    Georgios Naros

    2017-08-01

    Full Text Available ObjectiveNearly two-thirds of patients with vestibular schwannoma (VS are reporting a significantly impaired quality of life due to tinnitus. VS-associated tinnitus is attributed to an anatomical and physiological damage of the hearing nerve by displacing growth of the tumor. In contrast, the current pathophysiological concept of non-VS tinnitus hypothesizes a maladaptive neuroplasticity of the central nervous system to a (hidden hearing impairment resulting in a subjective misperception. However, it is unclear whether this concept fits to VS-associated tinnitus. This study aims to determine the clinical predictors of VS-associated tinnitus to ascertain the compatibility of both pathophysiological concepts.MethodsThis retrospective study includes a group of 478 neurosurgical patients with unilateral sporadic VS evaluated preoperatively regarding the occurrence of ipsilateral tinnitus depending on different clinical factors, i.e., age, gender, tumor side, tumor size (T1–T4 according to the Hannover classification, and hearing impairment (Gardner–Robertson classification, GR1–5, using a binary logistic regression.Results61.8% of patients complain about a preoperative tinnitus. The binary logistic regression analysis identified male gender [OR 1.90 (1.25–2.75; p = 0.002] and hearing impairment GR3 [OR 1.90 (1.08–3.35; p = 0.026] and GR4 [OR 8.21 (2.29–29.50; p = 0.001] as positive predictors. In contrast, patients with large T4 tumors [OR 0.33 (0.13–0.86; p = 0.024] and complete hearing loss GR5 [OR 0.36 (0.15–0.84; p = 0.017] were less likely to develop a tinnitus. Yet, 60% of the patients with good clinical hearing (GR1 and 25% of patients with complete hearing loss (GR5 suffered from tinnitus.ConclusionThese data are good accordance with literature about non-VS tinnitus indicating hearing impairment as main risk factor. In contrast, complete hearing loss appears a negative predictor for tinnitus. For the first

  16. Are stage IV vestibular schwannomas preoperatively different from other stages?

    Science.gov (United States)

    Tringali, Stéphane; Dubreuil, Christian; Zaouche, Sandra; Ferber-Viart, Chantal

    2008-01-01

    The aim of this study was to focus on the clinical and paraclinical symptoms of patients suffering from Stage IV vestibular schwannomas (VSs). In this prospective study, we included 734 patients who have VS and candidates for operation. Patients were classified as having Stage I, II, III, or IV tumors according to Tos criteria as evaluated by magnetic resonance imaging. PREOPERATIVE CLINICAL EVALUATION: We recorded the occurrence of complaints (%) and duration (yr) of hearing loss, tinnitus, and balance disorder. Preoperative paraclinical evaluation included pure-tone (PTA) and speech audiometry, auditory brainstem response (ABR) patterns, and vestibular deficit at videonystamography (VNG). Continuous variables were compared between Stage IV and other stages using analysis of variance. Qualitative variables expressed as a percentage of presence were compared between Stage IV and other stages using percentage comparison. Quantitative Parameters. Patients with Stage IV VS were significantly younger as compared with patients with other stages. Stage IV hearing loss was greater compared with other stages at 250 and 500 Hz but smaller at 2,000 and 8,000 Hz. We found no difference in the loss of PTA between Stage IV and the other stages. Speech discriminancy score was smaller in Stage IV. The durations of hearing loss, tinnitus, and balance disorders were similar whatever the tumor stage. Auditory brainstem response patterns showed no difference in Wave III latency between Stage IV VS and other stages, whereas Wave V latency and V-I interval were higher in Stage IV. Both ABR threshold and VNG caloric deficit were higher in Stage IV VS compared with other stages. Qualitative Parameters. The percentage of patients with Stage IV was lower than that with Stages II and III. The percentage of men and women was similar in all stages. The occurrence of hearing loss was similar in all stages, whereas that of tinnitus was lower in Stage IV compared with Stages I and II. In

  17. Postoperative Issues of Sacral Nerve Stimulation for Fecal Incontinence and Constipation: A Systematic Literature Review and Treatment Guideline

    DEFF Research Database (Denmark)

    Maeda, Yasuko; Matzel, Klaus; Lundby, Lilli

    2011-01-01

    BACKGROUND: There is a lack of knowledge on the incidence and management of suboptimal therapeutic effect and the complications associated with sacral nerve stimulation for fecal incontinence and constipation. OBJECTIVE: This study aimed to review current literature on postoperative issues...... and to propose a treatment algorithm. DATA SOURCE: PubMed, MEDLINE, and EMBASE were searched using the keywords “sacral nerve stimulation,” “sacral neuromodulation,” “fecal incontinence,” and “constipation” for English-language articles published from January 1980 to August 2010. A further search was conducted...

  18. Giant nuclear resonances

    International Nuclear Information System (INIS)

    Snover, K.A.

    1989-01-01

    Giant nuclear resonances are elementary mods of oscillation of the whole nucleus, closely related to the normal modes of oscillation of coupled mechanical systems. They occur systematically in most if not all nuclei, with oscillation energies typically in the range 10-30 MeV. One of the best - known examples is the giant electric dipole (El) resonance, in which all the protons and all the neutrons oscillate with opposite phase, producing a large time - varying electric dipole moment which acts as an effective antenna for radiating gamma ray. This paper discusses this mode as well as quadrupole and monopole modes

  19. Change in hearing during 'wait and scan' management of patients with vestibular schwannoma

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Caye-Thomasen, P.; Tos, M.

    2008-01-01

    : At the time of diagnosis, 334 patients (53 per cent) had good hearing and speech discrimination of better than 70 per cent; at the end of the 10-year observation period, this latter percentage was 31 per cent. In 17 per cent of the patients, speech discrimination at diagnosis was 100 per cent; of these, 88......Aim: To evaluate hearing changes during 'wait and scan' management of patients with vestibular schwannoma. Subjects: Over a 10-year period, 636 patients have prospectively been allocated to 'wait and scan' management, with annual magnetic resonance scanning and audiological examination. Results...... surgery and of radiation therapy with those of 'wait and scan' management, it appears that, in vestibular schwannoma patients with a small tumour and normal speech discrimination, the main indication for active treatment should be established tumour growth Udgivelsesdato: 2008/7...

  20. Use of Ir192 interstitial brachytherapy for an equine malignant dermal schwannoma : clinical communication

    Directory of Open Access Journals (Sweden)

    M.N. Saulez

    2009-05-01

    Full Text Available A 10-year-old Hanoverian mare was evaluated for a right buccal swelling that recurred 3 months following surgical resection. Ultrasonographic examination showed a broadly pedunculated subcutaneous mass at the level of 106-109 and 406-409 cheek teeth associated with an erosive mucosal lesion on the inside of the cheek. Histological examination of a biopsy specimen revealed a well-demarcated, malignant, dermal schwannoma. Following subcutaneous placement of platinum coated Ir192 wires under general anaesthesia, low-dose radiation of 5 gray per day was delivered for 14 days. Short-term complications included loss of patency of the right nasolacrimal duct, erythema, dermatitis, leukotrichia and left-sided deviation of the muzzle. Ten months later, there has been no tumour recurrence. Findings suggest that the use of interstitial brachytherapy should be considered for a malignant, dermal schwannoma that has recurred or is not amenable to surgery.

  1. Large Dumbbell-Shaped C1 Schwannoma Presenting as a Foramen Magnum Mass

    Science.gov (United States)

    Helms, Jody; Michael, Lattimore Madison

    2012-01-01

    Schwannomas involving the foramen magnum commonly originate from the lower cranial nerves, but they are rarely found arising from the first cervical root. To date, very few cases have been described in the literature. The majority involve either the intradural or extradural compartment but not both. We report the second case of a dumbbell-shaped schwannoma arising from the first cervical root. Our patient presented with hemisensory deficits secondary to brainstem compression at the level of the foramen magnum. The patient underwent a far lateral approach, and a gross total resection was achieved. Preoperative suspicion of the diagnosis is helpful in anticipating displacement and avoiding damage to the surrounding neurovascular structures. PMID:23946923

  2. Diagnosis and treatment of trigeminal schwannomas extending into both the middle and posterior cranial fossa

    Institute of Scientific and Technical Information of China (English)

    徐启武; 车晓明; 胡杰; 杨伯捷

    2004-01-01

    @@ Trigeminal schwannomas (TSs) account for 0.1%-0.4% of all intracranial tumors and 1%-8% of intracranial schwannomas.1,2 Yoshida and Kawase3 classified TSs into 6 types according to their locations: M (TS involving the middle cranial fossa), P (TS involving the posterior cranial fossa), E (TS located at extracranial space), MP (TS involving both the middle and the posterior cranial fossa), ME (TS involving the middle cranial fossa and the extracranial space), and MPE (TS involving the the middle and the posterior cranial fossa and the extracranial space). Of these types, MP is the commonest, but is difficult to be totally removed. Between January 1984 and June 2003, we surgically treated 28 patients with TSs of type MP and obtained satisfactory results. To make a correct diagnosis of TS, to select appropriate surgical approach, and to improve surgical outcome of TS of type MP, we analysed the related clinical data and experiences.

  3. Evaluation of Partial Cut-out of Sacroiliac Screws From the Sacral Ala Slope via Pelvic Inlet and Outlet View.

    Science.gov (United States)

    Zhang, Jingwei; Hamilton, Ryan; Li, Ming; Ebraheim, Nabil A; He, Xianfeng; Liu, Jiayong; Zhu, Limei

    2015-12-01

    An anatomic and radiographic study of placement of sacroiliac screws. The aim of this study was to quantitatively assess the risk of partial cut-out of sacroiliac screws from the sacral ala slope via inlet and outlet view. The partial cut-out of sacroiliac screws from the superior surface of sacral ala can jeopardize the L5 nerve root, which is difficult to identify on the pelvic inlet and outlet views. Computed tomography images of 60 patients without pelvic ring deformity or injury were used to measure the width (on inlet view) and height (on outlet view) of the sacral ala. The angle of the sacral ala slope was measured on lateral view. According to the measured parameters, the theoretical safe trajectories of screw placement were calculated using inverse trigonometric functions. Under fluoroscopic guidance, a sacroiliac screw was placed close to the midline on both inlet and outlet views, including posterosuperior, posteroinferior, anterosuperior, and anteroinferior regions to the midline. The incidence of screw partial cut-out from the superior surface of sacral ala was identified. The measured widths and heights of the sacral alas were 28.1 ± 2.8 and 29.8 ± 3.1 mm, respectively. The average angle between the superior aspect of the S1 vertebral body and the superior aspect of the sacral ala was 37.2 ± 2.5 degrees. The rate of partial cut-out of the screws from the superior surface of sacral ala slope was 12.5% (5/40) in posterosuperior, 0% (0/40) in posteroinferior, 70% (28/40) in anterosuperior, and 20% (8/40) in anteroinferior. To avoid the risk of partial cut-out from sacroiliac screw placement, more precise description should be added to the conventional description: the sacroiliac screws should be placed at the inferior half portion on outlet view and at the posterior half portion on inlet view. 4.

  4. Giant Congenital Melanocytic Nevus

    DEFF Research Database (Denmark)

    Rasmussen, Bo Sonnich; Henriksen, Trine Foged; Kølle, Stig-Frederik Trojahn

    2015-01-01

    Giant congenital melanocytic nevi (GCMN) occur in 1:20,000 livebirths and are associated with increased risk of malignant transformation. The treatment of GCMN from 1981 to 2010 in a tertiary referral center was reviewed evaluating the modalities used, cosmetic results, associated complications...

  5. Waking the Sleeping Giant

    NARCIS (Netherlands)

    Ollenburger, Mary H.; Descheemaeker, Katrien; Crane, Todd A.; Sanogo, Ousmane M.; Giller, Ken E.

    2016-01-01

    The World Bank argued that West Africa's Guinea Savannah zone forms part of “Africa's Sleeping Giant,” where increases in agricultural production could be an engine of economic growth, through expansion of cultivated land in sparsely populated areas. The district of Bougouni, in southern Mali,

  6. Isotopic effect giant resonances

    International Nuclear Information System (INIS)

    Buenerd, M.; Lebrun, D.; Martin, P.; Perrin, G.; Saintignon, P. de; Chauvin, J.; Duhamel, G.

    1981-10-01

    The systematics of the excitation energy of the giant dipole, monopole, and quadrupole resonances are shown to exhibit an isotopic effect. For a given element, the excitation energy of the transition decreases faster with the increasing neutron number than the empirical laws fitting the overall data. This effect is discussed in terms of the available models

  7. from the Giant Panda

    African Journals Online (AJOL)

    STORAGESEVER

    2009-06-03

    Jun 3, 2009 ... 1College of Life Science, China West Normal University, 44# Yuying Road, 637002, Nanchong, China. 2Zhan Jiang educational ... in Escherichia coli and the RPS28 protein fusioned with the N-terminally GST -tagged protein gave rise ... long Conservation Center of the Giant Panda, Sichuan, China. The.

  8. Giant scrotal elephantiasis.

    Science.gov (United States)

    Kuepper, Daniel

    2005-02-01

    How much can a man carry? Penoscrotal elephantiasis is a debilitating syndrome. This is a case report of a patient with giant genital elephantiasis secondary to long-standing lymphogranuloma venereum infection in Ethiopia. Complete surgical resection of the pathologic tissue and penile reconstruction was undertaken with good cosmetic and functional results.

  9. Giant vesical calculus

    African Journals Online (AJOL)

    Giant vesical calculus. A case report. H. H. LAUBSCHER. Summary. An exceptional case of bladder stone is presented. The case is unusual as regards the size of the stone and the fact that the patient did··not seek medical assistance much earlier, as this was readily avail- able. Furthermore, recovery after removal of the.

  10. Juvenile giant fibroadenoma

    Directory of Open Access Journals (Sweden)

    Vipul Yagnik

    2011-07-01

    Full Text Available Fibroadenomas are benign solid tumor associated with aberration of normal lobular development. Juvenile giant fibroadenoma is usually single and >5 cm in size /or >500 gms in weight. Important differential diagnoses are: phyllodes tumor and juvenile gigantomastia. Simple excision is the treatment of choice.

  11. Giant abdominal cystic lymphangioma

    International Nuclear Information System (INIS)

    Vazquez, V.; Florencio, I.; Boluda, F.

    1996-01-01

    We present a case of giant abdominal cystic lymphangioma in a 10-year-old boy. Despite numerous consultations with physicians to identify the underlying problem, it had originally been attributed to ascites of unknown cause. We review the characteristics of this lesion and the diagnostic features that aid in differentiating it from ascites

  12. Giant peritoneal loose bodies

    African Journals Online (AJOL)

    2015-03-27

    Mar 27, 2015 ... not be familiar with the entity, can potentially be confused with malignant or parasitic lesions. Familiarity with their characteristic computed tomographic ... preventing unnecessary surgical intervention in an asymptomatic patient.3,4 It is important to differentiate giant peritoneal loose bodies from lesions such ...

  13. Intracranial schwannomas arising from cranial nerves: Case series and review of literature

    Directory of Open Access Journals (Sweden)

    Rashmeet Kaur

    2017-01-01

    Full Text Available Tumors arising from the cranial nerve sheath are common intracranial neoplasms, with only few articles describing their imaging characteristics. In this present study of four cases of schwannomas originating from the cranial nerves in the head region, we are discussing the radiological features on imaging with the clinical presentation and contrasting them with other differentials in their respective locations. Magnetic resonance imaging and computed tomography were done in these cases and correlated with clinical and biopsy findings.

  14. Benign Ancient Schwannoma of the abdominal wall: An unwanted birthday present

    Directory of Open Access Journals (Sweden)

    Ram Manisha

    2010-01-01

    Full Text Available Abstract Background There has been a recent growth in the use of whole body Computerised Tomography (CT scans in the private sector as a screening test for asymptomatic disease. This is despite scant evidence to show any positive effect on morbidity or mortality. There has been concern raised over the possible harms of the test in terms of radiation exposure as well as the risk and anxiety of further investigation and treatment for the large numbers of benign lesions identified. Case Presentation A healthy 64 year old lady received a privately funded whole body CT scan for her birthday which revealed an incidental mass in the right iliac fossa. This was investigated with further imaging and colonoscopy and as confident diagnosis could not be made, eventually excised. Histology demonstrated this to be a benign ancient schwannoma and we believe this to be the first reported case of an abdominal wall schwannoma in the English literature Conclusions Ancient schwannomas are rare tumours of the peripheral nerve sheaths more usually found in the head, neck and flexor surfaces of extremities. They are a subtype of classical schwannomas with a predominance of degenerative changes. Our case highlights the pitfalls of such screening tests in demonstrating benign disease and subjecting patients to what turns out to be unnecessary invasive investigation and treatment. It provides evidence as to the consequences of the large number of false positive results that are created by blind CT scanning of asymptomatic patients i.e. its tendency to detect pseudodiesease rather than affect survival rates. Should the number of scans increase there may be an unnecessary burden on NHS resources due to the large numbers of benign lesions picked up, that are then referred for further investigation.

  15. Preoperative Identification of Facial Nerve in Vestibular Schwannomas Surgery Using Diffusion Tensor Tractography

    OpenAIRE

    Choi, Kyung-Sik; Kim, Min-Su; Kwon, Hyeok-Gyu; Jang, Sung-Ho; Kim, Oh-Lyong

    2014-01-01

    Objective Facial nerve palsy is a common complication of treatment for vestibular schwannoma (VS), so preserving facial nerve function is important. The preoperative visualization of the course of facial nerve in relation to VS could help prevent injury to the nerve during the surgery. In this study, we evaluate the accuracy of diffusion tensor tractography (DTT) for preoperative identification of facial nerve. Methods We prospectively collected data from 11 patients with VS, who underwent pr...

  16. Schwannoma of the 6th nerve: case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Xin Li; Jingjun Li; Jing Li; Zhen Wu

    2015-01-01

    Introduction: Schwannomas of the 6th nerve are extremely rare.Only 22 cases of intracranial schwannomas of the 6th cranial nerve pathologically confirmed have been reported.Case Presentation: Here, we report a case of a 14-year-old girl who presented with isolated progressive 6th nerve palsy.A cisternal type of schwannomawas found from neuro-imaging.Subtotal removal of the tumor was performed by a routine left subtemporal craniotomy with an petrosectomy.The attachment to the 6th nerve was found.After surgery, the patient's 6th nerve palsy remained.Histological images revealed a cellular schwannoma.Then the classification, clinical presentation, diagnosis, operation, stereotactic radiosurgery are reviewed.Conclusions: The location and the attachment to the 6th nerve is the key for diagnosis.Most cases are treated surgically.It looks like it is not easy to completely remove for CA type because of invasion of the cavernous sinus or firm adherence to the nerves.The 6th nerve function seldom completely recovered postoperatively.The direction of further research is to improve the diagnosis and therapy to have better nerve recovery.

  17. Schwannoma of the descending loop of the hypoglossal nerve: Case report.

    Science.gov (United States)

    Illuminati, Giulio; Pizzardi, Giulia; Pasqua, Rocco; Palumbo, Piergaspare; Vietri, Francesco

    2017-01-01

    Schwannomas of the descending loop of the hypoglossal nerve are very rare. They are slow-growing tumors that may masquerade a carotid body tumor. A 60-year-old female was referred for a latero-cervical mass appearing as a chemodectoma at CT-scan. At operation, a 2cm mass arising from the descending loop of the hypoglossal nerve was resected en bloc with the loop itself and a functional lymphadenectomy was associated. Post-operative course was uneventful and the patient is free from disease recurrence at one year follow-up. En bloc resection remains the real curative treatment of Schwannomas, ensuring unlimited freedom from disease, although causing functional impairment which may be significant. Nonetheless recurrence should be prevented as, beside requiring reintervention, it may harbor a malignant evolution towards sarcoma. Schwannomas of the descending lop of the hypoglossal nerve may masquerade a chemodectoma of the carotid bifurcation and can be curatively resected without any functional impairment. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  18. Melanotic Schwannomas Are Rarely Seen Pigmented Tumors with Unpredictable Prognosis and Challenging Diagnosis.

    Science.gov (United States)

    Keskin, Elif; Ekmekci, Sumeyye; Oztekin, Ozgur; Diniz, Gulden

    2017-01-01

    Melanotic Schwannoma (MS) is rarely seen and potentially malignant neoplasm that is categorized as a variant of Schwannoma. MS most frequently involves intracranial structures followed by posterior nerve roots in the spinal canal. Approximately 50% of the cases with MS have psammomatous calcifications and this type of MS is related to Carney complex with autosomal dominant inheritance. Most cases of MS are benign, though 10% of them are malignant with metastatic potential. MS mimics melanoma and the differential diagnosis should be made excluding other melanin producing neoplasms especially melanoma. Case 1 . A 42-year-old hypertensive male presented for checkup. He had a well-defined extraspinal oval lesion measuring 3.5 × 2.5 cm near right adrenal. Case 2 . A 22-year-old female presented with neurofibromatosis-2, bilateral acoustic schwannomas and café au lait lesions on sacrococcygeal region. She had an intradural extramedullary lesion measuring 6.1 × 2.0 cm at L1-2 level. MS is a rare neoplasm composed of Schwann cells and melanin pigment. These tumors are usually benign but they may become aggressive. The biologic behavior of MS is difficult to predict; the patients have to be followed up for a longer period due to its malignant potential.

  19. Communicating Hydrocephalus Associated with Intracranial Schwannoma Treated by Gamma Knife Radiosurgery.

    Science.gov (United States)

    Park, Chang Kyu; Lee, Sung Ho; Choi, Man Kyu; Choi, Seok Keun; Park, Bong Jin; Lim, Young Jin

    2016-05-01

    Gamma knife radiosurgery (GKRS) has been established as an effective and safe treatment for intracranial schwannoma. However, serious complications can occur after GKRS, including hydrocephalus. The pathophysiology and risk factors of this disorder are not yet fully understood. The objective of the study was to assess potential risk factors for hydrocephalus after GKRS. We retrospectively reviewed the medical radiosurgical records of 244 patients who underwent GKRS to treat intracranial schwannoma. The following parameters were analyzed as potential risk factors for hydrocephalus after GKRS: age, sex, target volume, irradiation dose, prior tumor resection, treatment technique, and tumor enhancement pattern. The tumor enhancement pattern was divided into 2 groups: group A (homogeneous enhancement) and group B (heterogeneous or rim enhancement). Of the 244 patients, 14 of them (5.7%) developed communicating hydrocephalus. Communicating hydrocephalus occurred within 2 years after GKRS in most patients (92.8%). No significant association was observed between any of the parameters investigated and the development of hydrocephalus, with the exception of tumor enhancement pattern. Group B exhibited a statistically significant difference by univariate analysis (P = 0.002); this difference was also significant by multivariate analysis (P = 0.006). Because hydrocephalus is curable, patients should be closely monitored for the development of this disorder after GKRS. In particular, patients with intracranial schwannomas with irregular enhancement patterns or cysts should be meticulously observed. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Dose verification to cochlea during gamma knife radiosurgery of acoustic schwannoma using MOSFET dosimeter.

    Science.gov (United States)

    Sharma, Sunil D; Kumar, Rajesh; Akhilesh, Philomina; Pendse, Anil M; Deshpande, Sudesh; Misra, Basant K

    2012-01-01

    Dose verification to cochlea using metal oxide semiconductor field effect transistor (MOSFET) dosimeter using a specially designed multi slice head and neck phantom during the treatment of acoustic schwannoma by Gamma Knife radiosurgery unit. A multi slice polystyrene head phantom was designed and fabricated for measurement of dose to cochlea during the treatment of the acoustic schwannoma. The phantom has provision to position the MOSFET dosimeters at the desired location precisely. MOSFET dosimeters of 0.2 mm x 0.2 mm x 0.5 μm were used to measure the dose to the cochlea. CT scans of the phantom with MOSFETs in situ were taken along with Leksell frame. The treatment plans of five patients treated earlier for acoustic schwannoma were transferred to the phantom. Dose and coordinates of maximum dose point inside the cochlea were derived. The phantom along with the MOSFET dosimeters was irradiated to deliver the planned treatment and dose received by cochlea were measured. The treatment planning system (TPS) estimated and measured dose to the cochlea were in the range of 7.4 - 8.4 Gy and 7.1 - 8 Gy, respectively. The maximum variation between TPS calculated and measured dose to cochlea was 5%. The measured dose values were found in good agreement with the dose values calculated using the TPS. The MOSFET dosimeter can be a suitable choice for routine dose verification in the Gamma Knife radiosurgery.

  1. Detection of Spontaneous Schwannomas by MRI in a Transgenic Murine Model of Neurofibromatosis Type 2

    Directory of Open Access Journals (Sweden)

    S.M. Messerli

    2002-01-01

    Full Text Available Spontaneous schwannomas were detected by magnetic resonance imaging (MRI in a transgenic murine model of neurofibromatosis type 2 (NF2 expressing a dominant mutant form of merlin under the Schwann cell-specific PO promoter. Approximately 85% of the investigated mice showed putative tumors by 24 months of age. Specifically, 21% of the mice showed tumors in the intercostal muscles, 14% in the limb muscles, 7% in the spinal cord and spinal ganglia, 7% in the external ear, 14% in the muscle of the abdominal region, and 7% in the intestine; 66% of the female mice had uterine tumors. Multiple tumors were detected by MRI in 21% of mice. The tumors were isointense with muscle by T1-weighted MRI, showed strong enhancement following administration of gadolinium-DTPA, and were markedly hyperintense by T2-weighted MRI, all hallmarks of the clinical manifestation. Hematoxylin and eosin staining and immunohistochemistry indicated that the tumors consisted of schwannomas and Schwann cell hyperplasias. The lesions stained positively for S-100 protein and a marker antigen for the mutated transgenic NF2 protein, confirming that the imaged tumors and areas of hyperplasia were of Schwann cell origin and expressed the mutated NF2 protein. Tumors were highly infectable with a recombinant herpes simplex virus type 1 vector, hrR3, which contains the reporter gene, lacZ. The ability to develop schwannoma growth with a noninvasive imaging technique will allow assessment of therapeutic interventions.

  2. Collision tumor of the facial nerve: a synchronous seventh nerve schwannoma and neurofibroma.

    Science.gov (United States)

    Gross, Brian C; Carlson, Matthew L; Driscoll, Colin L; Moore, Eric J

    2012-10-01

    To report a novel case of a collision tumor involving an intraparotid neurofibroma and a mastoid segment facial nerve schwannoma. Clinical capsule report. Tertiary academic referral center. A 29-year-old woman with a 2-year history of an asymptomatic enlarging left infraauricular mass and normal FN function presented to a tertiary care referral center. Computed tomography and magnetic resonance imaging demonstrated a cystic lesion in the deep portion of the parotid gland extending into the stylomastoid foramen. The patient underwent superficial parotidectomy, and a cystic parotid mass was found to be intrinsic to the intraparotid facial nerve. A portion of the mass was biopsied, and intraoperative frozen section pathology was consistent with a neurofibroma. A mastoidectomy with FN decompression was then performed until a normal-appearing segment was identified just proximal to the second genu. After biopsy, proximal facial nerve stimulation failed to elicit evoked motor potentials, and en bloc resection was performed. Final pathology demonstrated a schwannoma involving the mastoid segment and a neurofibroma involving the proximal intraparotid facial nerve. We report the first case of a facial nerve collision tumor involving an intraparotid neurofibroma and a mastoid segment facial nerve schwannoma. Benign FN sheath tumors of the parotid gland are rare but should be considered in the differential diagnosis of a parotid mass.

  3. Imaging Findings of Pelvic Tumor Thrombosis Extending from Sacral Bone Metastasis of Adrenocortical Carcinoma

    Directory of Open Access Journals (Sweden)

    Kenichiro Ishida

    2012-01-01

    Full Text Available We report the imaging findings of a patient with adrenocortical carcinoma who showed pelvic tumor thrombosis extending from sacral bone metastasis. Contrast-enhanced computed tomography demonstrated extensive intraluminal filling defects in the pelvic veins. A lytic lesion in the sacrum was also noted and continuity between the sacral lesion and the filling defect in the branch of pelvic veins was indicated. The filling defects showed increased uptake on positron emission tomography with 18F-fluorodeoxyglucose and single-photon emission computed tomography with 131I-iodomethylnorcholesterol, and fusion images with computed tomography aided the localization of the increased uptake areas. Multimodality imaging may be beneficial for the characterization and localization of lesions in patients suspected of having metastatic adrenocortical carcinoma.

  4. Rare location of spondylitis tuberculosis;atlanto-axial, sacral and cervico-thoracic junction

    Science.gov (United States)

    Victorio; Nasution, M. D.; Ibrahim, S.; Dharmajaya, R.

    2018-03-01

    Three cases of rare location spondylitis tuberculosis are reported, each in atlantoaxial, cervico-thoracic junction,and sacral. The complaints were aweakness of motoric strength and local back pain. Patients’thoracal x-ray was normal, there was no complaint of acough, PCR forTB was early diagnostic and positive in all three cases, HIV negative, intraoperative tissue samplings were sent for histopathology examination and the results showed thespecific inflammatory process. Lesions were evaluated with computer tomography and/or MRI imaging.Preoperative TB regimens therapy were given for 2 weeks and continued for nine months. The surgical procedurewas done in all cases with excellent improvement of symptoms and motoric strength. In our institution,25 cases of total TB spondylitis were performed in 2 years, only 1 case eachwas found in atlanto-axial, cervico-thoracic and sacral.

  5. Sacral myeloradiculitis complicating genital herpes in a HIV-infected patient.

    Science.gov (United States)

    Corral, I; Quereda, C; Navas, E; Pérez-Elias, M J; Jover, F; Moreno, S

    2005-02-01

    Myeloradiculitis is a rare neurological complication of herpes simplex type 2 (HSV-2) infection, frequently associated with a fatal outcome. Among patients with HIV infection, HSV-2 myeloradiculitis has occasionally been reported, always associated with advanced immunosuppression and AIDS. We report a patient with HIV infection but no history of previous opportunistic infections, who developed sacral myeloradiculitis immediately after an episode of genital herpes. Magnetic resonance imaging with gadolinium showed necrotizing myelitis in the conus medullaris and enhancement of sacral roots. CD4 lymphocyte count was 530/mm3. Other possible causes of myeloradiculitis in HIV-infected patients were appropriately excluded. Acyclovir therapy resulted in partial clinical improvement. This report shows that myeloradiculitis as a complication of genital herpes may occur in the early stages of HIV infection and may have a favourable outcome with antiviral treatment.

  6. Descrição do esqueleto axial de Liolaemus arambarensis Verrastro, Veronese, Bujes & Dias Filho (Iguania, Liolaemidae: regiões pré-sacral e sacral Description of the axial skeleton of Liolaemus arambarensis Verrastro et al. (Iguania, Liolaemidae: pre-sacral and sacral regions

    Directory of Open Access Journals (Sweden)

    Caroline M. da Silva

    2007-03-01

    Full Text Available Liolaemus arambarensis Verrastro, Veronese, Bujes & Dias Filho, 2003 (Iguania, Liolaemidae é um pequeno lagarto de areia, que vive nos ambientes de restingas da Laguna dos Patos. A descrição do esqueleto desta espécie pode elucidar algumas relações filogenéticas em relação a outras espécies do gênero. Tendo por objetivo a descrição das regiões pré-sacral e sacral do esqueleto axial de L. arambarensis, foram analisados sete exemplares da espécie. Observou-se que a maior estrutura axial é a coluna vertebral, que é dividida nas regiões: cervical, dorsal, sacral e caudal. A região cervical possui oito vértebras, e as costelas aparecem a partir da quarta vértebra. A região dorsal é dividida em: torácica, com cinco vértebras portando costelas unidas ao esterno; e pós-torácica, com 11 vértebras portando costelas livres. Segue-se a região sacral com duas vértebras fusionadas, que portam processos transversos fortemente expandidos lateralmente. O esterno de L. arambarensis constitui-se de uma placa cartilaginosa calcificada que se comunica com a região torácica da coluna vertebral e com a cintura escapular. Em vista do descrito anteriormente, pode-se dizer que L. arambarensis apresenta os padrões de esqueleto axial descritos para espécies de sua família e gênero.Liolaemus arambarensis Verrastro, Veronese, Bujes & Dias Filho, 2003 (Iguania: Liolaemidae is a small sand lizard that inhabits restingas in the Patos Lagoon, Southern Brazil. The description of the skeleton in this species could give some insights about the phylogenetic relationships with other species of the genus. With the main goal of describing the pre-sacral and sacral regions of the axial skeleton of L. arambarensis, a total of seven individuals were analyzed. It was observed that the largest axial structure is the vertebral column that is divided into four regions: cervical, dorsal, sacral and caudal. The cervical region presents eight vertebra and the

  7. Evidence to justify retention of transvaginal mesh: comparison between laparoscopic sacral colpopexy and transvaginal Elevate™ mesh.

    Science.gov (United States)

    To, Valérie; Hengrasmee, Pattaya; Lam, Alan; Luscombe, Georgina; Lawless, Anna; Lam, Justin

    2017-12-01

    To determine if laparoscopic sacral colpopexy (LSC) offers better apical support with a lower exposure rate than transvaginal mesh surgery with Elevate™. This was a retrospective cohort study comparing patients with apical prolapse (POP-Q point C ≥ -1) who underwent Elevate™ mesh repair (n = 146) with patients who underwent laparoscopic sacral colpopexy (n = 267). The sacral colpopexy group had a mean age of 59 years and a BMI of 25.7. Patients in the Elevate™ group were older, with a mean age of 63 and a BMI of 26.3. Most of the patients of both groups presented with pelvic organ prolapse stage III (LSC 73.8% and Elevate™ 87.0%) and their mean POP-Q point C were not significantly different (LSC 1.4 vs Elevate™ 1.2 cm). Operative time was longer in the LSC group (113 vs 91 min, p < 0.001), but estimated blood loss was lower (75 cm 3 vs 137 cm 3 , p < 0.001). No difference in mesh exposure rate could be found between the two groups at one year (Elevate™ 0.7% vs LSC 2.6%, OR 0.26, 95% CI 0.03 to 2.10, p = 0.21). One-year objective cure rate, defined as no descent beyond the hymen, was 97.0% in the LSC group and 96.6% in the Elevate™ group (p = .81). The overall recurrence (objective, subjective recurrence or reoperation) was also not different between the groups (LSC 4.5% vs Elevate 4.8%, p = 0.89). Transvaginal Elevate™ mesh delivers comparable apical support with a low exposure rate similar to that of laparoscopic sacral colpopexy.

  8. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies.

    Science.gov (United States)

    König, M A; Jehan, S; Boszczyk, A A; Boszczyk, B M

    2012-05-01

    U-shaped sacral fractures usually result from axial loading of the spine with simultaneous sacral pivoting due to a horizontal fracture which leads to a highly unstable spino-pelvic dissociation. Due to the rarity of these fractures, there is lack of an agreed treatment strategy. A thorough literature search was carried out to identify current treatment concepts. The studies were analysed for mechanism of injury, diagnostic imaging, associated injuries, type of surgery, follow-up times, complications, neurological, clinical and radiological outcome. Sixty-three cases were found in 12 articles. No Class I, II or III evidence was found in the literature. The most common mechanism of injury was a fall or jump from height. Pre-operative neurological deficit was noted in 50 (94.3%) out of 53 cases (not available in 10 patients). The most used surgical options were spino-pelvic fixation with or without decompression and ilio-sacral screws. Post-operative complications occurred in 24 (38.1%) patients. Average follow-up time was 18.6 months (range 2-34 months). Full neurological recovery was noted in 20 cases, partial recovery in 14 and 9 patients had no neurological recovery (5 patients were lost in follow-up). Fracture healing was mentioned in 7 articles with only 1 case of fracture reduction loss. From the current available data, an evidence based treatment strategy regarding outcome, neurological recovery or fracture healing could not be identified. Limited access and minimal-invasive surgery focussing on sacral reduction and restoration seems to offer comparable results to large spino-pelvic constructs with fewer complications and should be considered as the method of choice. If the fracture is highly unstable and displaced, spino-pelvic fixation might offer better stability.

  9. First experience using navigation-guided radiofrequency kyphoplasty for sacroplasty in sacral insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Klingler, J.H.; Kluge, P.; Sircar, R.; Kogias, E.; Scholz, C.; Krueger, M.T.; Scheiwe, C.; Hubbe, U. [Freiburg Univ. Medical Center, Freiburg (Germany). Dept. of Neurosurgery

    2013-08-15

    Purpose: To evaluate the efficacy and safety of navigation-guided radiofrequency kyphoplasty for sacroplasty in patients with sacral insufficiency fractures. Methods: In this single-center retrospective observational study, four consecutive patients with sacral insufficiency fractures were treated with navigation-guided radiofrequency kyphoplasty for sacroplasty between April 2010 and May 2012. Symptom characteristics, pain duration and pain intensity were recorded for each patient. Cement extravasation was evaluated in thin-sliced and triplanar reconstructed CT scans of the sacrum. Results: Four female patients with painful sacral insufficiency fractures and extensive osteopenic areas significantly improved from an average pre-treatment VAS score of 8.3 {+-} 0.5 to 2.3 {+-} 1.0 (p < 0.001) on the first postoperative day and to 1.3 {+-} 1.9 (p < 0.004) at follow-up (mean, 20.1 weeks). Slight cement extravasations were observed without evidence of being symptomatic. No major complications or procedure-related morbidity were noted. Conclusion: From the limited experience in four patients, navigation-guided radiofrequency kyphoplasty appears to be a safe and effective treatment option for sacral insufficiency fractures even though asymptomatic cement extravasation was noted. The use of navigation based on intraoperative 3 D images simplifies the positioning of the navigated bone needles via the long axis approach. The radiofrequency kyphoplasty system provides the possibility to administer a sufficient amount of bone cement with a well-defined viscosity over the entire period of the procedure leading to high security and low cement extravasation. Sacroplasty provides rapid and enduring pain relief and facilitates prompt mobilization. (orig.)

  10. Comparison of gluteal perforator flaps and gluteal fasciocutaneous rotation flaps for reconstruction of sacral pressure sores.

    Science.gov (United States)

    Chen, Yen-Chou; Huang, Eng-Yen; Lin, Pao-Yuan

    2014-03-01

    The gluteus maximus myocutaneous flap was considered the workhorse that reconstructed sacral pressure sores, but was gradually replaced by fasciocutaneous flap because of several disadvantages. With the advent of the perforator flap technique, gluteal perforator (GP) flap has gained popularity nowadays. The aim of this study was to compare the complications and outcomes between GP flaps and gluteal fasciocutaneous rotation (FR) flaps in the treatment of sacral pressure sores. Between April 2007 and June 2012, 63 patients underwent sacral pressure sore reconstructions, with a GP flap used in 31 cases and an FR flap used in 32 cases. Data collected on the patients included patient age, gender, co-morbidity for being bedridden and follow-up time. Surgical details collected included the defect size, operative time and estimated blood loss. Complications recorded included re-operation, dehiscence, flap necrosis, wound infection, sinus formation, donor-site morbidity and recurrence. The complications and clinical outcomes were compared between these two groups. We found that there was no significant difference in patient demographics, surgical complications and recurrence between these two groups. In gluteal FR flap group, all recurrent cases (five) were treated by reuse of previous flaps. Both methods are comparable, good and safe in treating sacral pressure sores. Gluteal FR flap can be performed without microsurgical dissection, and re-rotation is feasible in recurrent cases. The authors suggest using gluteal FR flaps in patients with a high risk of sore recurrence. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Does Sacral Nerve Stimulation Improve Continence Through Enhanced Sensitivity of the Anal Canal?

    DEFF Research Database (Denmark)

    Haas, S; Brock, C; Krogh, K

    2016-01-01

    . DESIGN: This is an explorative study. PATIENTS: Fifteen women with idiopathic fecal incontinence (mean age, 58 ± 12.2 years) were selected. INTERVENTIONS: Cortical evoked potentials were recorded during repeated rapid balloon distension of the rectum and the anal canal both before and during temporary...... the threshold for urge to defecate elicited from the anal canal, whereas supraspinal responses remained unaltered. This may suggest that sacral nerve stimulation, at least in part, acts via somatic afferent fibers enhancing anal sensation....

  12. National trends in the usage and success of sacral nerve test stimulation.

    Science.gov (United States)

    Cameron, Anne P; Anger, Jennifer T; Madison, Rodger; Saigal, Christopher S; Clemens, J Quentin

    2011-03-01

    Little is known about outcomes of sacral neuromodulation in the general community, with published reports to date limited to case series or randomized, controlled trials. The goal of this analysis was to identify the national sacral neuromodulation test phase success rate and patient factors that contribute to success. Medical claims data were obtained from a 5% sample of Medicare beneficiaries (1997 to 2007) and from employees of 25 large (Fortune 500) companies (Ingenix®, 2002 to 2007). Using billing codes for the sacral neuromodulation procedure, success was defined as progressing from test phase (percutaneous or staged) to battery implantation. The rate of success was compared based on age, race, gender and diagnosis. In the Medicare sample 358 patients received percutaneous test stimulation and 1,132 underwent 2-stage lead placement, of whom 45.8% and 35.4%, respectively, underwent subsequent battery implantation. In the privately insured sample there were 266 percutaneous procedures and 794, 2-stage procedures. Percutaneous procedures were followed by battery placement in 24.1% of cases, whereas 50.9% of staged procedures resulted in battery implantation. Gender was the only consistent predictor of success, with female patients demonstrating higher success rates in each data set. The sacral neuromodulation success rates in these data sets are inferior to those published in case series and small randomized, controlled trials. Women had significantly better results than men and privately insured individuals had better results than those with Medicare, indicating a potential age effect. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Effect of surgical approach on physical activity and pain control after sacral colpopexy.

    Science.gov (United States)

    Collins, Sarah A; Tulikangas, Paul K; O'Sullivan, David M

    2012-05-01

    We sought to compare recovery of activity and pain control after robotic (ROB) vs abdominal (ABD) sacral colpopexy. Women undergoing ROB and ABD sacral colpopexy wore accelerometers for 7 days preoperatively and the first 10 days postoperatively. They completed postoperative pain diaries and Short Form-36 questionnaires before and after surgery. At 5 days postoperatively, none of the 14 subjects in the ABD group and 4 of 28 (14.3%) in the ROB group achieved 50% total baseline activity counts (P = .283). At 10 days, 5 of 14 (35.7%) in the ABD group and 8 of 26 (30.8%) in the ROB group (P = .972) achieved 50%. Postoperative pain was similar in both groups. Short Form-36 vitality scores were lower (P = .017) after surgery in the ABD group, but not in the ROB group. Women undergoing ROB vs ABD sacral colpopexy do not recover physical activity faster, and pain control is not improved. Copyright © 2012 Mosby, Inc. All rights reserved.

  14. Foramen magnum schwannoma: review of the literature and report of a case; Schwannoma do forame magno: revisao e relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Nacif, Marcelo Souto; Caiado, Stella; Oliveira, Nidia di Paula Silva; Paula Neto, Walter Teixeira de [Fundacao Educacional Serra dos Orgaos, Teresopolis, RJ (Brazil). Centro de Ciencias Biomedicas. Faculdade de Medicina de Teresopolis]. E-mail: marcelonacif30@hotmail.com; Mello, Ricardo Andrade Fernandes de [Universidade Federal, Rio de Janeiro, RJ (brazil). Faculdade de Medicina. Dept. de Radiologia; Jauregui, Gustavo Federico [Hospital Geral de Bonsucesso, Rio de Janeiro, RJ (Brazil); Campos, Flavio do Amaral [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Servico de Radiologia; Santos, Alair Augusto Sarmet Moreira Damas dos [Instituto de Pos-graduacao Medica Carlos Chagas (IPGMCC), Niteroi, RJ (Brazil). Curso de Pos-graduacao em Radiologia

    2001-02-01

    The authors report an unusual presentation of a voluminous neck schwannoma in a 53-year-old female that presented with a three-year history of progressive weakness associated with impaired movement of the limbs. Neurological examination revealed postural instability, unstable and paraparetic gait, tetraparesis and dyspnea. A preoperative magnetic resonance imaging of the neck revealed an expansive, extradural, well-circumscribed lesion, with soft-tissue attenuation, at the level of C1-C2 vertebral bodies. During surgery, the tumor was found to be extradural, lateral to the cervical spinal cord, attached to the C1 left nerve root and extending upwards through the foramen magnum. Histopathological analysis of the resected specimen confirmed the diagnosis of schwannoma. The patient showed a favorable outcome with progressive improvement of the symptoms. Magnetic resonance imaging proved to be valuable in the detection and evaluation of the lesion, although the definite diagnosis was achieved only after histopathological studies. We concluded that magnetic resonance imaging for early diagnosis and prompt surgical resection seems to be the best approach to achieve good prognosis. (author)

  15. Malignant transformation in a hybrid schwannoma/perineurioma: Addition to the spectrum of a malignant peripheral nerve sheath tumor

    Directory of Open Access Journals (Sweden)

    Bharat Rekhi

    2011-01-01

    Full Text Available Benign nerve sheath tumors include schwannomas, neurofibromas and perineuriomas. The malignant counterpart of a nerve sheath tumor is designated as a malignant peripheral nerve sheath tumor (MPNST. Lately, benign nerve sheath tumors comprising more than one component have been described, including hybrid schwannomas/perineuriomas. However, malignant transformation in a hybrid schwannoma/perineurioma has not been documented so far. Herein, we present a rare case of a young adult male who presented with a soft tissue mass in his right thigh that was excised elsewhere and submitted to us for histopathological review. One of the tissue sections displayed histopathological features of a hybrid schwannoma/perineurioma, including alternate arrangement of benign schwann and perineurial cells, reinforced with S100-P and epithelial membrane antigen positivity, respectively, along with low MIB1 and negative p53 immunostaining. The other two tissue sections showed a spindly sarcomatous tumor that was immunohistochemically positive for S100-P, CD34, p53 and exhibited high MIB1 (30-40%. Diagnosis of a MPNST arising in a hybrid schwannoma/perineurioma was made. This unusual case forms yet another addition to the spectrum of a MPNST.

  16. Giant cystic craniopharyngiomas

    International Nuclear Information System (INIS)

    Young, S.C.; Zimmerman, R.A.; Nowell, M.A.; Bilaniuk, L.T.; Hackney, D.B.; Grossman, R.I.; Goldberg, H.I.

    1987-01-01

    Three cases of giant cystic craniopharyngiomas with large areas of extension beyond the suprasellar area are presented. The magnetic resonance (MR) appearance in one case is described. These giant tumors had large, multilobulated cysts that comprised the bulk of the tumors. In one case, there was an unusual extension of the large tumor cyst into the lateral ventricle. In two cases, the tumors extended to the level of the foramen magnum. On CT, the cyst contents of these two tumors were hyperdense and became hypodense postoperatively. All three tumors harbored calcifications in the form of clumps in the suprasellar region and rim calcifications around the cysts. None of the tumors exhibited contrast enhancement. A literature review of the radiographic features of craniopharyngiomas is discussed. (orig.)

  17. Giant duodenal ulcers

    Institute of Scientific and Technical Information of China (English)

    Eric Benjamin Newton; Mark R Versland; Thomas E Sepe

    2008-01-01

    Giant duodenal ulcers (GDUs) are a subset of duodenal ulcers that have historically resulted in greater morbidity than usual duodenal ulcers. Until recently,few cases had been successfully treated with medical therapy. However, the widespread use of endoscopy,the introduction of H-2 receptor blockers and proton pump inhibitors, and the improvement in surgical techniques all have revolutionized the diagnosis,treatment and outcome of this condition. Nevertheless,GDUs are still associated with high rates of morbidity,mortality and complications. Thus, surgical evaluation of a patient with a GDU should remain an integral part of patient care. These giant variants, while usually benign, can frequently harbor malignancy. A careful review of the literature highlights the important differences when comparing GDUs to classical peptic ulcers and why they must be thought of differently than their more common counterpart.

  18. Multispin giant magnons

    International Nuclear Information System (INIS)

    Bobev, N. P.; Rashkov, R. C.

    2006-01-01

    We investigate giant magnons from classical rotating strings in two different backgrounds. First we generalize the solution of Hofman and Maldacena and investigate new magnon excitations of a spin chain which are dual to a string on RxS 5 with two nonvanishing angular momenta. Allowing string dynamics along the third angle in the five sphere, we find a dispersion relation that reproduces the Hofman and Maldacena one and the one found by Dorey for the two spin case. In the second part of the paper we generalize the two 'spin' giant magnon to the case of β-deformed AdS 5 xS 5 background. We find agreement between the dispersion relation of the rotating string and the proposed dispersion relation of the magnon bound state on the spin chain

  19. Red giants seismology

    Science.gov (United States)

    Mosser, B.; Samadi, R.; Belkacem, K.

    2013-11-01

    The space-borne missions CoRoT and Kepler are indiscreet. With their asteroseismic programs, they tell us what is hidden deep inside the stars. Waves excited just below the stellar surface travel throughout the stellar interior and unveil many secrets: how old is the star, how big, how massive, how fast (or slow) its core is dancing. This paper intends to paparazze the red giants according to the seismic pictures we have from their interiors.

  20. Giant Otters in Peru

    OpenAIRE

    Schenk C.; Staib E.

    1992-01-01

    We are in the second year of fieldwork surveying for Giant Otters in the southeastern rainforest of Peru, in three areas with differing levels of legal protection. While there is some illegal hunting still happening outside the protected areas, the main threat to the otters is badly-conducted tourism. Well-organised tourism can be a promising argument for establishing protected areas like national parks.

  1. Intraoral giant condyloma acuminatum

    Directory of Open Access Journals (Sweden)

    Gupta R

    2001-09-01

    Full Text Available A case of intraoral giant condyloma acuminatum is reported in a 50- year- old Indian. He did not respond to topical application of podophyllin 20% but responded partially to electric cauterisation. Surgical excision was done to get rid of the warty growh completely. Since there were no skin or genital lesions and no history of marital or extramarital sexual contact the lesion was probably acquired from environmental sources. Nonsexual transmission should be considered especially when the lesions are extragenital.

  2. Specific Changes in Brain Activity During Urgency in Women with Overactive Bladder after Successful Sacral Neuromodulation: An fMRI Study.

    Science.gov (United States)

    Weissbart, Steven J; Bhavsar, Rupal; Rao, Hengyi; Wein, Alan J; Detre, John A; Arya, Lily A; Smith, Ariana L

    2018-04-06

    The mechanism of sacral neuromodulation is poorly understood. We compared brain activity during urgency before and after sacral neuromodulation in women with overactive bladder and according to response to treatment. Women with refractory overactive bladder who elected for sacral neuromodulation were invited to undergo a functional magnetic resonance imaging exam before and after treatment. During the imaging exams, the bladder was filled until urgency was experienced. Regions of interest were identified a priori, and brain activity in these regions of interest was compared before and after treatment as well as according to treatment response. A whole brain exploratory analysis with an uncorrected voxel level threshold of pbrain regions that changed after sacral neuromodulation. Among 12 women who underwent a pretreatment functional magnetic resonance imaging exam, seven were successfully treated with sacral neuromodulation and underwent a posttreatment exam. After sacral neuromodulation, brain activity decreased in the left anterior cingulate cortex, bilateral insula, left dorsolateral prefrontal cortex and bilateral orbitofrontal cortex (all pbrain regions with increased activity after sacral neuromodulation. Pretreatment brain activity levels in the bilateral anterior cingulate cortex, right insula, bilateral dorsolateral prefrontal cortex, right orbitofrontal cortex, right supplementary motor area, and right sensorimotor cortex were higher in women who underwent successful treatment (all pBrain activity during urgency changes after successful sacral neuromodulation. Sacral neuromodulation may be more effective in women with higher levels of pretreatment brain activity during urgency. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  3. Giant prolactinomas in women

    DEFF Research Database (Denmark)

    Delgrange, Etienne; Raverot, Gerald; Bex, Marie

    2014-01-01

    OBJECTIVE: To characterise distinctive clinical features of giant prolactinomas in women. DESIGN: A multicentre, retrospective case series and literature review. METHODS: We collected data from 15 female patients with a pituitary tumour larger than 4 cm and prolactin levels above 1000 μg/l and id......OBJECTIVE: To characterise distinctive clinical features of giant prolactinomas in women. DESIGN: A multicentre, retrospective case series and literature review. METHODS: We collected data from 15 female patients with a pituitary tumour larger than 4 cm and prolactin levels above 1000 μg....../l and identified 19 similar cases from the literature; a gender-based comparison of the frequency and age distribution was obtained from a literature review. RESULTS: The initial PubMed search using the term 'giant prolactinomas' identified 125 patients (13 women) responding to the inclusion criteria. The female......:male ratio was 1:9. Another six female patients were found by extending the literature search, while our own series added 15 patients. The median age at diagnosis was 44 years in women compared with 35 years in men (Pwomen (n=34), we...

  4. Reduced RAC1 activity inhibits cell proliferation and induces apoptosis in neurofibromatosis type 2(NF2)-associated schwannoma.

    Science.gov (United States)

    Wang, Ying; Wang, Bo; Li, Peng; Zhang, Qi; Liu, Pinan

    2017-12-01

    Objective To study the function and potential mechanism of RAC1 inhibitors in NF2-associated schwannoma. Methods In this study, we the downregulation of RAC1 activity and tumor cell phenotypes by RAC1 inhibitor NSC23766 in vitro. And we further validated the anti-proliferation effect by this RAC1 inhibitor in subcutaneous xenograft tumor model and sciatic nerve model. Results Pharmacological inhibition of RAC1 could significantly inhibit the proliferation of both RT4 cells and human NF2-associated primary schwannoma cells by inducing apoptosis. Pharmacological inhibition of RAC1 effectively reduced Rac1 activity and down-regulated the pathway downstream of Rac. Moreover, pharmacological inhibition of RAC1 showed a potential antitumor effect, with low toxicity in vivo. Conclusion RAC1 inhibitors may play a therapeutic role in patients with schwannoma.

  5. Communicating Hydrocephalus Associated with Small- to Medium-Sized Vestibular Schwannomas: Clinical Significance of the Tumor Apparent Diffusion Coefficient Map.

    Science.gov (United States)

    Taniguchi, Masaaki; Nakai, Tomoaki; Kohta, Masaaki; Kimura, Hidehito; Kohmura, Eiji

    2016-10-01

    The etiology of hydrocephalus associated with the small- to medium-sized vestibular schwannomas is still controversial. We investigated tumor-specific factors related to the association of hydrocephalus with small- to medium-sized vestibular schwannomas. Among the 77 patients with vestibular schwannoma smaller than 30 mm, 9 patients demonstrated associated communicating hydrocephalus. Patient medical records, radiologic data, and histopathologic specimens were reviewed retrospectively. The age of the patients, and size, mean apparent diffusion coefficient (ADC) value, and histologic features of the tumors were compared with those of patients without hydrocephalus. The symptoms related to hydrocephalus improved in all patients after tumor removal. Both the mean size and ADC values exhibited a statistically significant difference between the tumors with and without hydrocephalus (P hydrocephalus. The increased tumor ADC value was considered to be the result of degenerative change and suggested the involvement of protein sloughing in the etiology of the associated hydrocephalus. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. The Vertebral Column, Ribs, and Sternum of the African Giant Rat (Cricetomys gambianus Waterhouse)

    Science.gov (United States)

    Olude, Matthew Ayokunle; Mustapha, Oluwaseun Ahmed; Ogunbunmi, Temitope Kehinde; Olopade, James Olukayode

    2013-01-01

    Examined bones were obtained from eight adult African giant rats, Cricetomys gambianus Waterhouse. Animals used had an average body mass of 730.00 ± 41.91 gm and body length of 67.20 ± 0.05 cm. The vertebral formula was found to be C7, T13, L6, S4, Ca31–36. The lowest and highest points of the cervicothoracic curvature were at C5 and T2, respectively. The spinous process of the axis was the largest in the cervical group while others were sharp and pointed. The greatest diameter of the vertebral canal was at the atlas (0.8 cm) and the lowest at the caudal sacral bones (2 mm). The diameter of the vertebral foramen was the largest at C1 and the smallest at the S4; the foramina were negligibly indistinct caudal to the sacral vertebrae. There were 13 pairs of ribs. The first seven pairs were sternal, and six pairs were asternal of which the last 2-3 pairs were floating ribs. The sternum was composed of deltoid-shaped manubrium sterni, four sternebrae, and a slender processus xiphoideus. No sex-related differences were observed. The vertebral column is adapted for strong muscular attachment and actions helping the rodent suited for speed, agility, dexterity, and strength which might enable it to overpower prey and escape predation. PMID:24288518

  7. The Vertebral Column, Ribs, and Sternum of the African Giant Rat (Cricetomys gambianus Waterhouse

    Directory of Open Access Journals (Sweden)

    Matthew Ayokunle Olude

    2013-01-01

    Full Text Available Examined bones were obtained from eight adult African giant rats, Cricetomys gambianus Waterhouse. Animals used had an average body mass of 730.00±41.91 gm and body length of 67.20±0.05 cm. The vertebral formula was found to be C7, T13, L6, S4, Ca31–36. The lowest and highest points of the cervicothoracic curvature were at C5 and T2, respectively. The spinous process of the axis was the largest in the cervical group while others were sharp and pointed. The greatest diameter of the vertebral canal was at the atlas (0.8 cm and the lowest at the caudal sacral bones (2 mm. The diameter of the vertebral foramen was the largest at C1 and the smallest at the S4; the foramina were negligibly indistinct caudal to the sacral vertebrae. There were 13 pairs of ribs. The first seven pairs were sternal, and six pairs were asternal of which the last 2-3 pairs were floating ribs. The sternum was composed of deltoid-shaped manubrium sterni, four sternebrae, and a slender processus xiphoideus. No sex-related differences were observed. The vertebral column is adapted for strong muscular attachment and actions helping the rodent suited for speed, agility, dexterity, and strength which might enable it to overpower prey and escape predation.

  8. A Case of Action-Induced Clonus that Mimicked Action Tremors and was Associated with Cervical Schwannoma

    Directory of Open Access Journals (Sweden)

    Young-Hee Sung

    2010-10-01

    Full Text Available Clonus is the rhythmic muscle contraction which usually occurs in patients with lesions involving descending motor pathways. Sometimes, rhythmic oscillation of action induced clonus could be confused to action tremor. We report a case of action induced clonus associated with cervical schwannoma which was misdiagnosed as essential tremor. The patient had spasticity in all limbs with exaggerated tendon reflexes, and passive stretch-induced clonus. Imaging and histological examinations revealed a schwannoma extending from C2 to C7. The lesion was partially removed by surgery. Even though essential tremor is a common disease, clinician have to do sufficient neurologic examination considering differential diagnosis.

  9. MR imaging of a malignant schwannoma and an osteoblastoma with fluid-fluid levels. Report of two new cases

    Energy Technology Data Exchange (ETDEWEB)

    Vilanova, J.C.; Dolz, J.L.; Aldoma, J.; Capdevila, A. [Centre Diagnostic Pedralbes, Ressonancia Magnetica, Barcelona (Spain); Maestro de Leon, J.L.; Aparicio, A. [Department of Neurosurgery, Hospital Mutua de Terrassa, Barcelona (Spain)

    1998-10-01

    One case of malignant schwannoma of the sacrum and another of occipital osteoblastoma were evaluated by MR imaging. Both tumors showed fluid-fluid levels with different signal intensities in the sequences performed. Pathologic examination revealed hemmorhagic fluid in both tumors. Malignant schwannoma and osteoblastoma should be included in the list of bone and soft-tissue with fluid-fluid levels. Our data confirm the non-specificity of this finding, which only suggests the presence of previous intratumoral hemorrhage. (orig.) (orig.) With 2 figs., 2 tabs., 17 refs.

  10. Schwannoma do forame magno: revisão e relato de caso Foramen magnum schwannoma: review of the literature and report of a case

    Directory of Open Access Journals (Sweden)

    Marcelo Souto Nacif

    2005-02-01

    Full Text Available Os autores relatam um volumoso schwannoma cervical de apresentação incomum, numa paciente do sexo feminino, 53 anos de idade, que em fevereiro de 2002 apresentou queixa de fraqueza progressiva, iniciada há três anos, com dificuldade de mobilização das pernas e braços. Antes da cirurgia foi realizada ressonância magnética da região cervical. No exame físico apresentava postura com aumento da base de sustentação, marcha instável e paraparética, além de diminuição da força nos quatro membros, maior à esquerda, associada a dispnéia. Na ressonância magnética cervical evidenciou-se lesão expansiva extramedular de limites bem definidos, na altura de C1 e C2. Na cirurgia, o volumoso tumor encontrava-se ântero-lateralmente à medula, aderido à raiz esquerda de C1, estendendo-se superiormente através do forame magno, com localização extradural. O diagnóstico de schwannoma foi confirmado pela histopatologia. A paciente evoluiu satisfatoriamente, com melhora progressiva da hemiparesia e hemiparestesia esquerda. A ressonância magnética possibilita a detecção e avaliação da lesão, porém o diagnóstico definitivo só é feito com o exame histopatológico. Dessa forma, o diagnóstico precoce através da ressonância magnética e a exérese cirúrgica tornam-se a melhor forma de abordagem, com bom prognóstico.The authors report an unusual presentation of a voluminous neck schwannoma in a 53-year-old female that presented with a three-year history of progressive weakness associated with impaired movement of the limbs. Neurological examination revealed postural instability, unstable and paraparetic gait, tetraparesis and dyspnea. A preoperative magnetic resonance imaging of the neck revealed an expansive, extradural, well-circumscribed lesion, with soft-tissue attenuation, at the level of C1-C2 vertebral bodies. During surgery, the tumor was found to be extradural, lateral to the cervical spinal cord, attached to the C1 left

  11. Risk factors associated with vestibulocochlear nerve schwannoma: systematic review Fatores de risco associados ao Schwannoma do nervo vestibular: revisão sistemática

    Directory of Open Access Journals (Sweden)

    Ana Paula Corona

    2009-08-01

    Full Text Available The vestibulocochlear nerve schwannoma (VS is a benign tumor that stems from the edge of the Schwann´s sheath. It is considered the most frequent intracranial benign tumor, of low lethality rate and unknown etiology. AIM: to identify risk factors associated with VS. STUDY DESIGN: systematic review. METHODS: electronic search of studies using the following key words: "risk", "schwannoma", "vestibular", "neuroma" and "acoustic". All original articles on epidemiological studies published in Portuguese, English or Spanish describing measures of association were included. RESULTS: twenty case-control studies were found, most of them published in the United States. The analysis of those studies shows educational level, household income, occupation, exposure to ionizing radiation and noise, allergic diseases as well as the use of both cellular and cordless phones as risk factors for the VS. CONCLUSION: methodological limitations and lack of precision in the findings impose limits to definitive conclusions concerning those risk factors. The current study contributes with information which can subsidize decisions related to the methodology to be used, having in mind new investigations on risk factors for VS. Therefore, it is of great help for knowledge improvement in this field.O Schwannoma do nervo vestibular (SV é um tumor benigno que se origina da bainha de Schwann do VIII par craniano. É o tumor benigno intracraniano mais frequente, de baixa letalidade e etiologia obscura. OBJETIVO: Identificar fatores de risco associados ao SV. DESENHO DO ESTUDO: Revisão sistemática. MATERIAL E MÉTODO: Identificação de estudos em bases de dados eletrônicos utilizando as palavras-chaves "risk", "risco", "schwannoma", "vestibular", "neuroma" e "acoustic". Incluíram-se artigos originais de pesquisa epidemiológica publicados em português, espanhol ou inglês, que referiam alguma medida de associação. Foram comparados e analisados aspectos metodológicos e

  12. Isoscalar giant resonances

    Energy Technology Data Exchange (ETDEWEB)

    Youngblood, D. H. [Texas A and M Univ., College Station (USA). Cyclotron Inst.; Ikegami, H.; Muraoka, M. [eds.

    1980-01-01

    The current status of the knowledges of giant quadrupole resonance (GQR), low energy octupole resonance (LEOR), and giant monopole resonance (GMR), is described. In the lowest order of multipole resonance, both isoscalar and isovector modes can occur. The characteristics of the GQR in light nuclei are apparent in the experimental result for Mg-24. All of the isoscalar E2 strength are known in Mg-24. The Goldhaber-Teller model is preferred over the Steinwedel-Jensen model for the giant dipole resonance (GDR) transition density. A few interesting and puzzling features have been seen in Pb-208. There is some conflict between inelastic alpha and electron scatterings. About LEOR, the RPA calculation of Liu and Brown was compared to the data for 3/sup -/ strength in Ca-40, Zr-90 and Pb-208. The calculation was employed the residual interaction of the Skyrme type. The agreement in Zr-90 was excellent. The effect of quadrupole deformation on the LEOR in Sm isotopes was large. The inelastic alpha scattering data on Al-27, Ca-40, Ti-48, Ni-58, Zn-64 and 66, Zr-90, Sn-116, 118, 120 and 124, Sm-144, 148 and 154, and Pb-208 were utilized in order to identify the GMR, and the GMR parameters were obtained. The GMR exhausting a large fraction of the sum rule was apparent in the nuclei with mass larger than 90. The splitting of the GDR and the broadening of the GQR in permanently deformed nuclei were established. The splitting of GMR was seen in Sm-154. The studies with heavy ions are also described.

  13. Age, gender and tumour size predict work capacity after surgical treatment of vestibular schwannomas.

    Science.gov (United States)

    Al-Shudifat, Abdul Rahman; Kahlon, Babar; Höglund, Peter; Soliman, Ahmed Y; Lindskog, Kristoffer; Siesjo, Peter

    2014-01-01

    The aim of the present study was to identify predictive factors for outcome after surgery of vestibular schwannomas. This is a retrospective study with partially collected prospective data of patients who were surgically treated for vestibular schwannomas at a single institution from 1979 to 2000. Patients with recurrent tumours, NF2 and those incapable of answering questionnaires were excluded from the study. The short form 36 (SF36) questionnaire and a specific questionnaire regarding neurological status, work status and independent life (IL) status were sent to all eligible patients. The questionnaires were sent to 430 eligible patients (out of 537) and 395 (93%) responded. Scores for work capacity (WC) and IL were compared with SF36 scores as outcome estimates. Patients were divided into two groups (group age, gender and tumour diameter were independent predictive factors for postoperative WC in multivariate analysis. A high-risk group was identified in women with age >50 years and tumour diameter >25 mm. In patients ≥64, gender and tumour diameter were significant predictive factors for IL in univariate analysis. Perioperative and postoperative objective factors as length of surgery, blood loss and complications did not predict outcome in the multivariable analysis for any age group. Patients' assessment of change in balance function was the only neurological factor that showed significance both in univariate and multivariable analysis in both age cohorts. While SF36 scores were lower in surgically treated patients in relation to normograms for the general population, they did not correlate significantly to WC and IL. The SF36 questionnaire did not correlate to outcome measures as WC and IL in patients undergoing surgery for vestibular schwannomas. Women and patients above 50 years with larger tumours have a high risk for reduced WC after surgical treatment. These results question the validity of quality of life scores in assessment of outcome after surgery

  14. Postural Stability Evaluation of Patients Undergoing Vestibular Schwannoma Microsurgery Employing the Inertial Measurement Unit

    Directory of Open Access Journals (Sweden)

    Patrik Kutilek

    2018-01-01

    Full Text Available The article focuses on a noninvasive method and system of quantifying postural stability of patients undergoing vestibular schwannoma microsurgery. Recent alternatives quantifying human postural stability are rather limited. The major drawback is that the posturography system can evaluate only two physical quantities of body movement and can be measured only on a transverse plane. A complex movement pattern can be, however, described more precisely while using three physical quantities of 3-D movement. This is the reason why an inertial measurement unit (Xsens MTx unit, through which we obtained 3-D data (three Euler angles or three orthogonal accelerations, was placed on the patient’s trunk. Having employed this novel method based on the volume of irregular polyhedron of 3-D body movement during quiet standing, it was possible to evaluate postural stability. To identify and evaluate pathological balance control of patients undergoing vestibular schwannoma microsurgery, it was necessary to calculate the volume polyhedron using the 3-D Leibniz method and to plot three variables against each other. For the needs of this study, measurements and statistical analysis were made on nine patients. The results obtained by the inertial measurement unit showed no evidence of improvement in postural stability shortly after surgery (4 days. The results were consistent with the results obtained by the posturography system. The evaluated translation variables (acceleration and rotary variables (angles measured by the inertial measurement unit correlate strongly with the results of the posturography system. The proposed method and application of the inertial measurement unit for the purpose of measuring patients with vestibular schwannoma appear to be suitable for medical practice. Moreover, the inertial measurement unit is portable and, when compared to other traditional posturography systems, economically affordable. Inertial measurement units can

  15. Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient with Facial Nerve Schwannoma.

    Science.gov (United States)

    Marinelli, John P; Van Gompel, Jamie J; Link, Michael J; Carlson, Matthew L

    2018-05-01

    Secondary trigeminal neuralgia (TN) is uncommon. When a space-occupying lesion with mass effect is identified, the associated TN is often exclusively attributed to the tumor. This report illustrates the importance of considering coexistent actionable pathology when surgically treating secondary TN. A 51-year-old woman presented with abrupt-onset TN of the V2 and V3 nerve divisions with hypesthesia. She denied changes in hearing, balance, or facial nerve dysfunction. Magnetic resonance imaging revealed a 1.6-cm contrast-enhancing cerebellopontine angle tumor that effaced the trigeminal nerve, consistent with a vestibular schwannoma. In addition, a branch of the superior cerebellar artery abutted the cisternal segment of the trigeminal nerve on T2-weighted thin-slice magnetic resonance imaging. Intraoperative electrical stimulation of the tumor elicited a response from the facial nerve at low threshold over the entire accessible tumor surface, indicating that the tumor was a facial nerve schwannoma. Considering the patient's lack of facial nerve deficit and that the tumor exhibited no safe entry point for intracapsular debulking, tumor resection was not performed. Working between the tumor and tentorium, a branch of the superior cerebellar artery was identified and decompressed with a Teflon pad. At last follow-up, the patient exhibited resolution of her TN. Her hearing and facial nerve function remained intact. Despite obstruction from a medium-sized tumor, it is still possible to achieve microvascular decompression of the fifth cranial nerve. This emphasizes the importance of considering other actionable pathology during surgical management of presumed tumor-induced TN. Further, TN is relatively uncommon with medium-sized vestibular schwannomas and coexistent causes should be considered. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. Schwanoma de plexo braquial: relato de dois casos Schwannoma of brachial plexus: report of two cases

    Directory of Open Access Journals (Sweden)

    Manoel Baldoíno Leal Filho

    2004-03-01

    Full Text Available Schwanomas, neurinomas ou neurilemomas são tumores benignos de nervos periféricos. Podem ocorrer em associação com a neurofibromatose tipo 2. Relatamos dois casos de tumor cervical originado em plexo braquial sem associação com neurofibromatose. Uma mulher, de 31 anos apresentando uma tumefação em região supraclavicular direita, dor irradiada para o membro ipsilateral e sinal de Tinel à percussão da região. Outra mulher, 52 anos, com cervicobraquialgia persistente à direita há um ano. Ambas foram submetidas a microcirurgia, com ressecção total da lesão. O estudo histopatológico foi compatível com schwanoma. As duas pacientes tiveram boa evolução neurológica, com desaparecimento dos sinais e sintomas.Schwannomas, neurinomas or neurilemmomas are benign peripheral nerve tumors. The literature report some cases associated with neurofibromatosis 2. We report two cases of cervical schwannoma originating from the brachial plexus unassociated with neurofibromatosis. A 31-year-old woman presented with a mass in the right supraclavicular region, irradiating pain and distal tingling to percussion (Tinel's sign for 6 months. And a 52-year-old woman presented with pain in the cervical region and right arm for one year. Both the patients underwent to a microsurgery with total resection of the lesion. Histology of the surgical specimen confirmed the diagnosis of schwannoma. Postoperatively, the patients had a good recovery.

  17. Small-field fractionated radiotherapy with or without stereotactic boost for vestibular schwannoma

    International Nuclear Information System (INIS)

    Kagei, K.; Shirato, H.; Suzuki, K.; Isu, T.; Sawamura, Y.; Sakamoto, T.; Fukuda, S.; Nishioka, T.; Hashimoto, S.; Miyasaka, K.

    1999-01-01

    Purpose: To assess the efficacy and toxicity of small-field fractionated radiotherapy with or without stereotactic boost (SB) for vestibular schwannomas.Methods and materials: Thirty-nine patients with vestibular schwannoma were treated with irradiation between March 1991 and February 1996. Extra-meatal tumor diameters were under 30 mm. Thirty-three patients received small-field fractionated radiotherapy followed by SB. Basic dose schedule was 44 Gy in 22 fractions over 5 1/2 weeks plus 4 Gy in one session. Six patients received small-field fractionated radiotherapy only (40-44 Gy in 20-22 fractions over 5-5 1/2 weeks or 36 Gy in 20 fractions over 5 weeks).< Results: Follow-up ranged from 6 to 69 months (median, 24 months). Tumors decreased in size in 13 cases (33%), were unchanged in 25 (64%), and increased in one (3%). The actuarial 2-year tumor control rate was 97%. Fifteen patients had useful hearing (Gardner-Robertson class 1-2) and 25 patients had testable hearing (class 1-4) before irradiation. The 2-year actuarial rates of useful hearing preservation (free of deterioration from class 1-2 to class 3-5) were 78%. The 2-year actuarial rates of any testable hearing preservation (free of deterioration from class 1-4 to class 5) were 96%. No permanent facial and trigeminal neuropathy developed after irradiation. The 2-year actuarial incidences of facial and trigeminal neuropathies were 8% and 16%, respectively.Conclusions: Small-field fractionated radiotherapy with or without SB provides excellent short-term local control and a relatively low incidence of complications for vestibular schwannoma, although further follow-up is necessary to evaluate the long-term results. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

  18. A Patient-Assessed Morbidity to Evaluate Outcome in Surgically Treated Vestibular Schwannomas.

    Science.gov (United States)

    Al-Shudifat, Abdul Rahman; Kahlon, Babar; Höglund, Peter; Lindberg, Sven; Magnusson, Måns; Siesjo, Peter

    2016-10-01

    Outcome after treatment of vestibular schwannomas can be evaluated by health providers as mortality, recurrence, performance, and morbidity. Because mortality and recurrence are rare events, evaluation has to focus on performance and morbidity. The latter has mostly been reported by health providers. In the present study, we validate 2 new scales for patient-assessed performance and morbidity in comparison with different outcome tools, such as quality of life (QOL) (European Quality of Life-5 dimensions [EQ-5D]), facial nerve score, and work capacity. There were 167 total patients in a retrospective (n = 90) and prospective (n = 50) cohort of surgically treated vestibular schwannomas. A new patient-assessed morbidity score (paMS), a patient-assessed Karnofsky score (paKPS), the patient-assessed QOL (EQ-5D) score, work capacity, and the House-Brackmann facial nerve score were used as outcome measures. Analysis of paMS components and their relation to other outcomes was done as uni- and multivariate analysis. All outcome instruments, except EQ-5D and paKPS, showed a significant decrease postoperatively. Only the facial nerve score (House-Brackmann facial nerve score) differed significantly between the retrospective and prospective cohorts. Out of the 16 components of the paMS, hearing dysfunction, tear dysfunction, balance dysfunction, and eye irritation were most often reported. Both paMS and EQ-5D correlated significantly with work capacity. Standard QOL and performance instruments may not be sufficiently sensitive or specific to measure outcome at the cohort level after surgical treatment of vestibular schwannomas. A morbidity score may yield more detailed information on symptoms that can be relevant for rehabilitation and occupational training after surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Prognostic significance of electrophysiological tests for facial nerve outcome in vestibular schwannoma surgery.

    Science.gov (United States)

    van Dinther, J J S; Van Rompaey, V; Somers, T; Zarowski, A; Offeciers, F E

    2011-01-01

    To assess the prognostic significance of pre-operative electrophysiological tests for facial nerve outcome in vestibular schwannoma surgery. Retrospective study design in a tertiary referral neurology unit. We studied a total of 123 patients with unilateral vestibular schwannoma who underwent microsurgical removal of the lesion. Nine patients were excluded because they had clinically abnormal pre-operative facial function. Pre-operative electrophysiological facial nerve function testing (EPhT) was performed. Short-term (1 month) and long-term (1 year) post-operative clinical facial nerve function were assessed. When pre-operative facial nerve function, evaluated by EPhT, was normal, the outcome from clinical follow-up at 1-month post-operatively was excellent in 78% (i.e. HB I-II) of patients, moderate in 11% (i.e. HB III-IV), and bad in 11% (i.e. HB V-VI). After 1 year, 86% had excellent outcomes, 13% had moderate outcomes, and 1% had bad outcomes. Of all patients with normal clinical facial nerve function, 22% had an abnormal EPhT result and 78% had a normal result. No statistically significant differences could be observed in short-term and long-term post-operative facial function between the groups. In this study, electrophysiological tests were not able to predict facial nerve outcome after vestibular schwannoma surgery. Tumour size remains the best pre-operative prognostic indicator of facial nerve function outcome, i.e. a better outcome in smaller lesions.

  20. Giant Ulcerative Dermatofibroma

    Directory of Open Access Journals (Sweden)

    Turgut Karlidag

    2013-01-01

    Full Text Available Dermatofibroma is a slowly growing common benign cutaneous tumor characterized by hard papules and nodules. The rarely seen erosions and ulcerations may cause difficulties in the diagnosis. Dermatofibrosarcoma protuberans, which is clinically and histopathologically of malignant character, displays difficulties in the diagnosis since it has similarities with basal cell carcinoma, epidermoid carcinoma, and sarcomas. Head and neck involvement is very rare. In this study, a giant dermatofibroma case, which is histopathologically, ulcerative dermatofibroma, the biggest lesion of the head and neck region and seen rarely in the literature that has characteristics similar to dermatofibrosarcoma protuberans, has been presented.

  1. GIANT PROSTHETIC VALVE THROMBUS

    Directory of Open Access Journals (Sweden)

    Prashanth Kumar

    2015-04-01

    Full Text Available Mechanical prosthetic valves are predisposed to bleeding, thrombosis & thromboembolic complications. Overall incidence of thromboembolic complications is 1% per year who are on oral anticoagulants, whereas bleeding complications incidence is 0.5% to 6.6% per year. 1, 2 Minimization of Scylla of thromboembolic & Charybdis of bleeding complication needs a balancing act of optimal antithrombotic therapy. We are reporting a case of middle aged male patient with prosthetic mitral valve presenting in heart failure. Patient had discontinued anticoagulants, as he had subdural hematoma in the past. He presented to our institute with a giant prosthetic valve thrombus.

  2. A Giant Urethral Calculus.

    Science.gov (United States)

    Sigdel, G; Agarwal, A; Keshaw, B W

    2014-01-01

    Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy.

  3. Giant paraganglioma in

    Directory of Open Access Journals (Sweden)

    Alka Gupta

    2017-07-01

    Full Text Available Paraganglioma is a rare neuroendocrine catecholamine producing tumour in childhood which arises outside the adrenal medulla. We present a 12 year old girl with giant paraganglioma with severe hypertension and end organ damage. Diagnosis was confirmed with 24 h urinary Vanillymandelic Acid (VMA and CT scan. Preoperative blood pressure was controlled with intravenous nitroprusside, and oral prazosin, amlodepine, labetalol and metoprolol. General anaesthesia with epidural analgesia was given. Intra operative blood pressure rise was managed with infusion of nitriglycerine (NTG, esmolol, nitroprusside and propofol.

  4. GIANT INTRACANALICULAR FIBROADENOMA

    Science.gov (United States)

    Smith, Clyn; Parsons, Robert J.; Bogart, William M.

    1951-01-01

    Five cases of giant intracanalicular fibroadenoma (“cystosarcoma phylloides”) were observed at one hospital in a period of three years. In a search of the literature, additional reports of breast tumors of this kind, not included in previous reviews, were noted. As there is record of 229 cases, it would appear that this rapidly growing benign tumor should be kept in mind in the diagnosis of masses in the breast. If removal is incomplete, there may be recurrence. Simple mastectomy is the treatment of choice. Radical mastectomy should be avoided. ImagesFigure 1Figure 2.Figure 3Figure 4Figure 5 PMID:14848732

  5. Vestibular schwannoma (acoustic neuroma mimicking temporomandibular disorders: a case report Schwannoma vestibular (neurinoma do acústico imitando desordens temporomandibulares: um relato de caso

    Directory of Open Access Journals (Sweden)

    Maurício A. Bisi

    2006-12-01

    Full Text Available Approximately 6 to 16% of patients with trigeminal neuralgia symptoms present intracranial tumors, the most common being the vestibular schwannoma (acoustic neuroma. Some symptoms reported by patients include hearing loss, tinnitus, headaches, vertigo and trigeminal disturbances. An increased muscle response in the surrounding head and neck musculature may also be observed, which mimics signs and symptoms of temporomandibular disorders. In these cases, magnetic resonance imaging (MRI has proved to be a useful tool in tumor diagnosis. The differential diagnosis between myofascial and neuralgic pain is important, as both may present similar characteristics, while being of different origin, and demanding special treatment approaches. The purpose of this paper is to demonstrate the relationship among trigeminal neuralgia symptoms, intracranial tumors and temporomandibular dysfunction by presenting a clinical case.Aproximadamente 6 a 16% dos pacientes com sintomas de neuralgia trigeminal apresentam tumores intracranianos, sendo mais comum o schwannoma vestibular (neurinoma do acústico. Alguns sintomas relatados pelos pacientes são perda da audição, zumbido, dores de cabeça, vertigens e distúrbios trigeminais. Uma resposta muscular aumentada na musculatura associada da cabeça e do pescoço também pode ser observada, o que pode mimetizar sinais e sintomas de desordens temporomandibulares. Nestes casos é de grande valia o uso de imagem de ressonância magnética (IRM para detecção de tumores. É importante, também, a diferenciação de dores miofasciais e neurálgicas, pois ambas podem apresentar características semelhantes, mas com origens e tratamentos diferentes. O objetivo desse trabalho foi demonstrar através de relato de caso clínico a associação entre sintomas de neuralgia trigeminal, tumores intracranianos e disfunção temporomandibular.

  6. The Effect of Early Complications on Flap Selection on Sacral Pressure Sores

    Directory of Open Access Journals (Sweden)

    Musa Kemal Keleş

    2017-06-01

    Full Text Available Objective: Pressure sores occur in bedridden patients in intensive care units, clinics, and even at their own places. Care for sick relatives and working with doctors to address treatment options and ensure proper follow-up are some of the problems associated with these types of wounds. Surgical therapy in the treatment of pressure ulcers is associated with significant complications. In comparison to non-surgical treatment, surgical treatment has a low complication rate and is more cost-effective. The surgical treatment enables the patients to return to their social life sooner than non-surgical treatment. Patient's ability to early return to their social life is advantageous in terms of reducing morbidity and the need for additional operations. This study is aimed to review the flap choices used to treat sacral pressure sores and the resulting acute complications rates retrospectively. Material and Methods: Patients treated for stage 3 and stage 4 sacral pressure sores in our clinic in the past 5 years were included in the study. Patient records were analyzed retrospectively. Patients' demographic data and surgical treatment they received were documented. Surgical method and surgical outcomes were evaluated and early complication rates were determined. Result: Fifty patients were included in the study; 10 of them were female, 40 of were male cases. The most common causative agent was paraplegia after traffic accident. Conclusion: A significant difference was not observed between the type of flap used in the surgical treatment and the rate of complications. Consequently, the surgical treatment of pressure ulcers in the sacral region depends on the patient's individual situation, the cooperation of the family, and previously applied treatments

  7. Does cortical bone thickness in the last sacral vertebra differ among tail types in primates?

    Science.gov (United States)

    Nishimura, Abigail C; Russo, Gabrielle A

    2017-04-01

    The external morphology of the sacrum is demonstrably informative regarding tail type (i.e., tail presence/absence, length, and prehensility) in living and extinct primates. However, little research has focused on the relationship between tail type and internal sacral morphology, a potentially important source of functional information when fossil sacra are incomplete. Here, we determine if cortical bone cross-sectional thickness of the last sacral vertebral body differs among tail types in extant primates and can be used to reconstruct tail types in extinct primates. Cortical bone cross-sectional thickness in the last sacral vertebral body was measured from high-resolution CT scans belonging to 20 extant primate species (N = 72) assigned to tail type categories ("tailless," "nonprehensile short-tailed," "nonprehensile long-tailed," and "prehensile-tailed"). The extant dataset was then used to reconstruct the tail types for four extinct primate species. Tailless primates had significantly thinner cortical bone than tail-bearing primates. Nonprehensile short-tailed primates had significantly thinner cortical bone than nonprehensile long-tailed primates. Cortical bone cross-sectional thickness did not distinguish between prehensile-tailed and nonprehensile long-tailed taxa. Results are strongly influenced by phylogeny. Corroborating previous studies, Epipliopithecus vindobonensis was reconstructed as tailless, Archaeolemur edwardsi as long-tailed, Megaladapis grandidieri as nonprehensile short-tailed, and Palaeopropithecus kelyus as nonprehensile short-tailed or tailless. Results indicate that, in the context of phylogenetic clade, measures of cortical bone cross-sectional thickness can be used to allocate extinct primate species to tail type categories. © 2017 Wiley Periodicals, Inc.

  8. Sciatica from a Foraminal Lumbar Root Schwannoma: Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Tarush Rustagi

    2012-01-01

    This case report describes lumbar foraminal schwannoma as an unusual cause of radiculopathy, presenting clinically as a lumbar disc prolapse. The diagnosis was confirmed on MRI scan. Patient had complete symptomatic recovery following surgical enucleation of the tumour mass from the L5 nerve root. This case report is of particular interest as it highlights the diagnostic confusion, which is bound to arise, because the clinical presentation closely mimics a lumbar PID. This often leads to delay in diagnosis and “failure of conservative treatment.”

  9. Schwannoma del nervio facial intraparotídeo. Un dilema terapéutico

    Directory of Open Access Journals (Sweden)

    Paula Barba-Recreo

    2015-07-01

    Full Text Available Los schwannomas del nervio facial intraparotídeos son tumores benignos poco frecuentes, suponiendo frecuentemente un reto diagnóstico y terapéutico. La mayoría de los pacientes presentan una masa parotídea asintomática y las pruebas de imagen y la punción con aguja fina no suelen ser concluyentes en el diagnóstico. Tras la revisión de la literatura a propósito de un caso, pretendemos proporcionar cierta guía para el tratamiento de esta rara patología.

  10. Isolated spinal accessory neuropathy and intracisternal schwannomas of the spinal accessory nerve

    Directory of Open Access Journals (Sweden)

    Abdullah M. Al-Ajmi

    2015-03-01

    Full Text Available We report a 40-year-old female patient presenting with isolated left spinal accessory neuropathy that developed insidiously over 6 years. She complained of ill-defined deep neck and shoulder pain. On examination, prominent sternocleidomastoid and trapezoid muscle weakness and atrophy, shoulder instability, and lateral scapular winging were observed. MRI identified a small mass of the cisternal portion of the spinal accessory nerve. Its appearance was typical of schwannoma. Surgical treatment was not offered because of the small tumor size, lack of mass effect and the questionable functional recovery in the presence of muscular atrophy.

  11. Hypofractionated stereotactic radiation therapy in three to five fractions for vestibular schwannoma

    International Nuclear Information System (INIS)

    Morimoto, Masahiro; Yoshioka, Yasuo; Kotsuma, Tadayuki

    2013-01-01

    The objective of this study was to retrospectively examine the outcomes of hypofractionated stereotactic radiation therapy in three to five fractions for vestibular schwannomas. Twenty-five patients with 26 vestibular schwannomas were treated with hypofractionated stereotactic radiation therapy using a CyberKnife. The vestibular schwannomas of 5 patients were associated with type II neurofibromatosis. The median follow-up time was 80 months (range: 6-167); the median planning target volume was 2.6 cm 3 (0.3-15.4); and the median prescribed dose (≥D90) was 21 Gy in three fractions (18-25 Gy in three to five fractions). Progression was defined as ≥2 mm 3-dimensional post-treatment tumor enlargement excluding transient expansion. Progression or any death was counted as an event in progression-free survival rates, whereas only progression was counted in progression-free rates. The 7-year progression-free survival and progression-free rates were 78 and 95%, respectively. Late adverse events (≥3 months) with grades based on Common Terminology Criteria for Adverse Events, v4.03 were observed in 6 patients: Grade 3 hydrocephalus in one patient, Grade 2 facial nerve disorders in two and Grade 1-2 tinnitus in three. In total, 12 out of 25 patients maintained pure tone averages ≤50 dB before hypofractionated stereotactic radiation therapy, and 6 of these 12 patients (50%) maintained pure tone averages at this level at the final audiometric follow-up after hypofractionated stereotactic radiation therapy. However, gradient deterioration of pure tone average was observed in 11 of these 12 patients. The mean pure tone averages before hypofractionated stereotactic radiation therapy and at the final follow-up for the aforementioned 12 patients were 29.8 and 57.1 dB, respectively. Treating vestibular schwannomas with hypofractionated stereotactic radiation therapy in three to five fractions may prevent tumor progression with tolerable toxicity. However, gradient

  12. Hypofractionated stereotactic radiation therapy in three to five fractions for vestibular schwannoma

    Energy Technology Data Exchange (ETDEWEB)

    Morimoto, Masahiro; Yoshioka, Yasuo [Osaka Univ., Graduate School of Medicine, Suita, Osaka (Japan); Kotsuma, Tadayuki [Kinki-chuo Chest Medical Center, Sakai, Osaka (Japan); others, and

    2013-08-15

    The objective of this study was to retrospectively examine the outcomes of hypofractionated stereotactic radiation therapy in three to five fractions for vestibular schwannomas. Twenty-five patients with 26 vestibular schwannomas were treated with hypofractionated stereotactic radiation therapy using a CyberKnife. The vestibular schwannomas of 5 patients were associated with type II neurofibromatosis. The median follow-up time was 80 months (range: 6-167); the median planning target volume was 2.6 cm{sup 3} (0.3-15.4); and the median prescribed dose ({>=}D90) was 21 Gy in three fractions (18-25 Gy in three to five fractions). Progression was defined as {>=}2 mm 3-dimensional post-treatment tumor enlargement excluding transient expansion. Progression or any death was counted as an event in progression-free survival rates, whereas only progression was counted in progression-free rates. The 7-year progression-free survival and progression-free rates were 78 and 95%, respectively. Late adverse events ({>=}3 months) with grades based on Common Terminology Criteria for Adverse Events, v4.03 were observed in 6 patients: Grade 3 hydrocephalus in one patient, Grade 2 facial nerve disorders in two and Grade 1-2 tinnitus in three. In total, 12 out of 25 patients maintained pure tone averages {<=}50 dB before hypofractionated stereotactic radiation therapy, and 6 of these 12 patients (50%) maintained pure tone averages at this level at the final audiometric follow-up after hypofractionated stereotactic radiation therapy. However, gradient deterioration of pure tone average was observed in 11 of these 12 patients. The mean pure tone averages before hypofractionated stereotactic radiation therapy and at the final follow-up for the aforementioned 12 patients were 29.8 and 57.1 dB, respectively. Treating vestibular schwannomas with hypofractionated stereotactic radiation therapy in three to five fractions may prevent tumor progression with tolerable toxicity. However, gradient

  13. Chondromyxoid fibroma of the mastoid facial nerve canal mimicking a facial nerve schwannoma.

    Science.gov (United States)

    Thompson, Andrew L; Bharatha, Aditya; Aviv, Richard I; Nedzelski, Julian; Chen, Joseph; Bilbao, Juan M; Wong, John; Saad, Reda; Symons, Sean P

    2009-07-01

    Chondromyxoid fibroma of the skull base is a rare entity. Involvement of the temporal bone is particularly rare. We present an unusual case of progressive facial nerve paralysis with imaging and clinical findings most suggestive of a facial nerve schwannoma. The lesion was tubular in appearance, expanded the mastoid facial nerve canal, protruded out of the stylomastoid foramen, and enhanced homogeneously. The only unusual imaging feature was minor calcification within the tumor. Surgery revealed an irregular, cystic lesion. Pathology diagnosed a chondromyxoid fibroma involving the mastoid portion of the facial nerve canal, destroying the facial nerve.

  14. The Thoracic Lordosis Correction Improves Sacral Slope and Walking Ability in Neuromuscular Scoliosis.

    Science.gov (United States)

    Kim, Do Yeon; Moon, Eun Su; Park, Jin Oh; Chong, Hyon Su; Lee, Hwan Mo; Moon, Seong Hwan; Kim, Sung Hoon; Kim, Hak Sun

    2016-10-01

    Retrospective study. To report on neuromuscular patients with preserved walking ability, but forward bending of the body due to thoracic lordosis, and to suggest thoracic lordosis correction as the surgical treatment. It is an established fact that lumbar lordosis or pelvic parameter is directly related to thoracic sagittal balance. However, the reverse relationship has not been fully defined yet. Loss of thoracic kyphosis results in positive sagittal balance, which causes walking difficulty. Neuromuscular patients with thoracic lordosis have not been reported yet, and there have been no reports on their surgical treatments. This study analyzed 8 patients treated with thoracic lordosis correction surgery. Every patient was diagnosed with muscular dystrophy. In thoracic lordosis correction surgery, anterior release was performed in the first stage and posterior segmental instrumentation was performed in the second stage. Radiographic parameters were compared and walking ability was evaluated with gait analysis. All patients were classified according to the modified Rancho Los Amigos Hospital system preoperatively and 2 years postoperatively to evaluate functional ability. The average follow-up period was 2.9 years. Before surgery, the mean thoracic sagittal alignment was -2.1-degree lordosis, the mean Cobb angle and sacral slope increased to 36.3 and 56.6 degrees, respectively. The anterior pelvic tilt in gait analysis was 29.3 degrees. At last follow-up after surgery, the mean thoracic sagittal alignment changed to 12.6-degree kyphosis, and the Cobb angle and sacral slope decreased to 18.9 and 39.5 degrees, respectively. Lumbar lordosis and the sacral slope showed significant positive correlation (Plordosis showed a significant correlation to the preoperative flexibility of the major curve (P=0.028). The anterior pelvic tilt in gait analysis improved to 15.4 degrees. The functional ability improved in 2 (50%) of 4 patients in class 2 and maintained in remaining 6

  15. Effects of Low-frequency Current Sacral Dermatome Stimulation on Idiopathic Slow Transit Constipation.

    Science.gov (United States)

    Kim, Jin-Seop; Yi, Seung-Ju

    2014-06-01

    [Purpose] This study aimed to determine whether low-frequency current therapy can be used to reduce the symptoms of idiopathic slow transit constipation (ISTC). [Subjects] Fifteen patients (ten male and five female) with idiopathic slow transit constipation were enrolled in the present study. [Results] Bowel movements per day, bowel movements per week, and constipation assessment scale scores significantly improved after low-frequency current simulation of S2-S3. [Conclusion] Our results show that stimulation with low-frequency current of the sacral dermatomes may offer therapeutic benefits for a subject of patients with ISTC.

  16. Sacral nerve root neuromodulation: an effective treatment for refractory urge incontinence.

    Science.gov (United States)

    Shaker, H S; Hassouna, M

    1998-05-01

    Sacral foramina implants have been recognized recently as a method for treatment of refractory urinary urge incontinence. We study the outcome of the procedure with in-depth analysis of the results of 18 implanted cases. Patients with urinary urge incontinence were subjected to percutaneous nerve evaluation of the S3 roots as a temporary screening test to determine response to neuromodulation. Satisfactory responders were implanted with permanent sacral root neuroprosthesis. The study design included comprehensive voiding diaries for 4 consecutive days twice as a baseline, 1 with percutaneous nerve evaluation screening, 1 after the percutaneous nerve evaluation, 1 at the 1, 3 and 6 post-implantation visits, and every 6 months thereafter. Uroflowmetry and quality of life questionnaires were performed at the same intervals. Urodynamic study was done as a baseline and 6 months after implantation of the neuroprosthesis. All 18 patients (16 women and 2 men) with refractory urge incontinence received a sacral foramina neuroprosthesis after demonstrating a good response to the percutaneous nerve evaluation. Average patient age at presentation was 42.3+/-3.3 years (range 22 to 67) and duration of urinary symptoms was 6.6+/-1.3 years (range 1.2 to 18.8). Average followup was 18.8 months (range 3 to 83). Neuromodulation in these patients showed a marked reduction in leakage episodes from 6.49 to 1.98 times per 24 hours and in the leakage severity score. Eight patients became completely dry and 4 had average leakage episodes of 1 or less daily. Patients showed as well a decrease in urinary frequency with an increase in functional bladder capacity. Associated pelvic pain improved substantially. Cystometrograms demonstrated increased volume at first sensation by 50% and increased cystometric capacity by 15% with the disappearance of uninhibited contractions in 1 of the 4 patients who presented with it preoperatively. There was also noticeable improvement in the quality of life

  17. Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus

    OpenAIRE

    Hur, Jian

    2015-01-01

    When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster...

  18. Development and validation of a bowel-routine-based self-report questionnaire for sacral sparing after spinal cord injury

    DEFF Research Database (Denmark)

    Liu, N; Xing, H; Zhou, M-W

    2017-01-01

    -report questionnaire was developed based on several events that most patients might experience during bowel routine. 102 participants who sustained SCI within 12 months were asked to complete the questionnaire followed by an anorectal examination. Agreements of answers to the questionnaire and the physical examination......STUDY DESIGN: An observational study. OBJECTIVE: To develop a self-administered tool for assessment of sacral sparing after spinal cord injury (SCI) and to test its validity in individuals with SCI. SETTING: Peking University Third Hospital, Beijing, China. METHODS: A 5-item SCI sacral sparing self......: The validity of this questionnaire for the assessment of sacral sparing in up to 12 months post injury is good except for the motor function when there was increased AST. In some situations it could be considered as an alternative tool for digital rectal examination, especially when repeated examinations...

  19. Evaluation of the rostral projection of the sacral lamina as a component of degenerative lumbosacral stenosis in German shepherd dogs.

    Science.gov (United States)

    Saunders, Harvey; Worth, Andrew J; Bridges, Janis P; Hartman, Angela

    2018-05-20

    To determine the association between a greater rostral projection of the sacral lamina and clinical signs of cauda equina syndrome (CES) in German shepherd dogs (GSD) with presumptive degenerative lumbosacral disease (DLSS). Retrospective cohort study. One hundred forty-three GSD (125 police dogs and 18 pet dogs) presenting for either CES or prebreeding evaluation. Fifty-five were classified as affected by CES and diagnosed with DLSS, and 88 were classified as unaffected on the basis of clinical and imaging findings. The position of the rostral edge of the sacral lamina was measured from radiographs and/or computed tomography (CT) scans. This position was compared between affected and unaffected dogs. In dogs that underwent both radiography and CT scanning, the agreement between sacral lamina localization using each imaging modality was determined. Owners/handlers were contacted to determine whether dogs subsequently developed clinical signs compatible with CES at a mean of 29 months (unaffected). The sacral lamina did not extend as far rostrally in affected dogs, compared to unaffected dogs (P = .04). Among the 88 dogs unaffected by CES at initial evaluation, 2 developed clinical signs consistent with CES at follow-up. Rostral projection of the sacral lamina, previously proposed as a potential risk factor in dogs with CES due to lumbosacral degeneration, was not associated with a diagnosis of DLSS in this study; the opposite was true. Rostral projection of the sacral lamina may not be a predisposing factor in the development of CES due to DLSS in GSD. © 2018 The American College of Veterinary Surgeons.

  20. Allometry indicates giant eyes of giant squid are not exceptional.

    Science.gov (United States)

    Schmitz, Lars; Motani, Ryosuke; Oufiero, Christopher E; Martin, Christopher H; McGee, Matthew D; Gamarra, Ashlee R; Lee, Johanna J; Wainwright, Peter C

    2013-02-18

    The eyes of giant and colossal squid are among the largest eyes in the history of life. It was recently proposed that sperm whale predation is the main driver of eye size evolution in giant squid, on the basis of an optical model that suggested optimal performance in detecting large luminous visual targets such as whales in the deep sea. However, it is poorly understood how the eye size of giant and colossal squid compares to that of other aquatic organisms when scaling effects are considered. We performed a large-scale comparative study that included 87 squid species and 237 species of acanthomorph fish. While squid have larger eyes than most acanthomorphs, a comparison of relative eye size among squid suggests that giant and colossal squid do not have unusually large eyes. After revising constants used in a previous model we found that large eyes perform equally well in detecting point targets and large luminous targets in the deep sea. The eyes of giant and colossal squid do not appear exceptionally large when allometric effects are considered. It is probable that the giant eyes of giant squid result from a phylogenetically conserved developmental pattern manifested in very large animals. Whatever the cause of large eyes, they appear to have several advantages for vision in the reduced light of the deep mesopelagic zone.

  1. Topography of the medullar cone in the giant anteater (Myrmecophaga tridactyla Linnaeus, 1758

    Directory of Open Access Journals (Sweden)

    Lucas de Assis Ribeiro

    2015-12-01

    Full Text Available ABSTRACT. Ribeiro L.A., Souza T.A.M., Ribeiro P.R.Q., Santos L.A., Silva D.C.O., Carneiro e Silva F.O., Barros R.A.C. & Zanon R.G. [Topography of the medullar cone in the giant anteater (Myrmecophaga tridactyla Linnaeus, 1758.] Topografia do cone medular do Tamanduá-bandeira (Myrmecophaga tridactyla Linnaeus, 1758. Revista Brasileira de Medicina Veterinária, 37(4:353-358, 2015. Programa de Pós-Graduação em Ciências Veterinárias e Zootecnia, Faculdade de Medicina Veterinária, Universidade Federal de Uberlândia, Rua João Naves de Ávila, 2121, Uberlândia, MG 38408-100, Brasil. E-mail: lucasassis83@yahoo.com.br The giant anteater (Myrmecophaga tridactyla is a representative of the Order Hairy, belonging to the family Myrmecophagidae. General approaches on the behavior, ecology and physical abilities of this animal are available in the literature. However, information regarding different aspects of the anatomy of the nervous system giant anteater are sparsely found. Therefore, the morphological knowledge of the relationship between the spinal cord and vertebral column is of great importance to the scientific, as in the various species of animals, whether domestic or not, the relations of the caudal spinal differ. This difference comes out to meet the interests of wild animal medicine, especially as support for the practice of epidural anesthesia. Thus, the objective was to describe the topography of the conus M. tridactyla, providing anatomical data as a basis for the practice of epidural anesthesia. For this study we used three specimens of giant anteater, prepared by the usual techniques in Macroscopic Anatomy, which had three sacral vertebrae and 4. Sendo que a base do cone medular foi registrada ao nível da terceira vértebra lombar (L3, com comprimento variando entre 3,5cm e 4,5cm e ápice localizando-se ao nível da segunda vértebra sacral (S2. These anatomical findings may point out as a safe place to perform epidural anesthesia

  2. Diffusion tensor magnetic resonance imaging and fiber tractography of the sacral plexus in children with spina bifida

    DEFF Research Database (Denmark)

    Haakma, Wieke; Dik, Pieter; ten Haken, Bennie

    2014-01-01

    anatomical and microstructural properties of the sacral plexus of patients with spina bifida using diffusion tensor imaging and fiber tractography. MATERIALS AND METHODS: Ten patients 8 to 16 years old with spina bifida underwent diffusion tensor imaging on a 3 Tesla magnetic resonance imaging system...... diffusivity values at S1-S3 were significantly lower in patients. CONCLUSIONS: To our knowledge this 3 Tesla magnetic resonance imaging study showed for the first time sacral plexus asymmetry and disorganization in 10 patients with spina bifida using diffusion tensor imaging and fiber tractography...

  3. Single-fraction vs. fractionated linac-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study

    NARCIS (Netherlands)

    Meijer, O. W. M.; Vandertop, W. P.; Baayen, J. C.; Slotman, B. J.

    2003-01-01

    PURPOSE: In this single-institution trial, we investigated whether fractionated stereotactic radiation therapy is superior to single-fraction linac-based radiosurgery with respect to treatment-related toxicity and local control in patients with vestibular schwannoma. METHODS AND MATERIALS: All 129

  4. Jugular Foramen Collision Tumor (Schwannoma and Plasma Cell Pseudotumor), a Probable IgG4-Related Disease.

    Science.gov (United States)

    Bakhit, Mudathir S; Fujii, Masazumi; Jinguji, Shinya; Sato, Taku; Sakuma, Jun; Saito, Kiyoshi

    2017-06-01

    Lower cranial nerve sheath tumors are relatively rare. Cases of schwannoma collision tumors have rarely been reported, with most of the reported cases describing schwannoma and meningioma collision tumors. We report a very rare case of a cerebellopontine angle collision tumor of the ninth cranial nerve schwannoma with an IgG4 plasma cell pseudotumor. IgG4 plasma cell pseudotumors comprise a group of diseases called IgG4-related diseases (IgG4-RDs). These diseases usually affect organs such as the pancreas and salivary gland. Few cases of nervous system IgG4-RDs have been reported. Under intraoperative microscopy, the tumor in our case did not appear different from usual cases of schwannoma, but histopathology showed significant infiltration of IgG4 plasma cells. IgG4-RDs have a distinctive histopathologic pattern; however, their pathophysiology remains unclear. Special attention must be paid to the diagnosis of such diseases because they mimic other diseases and can be missed. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Ten-Year Follow-up on Tumor Growth and Hearing in Patients Observed With an Intracanalicular Vestibular Schwannoma

    DEFF Research Database (Denmark)

    Kirchmann, Malene; Karnov, Kirstine; Hansen, Søren

    2017-01-01

    BACKGROUND: Reports on the natural history of tumor growth and hearing in patients with a vestibular schwannoma (VS) are almost exclusively short-term data. Long-term data are needed for comparison with results of surgery and radiotherapy.  OBJECTIVE: To report the long-term occurrence of tumor g...

  6. Impact of video-endoscopy on the results of retrosigmoid-transmeatal microsurgery of vestibular schwannoma: prospective study

    Czech Academy of Sciences Publication Activity Database

    Chovanec, M.; Zvěřina, E.; Profant, Oliver; Skřivan, J.; Čakrt, O.; Lisý, J.; Betka, J.

    2013-01-01

    Roč. 270, č. 4 (2013), s. 1277-1284 ISSN 0937-4477 Grant - others:GA MZd(CZ) NS9909 Institutional support: RVO:68378041 Keywords : vestibular schwannoma * acoustic neuroma * endoscopy-assisted microsurgery Subject RIV: FH - Neurology Impact factor: 1.608, year: 2013

  7. Vestibular schwannomas: Accuracy of tumor volume estimated by ice cream cone formula using thin-sliced MR images.

    Science.gov (United States)

    Ho, Hsing-Hao; Li, Ya-Hui; Lee, Jih-Chin; Wang, Chih-Wei; Yu, Yi-Lin; Hueng, Dueng-Yuan; Ma, Hsin-I; Hsu, Hsian-He; Juan, Chun-Jung

    2018-01-01

    We estimated the volume of vestibular schwannomas by an ice cream cone formula using thin-sliced magnetic resonance images (MRI) and compared the estimation accuracy among different estimating formulas and between different models. The study was approved by a local institutional review board. A total of 100 patients with vestibular schwannomas examined by MRI between January 2011 and November 2015 were enrolled retrospectively. Informed consent was waived. Volumes of vestibular schwannomas were estimated by cuboidal, ellipsoidal, and spherical formulas based on a one-component model, and cuboidal, ellipsoidal, Linskey's, and ice cream cone formulas based on a two-component model. The estimated volumes were compared to the volumes measured by planimetry. Intraobserver reproducibility and interobserver agreement was tested. Estimation error, including absolute percentage error (APE) and percentage error (PE), was calculated. Statistical analysis included intraclass correlation coefficient (ICC), linear regression analysis, one-way analysis of variance, and paired t-tests with P ice cream cone method, and ellipsoidal and Linskey's formulas significantly reduced the APE to 11.0%, 10.1%, and 12.5%, respectively (all P ice cream cone method and other two-component formulas including the ellipsoidal and Linskey's formulas allow for estimation of vestibular schwannoma volume more accurately than all one-component formulas.

  8. Schwannoma of the Median Nerve at the Wrist and Palmar Regions of the Hand: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Harun Kütahya

    2013-01-01

    Full Text Available Schwannomas are also known as neurolemmas that are usually originated from Schwann cells located in the peripheric nerve sheaths. They are the most common tumours of the hand (0.8–2%. They usually present solitary swelling along the course of the nerve however multiple lesions may be present in cases of NF type 1, familial neurofibromatosis, and sporadic schwannomatosis. Schwannomas are generally represented as an asymptomatic mass; however pain, numbness and fatigue may take place with the increasing size of the tumour. EMG (electromyelography, MRI (magnetic resonance imagination, and USG (ultrasound are helpful in the diagnosis. Surgical removal is usually curative. In this paper, we present a 24-year-old male referred to our clinic for a lump located at the volar side of the left wrist and a lump located in his left palm and numbness at his 3rd and 4th fingers. Total excision was performed for both lesions. Histopathological examination of the masses revealed typical features of schwannoma. At the 6th-month followup the patient was symptom-free except for slight paresthesia of the 3rd and the 4th fingers. For our knowledge, this is the second case in the literature presenting wrist and palm involvement of the median nerve schwannoma.

  9. Ipsilateral Hip Dysplasia in Patients with Sacral Hemiagenesis: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Tadatsugu Morimoto

    2015-01-01

    Full Text Available Sacral agenesis (SA is a rare condition consisting of the imperfect development of any part of the sacrum. This paper describes two cases of the rare cooccurrence of ipsilateral SA and developmental dysplasia of the hip (DDH and analyzes possible contributory factors for SA and DDH. Each of a 16-year-old female and 13-year-old female visited our hospital for left hip pain and limping. The findings of physical examinations showed a lower limb length discrepancy (left side in both cases, as well as left hip pain without limitations of the range of motion or neurological deficits. Initial radiographs demonstrated left subluxation of the left hip with associated acetabular dysplasia and partial left sacral agenesis. MRI revealed a tethering cord with a fatty filum terminale, and periacetabular osteotomy combined with allogeneic bone grafting was performed. After the surgery, the patients experienced no further pain, with no leg length discrepancy and were able to walk without a limp, being neurologically normal with a normal left hip range of motion. The cooccurrence of SA and DDH suggests a plausible hypothesis to explain the embryogenic relationship between malformation of the sacrum and hip.

  10. Combined V-Y Fasciocutaneous Advancement and Gluteus Maximus Muscle Rotational Flaps for Treating Sacral Sores

    Directory of Open Access Journals (Sweden)

    Hyun Ho Han

    2016-01-01

    Full Text Available The sacral area is the most common site of pressure sore in bed-ridden patients. Though many treatment methods have been proposed, a musculocutaneous flap using the gluteus muscles or a fasciocutaneous flap is the most popular surgical option. Here, we propose a new method that combines the benefits of these 2 methods: combined V-Y fasciocutaneous advancement and gluteus maximus muscle rotational flaps. A retrospective review was performed for 13 patients who underwent this new procedure from March 2011 to December 2013. Patients’ age, sex, accompanying diseases, follow-up duration, surgical details, complications, and recurrence were documented. Computed tomography was performed postoperatively at 2 to 4 weeks and again at 4 to 6 months to identify the thickness and volume of the rotational muscle portion. After surgery, all patients healed within 1 month; 3 patients experienced minor complications. The average follow-up period was 13.6 months, during which time 1 patient had a recurrence (recurrence rate, 7.7%. Average thickness of the rotated muscle was 9.43 mm at 2 to 4 weeks postoperatively and 9.22 mm at 4 to 6 months postoperatively (p=0.087. Muscle thickness had not decreased, and muscle volume was relatively maintained. This modified method is relatively simple and easy for reconstructing sacral sores, provides sufficient padding, and has little muscle donor-site morbidity.

  11. Effects of acute urinary bladder overdistension on bladder response during sacral neurostimulation.

    Science.gov (United States)

    Bross, S; Schumacher, S; Scheepe, J R; Zendler, S; Braun, P M; Alken, P; Jünemann, K

    1999-10-01

    Urinary retention and micturition disorders after overdistension are clinically well-known complications of subvesical obstruction. We attempted to evaluate whether bladder overdistension influences bladder response and whether overdistension supports detrusor decompensation. Following lumbal laminectomy in 9 male foxhounds, the sacral anterior roots S2 and S3 were placed into a modified Brindley electrode for reproducible and controlled detrusor activation. The bladder was filled in stages of 50 ml from 0 to 700 ml, corresponding to an overdistension. At each volume, the bladder response during sacral anterior root stimulation was registered. After overdistension, the bladder was refilled stepwise from 0 to 300 ml and stimulated. In all dogs, the bladder response was influenced by the intravesical volume. The maximum pressure (mean 69.1 cm H(2)O) was observed at mean volume of 100 ml. During overdistension, a significant reduction in bladder response of more than 80% was seen. After overdistension, a significant reduction in intravesical pressure of 19.0% was observed. In 2 cases, reduction in bladder response was more than 50% after a single overdistension. We conclude that motoric bladder function is influenced during and after overdistension. A single bladder overdistension can support acute and long-lasting detrusor decompensation. In order to protect motoric bladder function, bladder overdistension must be prevented.

  12. Neurostimulation for bladder evacuation: is sacral root stimulation a substitute for microstimulation?

    Science.gov (United States)

    Probst, M; Piechota, H J; Hohenfellner, M; Gleason, C A; Tanagho, E A

    1997-04-01

    To determine by anatomical and functional studies whether stimulation of sacral rootlets might permit selective stimulation of autonomic fibres, thus avoiding the detrusor/sphincter dyssynergia characteristic of current techniques of neurostimulation for bladder evacuation. In 10 male mongrel dogs, the S2 root was isolated and its constituent rootlets followed from their origin in the spinal cord to the point of exit from the dura. The entire root and the individual rootlets were then stimulated, including intra- and extra-dural stimulation and at proximal, mid and distal levels. Neuroanatomical and histological findings showed that rootlets of ventral S2 maintain their identity throughout their intradural course; some carry predominantly autonomic fibres, some predominantly somatic and some a mixture of the two. It appears surgically feasible to identify, isolate and sever the predominantly somatic rootlets intradurally, sparing the predominantly autonomic rootlets for inclusion in extradural electrode placement around the entire sacral root, thus eliminating sphincteric interference with detrusor contraction for voiding at low pressure.

  13. A new technique for long time catheterization of sacral epidural canal in rabbits.

    Science.gov (United States)

    Erkin, Yüksel; Aydın, Zeynep; Taşdöğen, Aydın; Karcı, Ayşe

    2013-01-01

    In this study we aimed to develop a simple and practical technique for chronic sacral epidural catheterization of rabbits. We included ten rabbits weighing 2-2.5 kg in the study. After anesthesia and analgesia, we placed an epidural catheter by a 2 cm longitudinal skin incision in the tail above the sacral hiatus region. We confirmed localization by giving 1% lidocaine (leveling sensory loss and motor function loss of the lower extremity). The catheter was carried forward through a subcutaneous tunnel and fixed at the neck. Chronic caudal epidural catheter placement was succesful in all rabbits. The catheters stayed in place effectively for ten days. We encountered no catheter complications during this period. The localization of the catheter was reconfirmed by 1% lidocaine on the last day. After animals killing, we performed a laminectomy and verified localization of the catheter in the epidural space. Various methods for catheterization of the epidural space in animal models exist in the literature. Epidural catheterization of rabbits can be accomplished by atlanto-occipital, lumbar or caudal routes by amputation of the tail. Intrathecal and epidural catheterization techniques defined in the literature necessitate surgical skill and knowledge of surgical procedures like laminectomy and tail amputation. Our technique does not require substantial surgical skill, anatomical integrity is preserved and malposition of the catheter is not encountered. In conclusion, we suggest that our simple and easily applicable new epidural catheterization technique can be used as a model in experimental animal studies.

  14. Residential traffic noise exposure and vestibular schwannoma - a Danish case-control study.

    Science.gov (United States)

    Roswall, Nina; Stangerup, Sven-Eric; Cayé-Thomasen, Per; Schüz, Joachim; Johansen, Christoffer; Jensen, Steen Solvang; Raaschou-Nielsen, Ole; Sørensen, Mette

    2017-10-01

    Few risk factors for sporadic vestibular schwannoma (VS) are known. Several studies have proposed an increased risk with occupational noise exposure, whereas no studies have investigated residential traffic noise exposure as a risk factor. The present study investigated if residential traffic noise was associated with vestibular schwannoma in a large, population-based Danish case-control study. We identified 1454 VS cases, age above 30 years at diagnosis, between 1990 and 2007. For each case, we selected two random population controls, matched on sex and year of birth. Road and railway traffic noise at the residence was calculated for all present and historical addresses between 1987 and index date. Associations between traffic noise and risk for VS were estimated using conditional logistic regression, adjusted for education, disposable personal income, cohabitation status, railway noise exposure, municipal population density, and municipal income. A two-year time-weighted mean road traffic noise exposure was associated with an adjusted odds ratio of 0.92 (0.82-1.03) for developing VS, per 10 dB increment. There was no clear trend in categorical analyses. Similarly, linear and categorical analyses of residential railway noise did not suggest an association. We found no interaction with demographics, year of diagnosis, individual and municipal socioeconomic variables, and railway noise exposure. The results did not differ by tumor side, spread or size. The present study does not suggest an association between residential traffic noise and VS.

  15. Magnetic resonance cisternography using the fast spin echo method for the evaluation of vestibular schwannoma

    Energy Technology Data Exchange (ETDEWEB)

    Nishizawa, Shigeru; Yokoyama, Tetsuo; Uemura, Kenichi [Hamamatsu Univ. School of Medicine, Shizuoka (Japan)

    1999-04-01

    Neuroimaging of vestibular schwannoma was performed with the fat-suppression spoiled gradient recalled acquisition in the steady state (SPGR) method and magnetic resonance (MR) cisternography, which is a fast spin echo method using a long echo train length, for the preoperative evaluation of the lateral extension of the tumor in the internal auditory canal, and the anatomical identification of the posterior semicircular canal and the nerves in the canal distal to the tumor. The SPGR method overestimated the lateral extension in eight cases, probably because of enhancement of the nerves adjacent to the tumor in the canal. The posterior semicircular canal could not be clearly identified, and the cranial nerves in the canal were shown only as a nerve bundle. In contrast, MR cisternography showed clear images of the lateral extension of the tumor and the facial and cochlear nerves adjacent to the tumor in the internal auditory canal. The anatomical location of the posterior semicircular canal was also clearly shown. These preoperative findings are very useful to plan the extent to which the internal auditory canal can be opened, and for intraoperative identification of the nerves in the canal. MR cisternography is less invasive since no contrast material or radiation is required, as with thin-slice high-resolution computed tomography (CT). MR cisternography should replace high-resolution CT for the preoperative neuroradiological evaluation of vestibular schwannoma. (author)

  16. Tissue-Specific Ablation of Prkar1a Causes Schwannomas by Suppressing Neurofibromatosis Protein Production

    Directory of Open Access Journals (Sweden)

    Georgette N. Jones

    2008-11-01

    Full Text Available Signaling events leading to Schwann cell tumor initiation have been extensively characterized in the context of neurofibromatosis (NF. Similar tumors are also observed in patients with the endocrine neoplasia syndrome Carney complex, which results from inactivating mutations in PRKAR1A. Loss of PRKAR1A causes enhanced protein kinase A activity, although the pathways leading to tumorigenesis are not well characterized. Tissue-specific ablation of Prkar1a in neural crest precursor cells (TEC3KO mice causes schwannomas with nearly 80% penetrance by 10 months. These heterogeneous neoplasms were clinically characterized as genetically engineered mouse schwannomas, grades II and III. At the molecular level, analysis of the tumors revealed almost complete loss of both NF proteins, despite the fact that transcript levels were increased, implying posttranscriptional regulation. Although Erk and Akt signaling are typically enhanced in NF-associated tumors, we observed no activation of either of these pathways in TEC3KO tumors. Furthermore, the small G proteins Ras, Rac1, and RhoA are all known to be involved with NF signaling. In TEC3KO tumors, all three molecules showed modest increases in total protein, but only Rac1 showed significant activation. These data suggest that dysregulated protein kinase A activation causes tumorigenesis through pathways that overlap but are distinct from those described in NF tumorigenesis.

  17. [Dumbbell malignant dorsal schwannoma embolized and operated by single posterior approach].

    Science.gov (United States)

    Zabalo, Gorka; de Frutos, Daniel; García, Juan Carlos; Ortega, Rodrigo; Guelbenzu, Juan José; Zazpe, Idoya

    2018-02-19

    We report a case of a 41 years old patient complaining of chronic dorsalgia. MRI showed a well defined intradural extramedular dumbbell-shaped lesion, associated to a left paravertebral tumor at D5-D6 level. The tumor was embolizated prior to surgery. Following she underwent a D4-D6 laminotomy, left D5-D6 costotransversectomy and resection of the intracanal extradural part of the lesion with section of the left D5 nerve. Posteriorly, complete resection of the extracanal portion of the tumor was performed by a postero-lateral approach. The anatomopathologic diagnosis was a malignant schwannoma. After the surgery, the patient required adyuvant radiotherapic treatment. Malignant schwannoma is a very uncommon tumor which belongs to the malignant peripheral nerve sheath tumors (MPNST). It develops from Schwann cells. It is frequently associated with type 1 neurofibromatosis. MPNST usually present local recurrence and can metastatize. Copyright © 2018 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Thorascopic resection of an apical paraspinal schwannoma using the da Vinci surgical system.

    Science.gov (United States)

    Finley, David; Sherman, Jonathan H; Avila, Edward; Bilsky, Mark

    2014-01-01

    Posterior mediastinal neurogenic tumors have traditionally been resected via an open posterolateral thoracotomy. Video-assisted thorascopic surgery has emerged as an alternative technique allowing for improved morbidity with decreased blood loss, less postoperative pain, and a shorter recovery period, among others. The da Vinci surgical system, as first described for urologic procedures, has recently been reported for lung lobectomy. This technique provides the advantages of instrumentation with 6 degrees of freedom, stable operating arms, and improved visualization with the three-dimensional high-definition camera. We describe the technique for thorascopic resection of an apical paraspinal schwannoma of the T1 nerve root with the da Vinci surgical system. This technique used a specialized intraoperative neuromonitoring probe for free-running electromyography (EMG) and triggered EMG. We demonstrate successful resection of a posterior paraspinal schwannoma with the da Vinci surgical system while preserving neurologic function. The patient displayed stable intraoperative monitoring of the T1 nerve root and full intrinsic hand strength postoperatively. The technique described in this article introduces robotic system accuracy and precludes the need for an open thoracotomy. In addition, this approach demonstrates the ability of the da Vinci surgical system to safely dissect tumors from their neural attachments and is applicable to other such lesions of similar size and location. Georg Thieme Verlag KG Stuttgart · New York.

  19. Gamma knife radiosurgery for acoustic Schwannoma. Early effects and preservation of hearing

    Energy Technology Data Exchange (ETDEWEB)

    Hirato, Masafumi; Inoue, Hiroshi; Nakamura, Masaru; Ohye, Chihiro; Hirato, Junko [Gunma Univ., Maebashi (Japan). School of Medicine; Shibazaki, Tohru; Andou, Yoshitaka

    1995-10-01

    The effects of relatively low dose gamma knife irradiation on acoustic Schwannoma were evaluated. The signal intensity change and tumor shrinkage on magnetic resonance (MR) images, change in hearing, and complications in 28 patients (mean age 47.0{+-}13.6 yrs) were studied. Three patients had bilateral tumors. Six were already deaf when treated. The maximum tumor diameter was 35 mm. The mean dose delivered to the tumor was 12.1{+-}1.6 Gy at the periphery, and 25.2{+-}4.3 Gy at the center. The mean follow-up time was 16 months and the longest 24 months. Lowering of the MR signal intensity in the tumor center appeared after 3 months at earliest but generally after 6 months. Signs of tumor shrinkage appeared within 12 months on average. Cyst in the tumor enlarged rapidly after treatment in two patients. The percentage of hearing preservation was 85% (17/20) at 3 months, 80% (16/20) at 6 months, 72% (13/18) at 9 months, 75% (12/16) at 12 months, 67% (8/12) at 15 months, 60% (6/10) at 18 months, and 50% (2/4) at 24 months. Subtle changes in hearing were detected by speech tone audiometry. Temporary facial numbness and weakness was seen in one patient each. No patient had lower cranial nerve paresis. Relatively low dose gamma knife radiosurgery is effective in suppressing growth of acoustic Schwannoma with preservation of hearing. (author).

  20. Gamma knife radiosurgery for acoustic Schwannoma. Early effects and preservation of hearing

    International Nuclear Information System (INIS)

    Hirato, Masafumi; Inoue, Hiroshi; Nakamura, Masaru; Ohye, Chihiro; Hirato, Junko; Shibazaki, Tohru; Andou, Yoshitaka.

    1995-01-01

    The effects of relatively low dose gamma knife irradiation on acoustic Schwannoma were evaluated. The signal intensity change and tumor shrinkage on magnetic resonance (MR) images, change in hearing, and complications in 28 patients (mean age 47.0±13.6 yrs) were studied. Three patients had bilateral tumors. Six were already deaf when treated. The maximum tumor diameter was 35 mm. The mean dose delivered to the tumor was 12.1±1.6 Gy at the periphery, and 25.2±4.3 Gy at the center. The mean follow-up time was 16 months and the longest 24 months. Lowering of the MR signal intensity in the tumor center appeared after 3 months at earliest but generally after 6 months. Signs of tumor shrinkage appeared within 12 months on average. Cyst in the tumor enlarged rapidly after treatment in two patients. The percentage of hearing preservation was 85% (17/20) at 3 months, 80% (16/20) at 6 months, 72% (13/18) at 9 months, 75% (12/16) at 12 months, 67% (8/12) at 15 months, 60% (6/10) at 18 months, and 50% (2/4) at 24 months. Subtle changes in hearing were detected by speech tone audiometry. Temporary facial numbness and weakness was seen in one patient each. No patient had lower cranial nerve paresis. Relatively low dose gamma knife radiosurgery is effective in suppressing growth of acoustic Schwannoma with preservation of hearing. (author)

  1. Foramen magnum schwannoma: review of the literature and report of a case

    International Nuclear Information System (INIS)

    Nacif, Marcelo Souto; Caiado, Stella; Oliveira, Nidia di Paula Silva; Paula Neto, Walter Teixeira de; Campos, Flavio do Amaral; Santos, Alair Augusto Sarmet Moreira Damas dos

    2001-01-01

    The authors report an unusual presentation of a voluminous neck schwannoma in a 53-year-old female that presented with a three-year history of progressive weakness associated with impaired movement of the limbs. Neurological examination revealed postural instability, unstable and paraparetic gait, tetraparesis and dyspnea. A preoperative magnetic resonance imaging of the neck revealed an expansive, extradural, well-circumscribed lesion, with soft-tissue attenuation, at the level of C1-C2 vertebral bodies. During surgery, the tumor was found to be extradural, lateral to the cervical spinal cord, attached to the C1 left nerve root and extending upwards through the foramen magnum. Histopathological analysis of the resected specimen confirmed the diagnosis of schwannoma. The patient showed a favorable outcome with progressive improvement of the symptoms. Magnetic resonance imaging proved to be valuable in the detection and evaluation of the lesion, although the definite diagnosis was achieved only after histopathological studies. We concluded that magnetic resonance imaging for early diagnosis and prompt surgical resection seems to be the best approach to achieve good prognosis. (author)

  2. Stereotactic Radiosurgery versus Natural History in Patients with Growing Vestibular Schwannomas.

    Science.gov (United States)

    Tu, Albert; Gooderham, Peter; Mick, Paul; Westerberg, Brian; Toyota, Brian; Akagami, Ryojo

    2015-08-01

    Objective To describe our experience with stereotactic radiosurgery and its efficacy on growing tumors, and then to compare this result with the natural history of a similar cohort of non-radiation-treated lesions. Study Design A retrospective chart review and cohort comparison. Methods The long-term control rates of patients having undergone radiosurgery were collected and calculated, and this population was then compared with a group of untreated patients from the same period of time with growing lesions. Results A total of 61 patients with growing vestibular schwannomas treated with radiosurgery were included. After a mean of 160 months, we observed a control rate of 85.2%. When compared with a group of 36 patients with growing tumors who were yet to receive treatment (previously published), we found a corrected control rate or relative risk reduction of only 76.8%. Conclusion Radiosurgery for growing vestibular schwannomas is less effective than previously reported in unselected series. Although radiosurgery still has a role in managing this disease, consideration should be given to the actual efficacy that may be calculated when the natural history is known. We hope other centers will similarly report their experience on this cohort of patients.

  3. Lack of association between human herpesvirus and vestibular schwannoma: analysis of 121 cases.

    Science.gov (United States)

    Bhimrao, Sanjiv K; Maguire, John; Garnis, Cathie; Tang, Patrick; Lea, Jane; Akagami, Ryojo; Westerberg, Brian D

    2015-03-01

    To assess for the presence of human herpesvirus (HHV) using immunohistochemical and polymerase chain reaction (PCR) assay in surgically excised vestibular schwannoma (VS) samples. Cross-sectional study. A retrospective laboratory-based study of tumors from patients with vestibular schwannoma. Tissue microarrays (TMAs) representing sporadic and NF2-associated VS from 121 patients, as well as appropriate positive and negative controls, were studied. TMA sections were immunostained using antibodies directed against HHV-1, HHV-2, HHV-3, HHV-4, HHV-5, and HHV-8. PCR was used for the detection of all 8 known human herpesviruses. There was no detectable HHV (HHV-1, HHV-2, HHV-3, HHV-4, HHV-5, HHV-8) by immunohistochemistry in any of the 121 cases of sporadic and NF2 cases analyzed. These data were further validated by DNA sequence analyses using PCR in a subset of the VS samples, all of which were found to be negative for all HHV. The data offer no support for an association between HHV and the development of sporadic or NF2-associated VS in humans. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  4. Surgical management of vestibular schwannoma: attempted preservation of hearing and facial function.

    Science.gov (United States)

    Youssef, T F; Matter, A; Ahmed, M R

    2013-05-01

    Vestibular schwannomas are benign tumours which usually originate from the vestibular portion of the VIIIth cranial nerve. Treatment options include observation with serial imaging, stereotactic radiation and microsurgical removal. The goal of surgery was complete eradication of tumour with preservation of hearing and facial nerve function. A retrospective review was undertaken of 24 cases of vestibular schwannoma jointly operated upon by a team of neurosurgeons and otologists at the Suez Canal University Hospital, with assessment of VIIth and VIIIth cranial nerve function, tumour size, and extent of growth. All surgery utilised a retromastoid, suboccipital approach. Complete tumour removal was achieved in 19 patients. Anatomical preservation of the facial nerve was possible in 66.6 per cent of patients. Pre-operative, useful hearing was present in four patients, and preserved in 80 per cent. Cerebrospinal fluid leakage was diagnosed in two (8.3 per cent) patients, who responded to conservative therapy. The retromastoid, suboccipital surgical approach to the skull base can be safely and successfully achieved using a microsurgical technique, with minimal or no damage to neurovascular structures, even for large tumours.

  5. Recurrent giant juvenile fibroadenoma

    Directory of Open Access Journals (Sweden)

    Kathryn S. King

    2017-11-01

    Full Text Available Breast masses in children, though rare, present a difficult clinical challenge as they can represent a wide variety of entities from benign fibroadenomas to phyllodes tumors. Rapidly growing or recurrent masses can be particularly concerning to patients, families and physicians alike. Clinical examination and conventional imaging modalities are not efficacious in distinguishing between different tumor types and surgical excision is often recommended for both final diagnosis and for treatment of large or rapidly growing masses. While surgical excision can result in significant long-term deformity of the breast there are some surgical techniques that can be used to limit deformity and/or aid in future reconstruction. Here we present a case of recurrent giant juvenile fibroadenoma with a review of the clinical presentation, diagnostic tools and treatment options.

  6. Hadron excitation of giant resonances

    International Nuclear Information System (INIS)

    Morsch, H.-P.

    1985-01-01

    A review is given on giant resonance studies in heavy nuclei using scattering of different hadronic probes. Concerning isoscalar giant resonances compression modes are discussed with the possibility to obtain more detailed structure information. From detailed studies of α scattering the distribution of isoscalar strengths of multipolarity up to L=6 was obtained. Some recent aspects of heavy ion excitation of collective modes are mentioned. The possibility to study isovector giant resonances in hadron charge exchange reactions is discussed. Finally, a comparison is made between α and 200 MeV proton scattering from which isoscalar and spin-isospin continuum response are extracted. (orig.)

  7. Maxillomandibular giant osteosclerotic lesions

    Directory of Open Access Journals (Sweden)

    Constantino LEDESMA-MONTES

    2018-06-01

    Full Text Available Abstract Giant Osteosclerotic Lesions (GOLs are a group of rarely reported intraosseous lesions. Their precise diagnosis is important since they can be confused with malignant neoplasms. Objective This retrospective study aimed to record and analyze the clinical and radiographic Giant Osteosclerotic Lesions (GOLs detected in the maxillomandibular area of patients attending to our institution. Materials and Methods: Informed consent from the patients was obtained and those cases of 2.5 cm or larger lesions with radiopaque or mixed (radiolucid-radiopaque appearance located in the maxillofacial bones were selected. Assessed parameters were: age, gender, radiographic aspect, shape, borders, size, location and relations to roots. Lesions were classified as radicular, apical, interradicular, interradicular-apical, radicular-apical or located in a previous teeth extraction area. Additionally, several osseous and dental developmental alterations (DDAs were assessed. Results Seventeen radiopacities in 14 patients were found and were located almost exclusively in mandible and were two types: idiopathic osteosclerosis and condensing osteitis. GOLs were more frequent in females, and in the anterior and premolar zones. 94.2% of GOLs were qualified as idiopathic osteosclerosis and one case was condensing osteitis. All studied cases showed different osseous and dental developmental alterations (DDAs. The most common were: Microdontia, hypodontia, pulp stones, macrodontia and variations in the mental foramina. Conclusions GOLs must be differentiated from other radiopaque benign and malignant tumors. Condensing osteitis, was considered an anomalous osseous response induced by a chronic low-grade inflammatory stimulus. For development of idiopathic osteosclerosis, two possible mechanisms could be related. The first is modification of the normal turnover with excessive osseous deposition. The second mechanism will prevent the normal bone resorption, arresting the

  8. Hypointensity on postcontrast MR imaging from compression of the sacral promontory in enlarged uterus with huge leiomyoma and adenomyosis

    International Nuclear Information System (INIS)

    Uotani, Kensuke; Monzawa, Shuichi; Adachi, Shuji; Takemori, Masayuki; Kaji, Yasushi; Sugimura, Kazuro

    2007-01-01

    In patients with huge leiomyoma and with adenomyosis of the uterus, a peculiar area of hypointensity was occasionally observed on postcontrast magnetic resonance (MR) imaging in the dorsal portion of the enlarged uterus near the sacral promontory. We describe the imaging characteristics of these MR findings and correlate them with histopathological findings to examine whether the areas represent specific pathological changes. Ten patients with huge leiomyomas and two with huge adenomyotic lesions whose imaging revealed the hypointensity were enrolled. All had enlarged uteri that extended beyond the sacral promontory. MR findings of the hypointense areas were evaluated and correlated with histopathological findings in 5 patients with leiomyoma and two with adenomyosis who had hysterectomy. The ten patients with leiomyoma showed flare-shaped hypointensity arising from the dorsal surface of the uterine body that extended deep into the tumor. The base of the hypointense areas was narrow in 5 patients with intramural leiomyoma and broad in five with subserosal leiomyoma. Two patients with adenomyosis showed nodular-shaped areas of hypointensity in front of the sacral promontory. Precontrast T 1 - and T 2 -weighted MR images showed no signal abnormalities in the portions corresponding to the hypointensity in any of the 12 patients. Pathological examinations showed no specific findings in the portions corresponding to the hypointensity in the 7 patients who had hysterectomy. The areas of hypointensity may represent functional changes, such as decreased localized blood flow caused by compression of the sacral promontory. (author)

  9. Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model.

    LENUS (Irish Health Repository)

    Griffin, K M

    2011-08-01

    Sacral and posterior tibial nerve stimulation may be used to treat faecal incontinence; however, the mechanism of action is unknown. The aim of this study was to establish whether sensory activation of the cerebral cortex by anal canal stimulation was increased by peripheral neuromodulation.

  10. Collective motion and giant resonances

    International Nuclear Information System (INIS)

    Wilhelmi, Z.; Kicinska-Habior, M.

    1984-01-01

    The report contains 15 papers devoted to problems of giant collective excitations of nuclei, heavy-ion induced reactions and their bearing on various aspects of nuclear structure. In some of them the numerical data are given. (A.S.)

  11. Mechanical comparison between lengthened and short sacroiliac screws in sacral fracture fixation: a finite element analysis.

    Science.gov (United States)

    Zhao, Y; Zhang, S; Sun, T; Wang, D; Lian, W; Tan, J; Zou, D; Zhao, Y

    2013-09-01

    To compare the stability of lengthened sacroiliac screw and standard sacroiliac screw for the treatment of unilateral vertical sacral fractures; to provide reference for clinical applications. A finite element model of Tile type C pelvic ring injury (unilateral Denis type II fracture of the sacrum) was produced. The unilateral sacral fractures were fixed with lengthened sacroiliac screw and sacroiliac screw in six different types of models respectively. The translation and angle displacement of the superior surface of the sacrum (in standing position on both feet) were measured and compared. The stability of one lengthened sacroiliac screw fixation in S1 or S2 segment is superior to that of one sacroiliac screw fixation in the same sacral segment. The stability of one lengthened sacroiliac screw fixation in S1 and S2 segments respectively is superior to that of one sacroiliac screw fixation in S1 and S2 segments respectively. The stability of one lengthened sacroiliac screw fixation in S1 and S2 segments respectively is superior to that of one lengthened sacroiliac screw fixation in S1 or S2 segment. The stability of one sacroiliac screw fixation in S1 and S2 segments respectively is markedly superior to that of one sacroiliac screw fixation in S1 or S2 segment. The vertical and rotational stability of lengthened sacroiliac screw fixation and sacroiliac screw fixation in S2 is superior to that of S1. In a finite element model of type C pelvic ring disruption, S1 and S2 lengthened sacroiliac screws should be utilized for the fixation as regularly as possible and the most stable fixation is the combination of the lengthened sacroiliac screws of S1 and S2 segments. Even if lengthened sacroiliac screws cannot be systematically used due to specific conditions, one sacroiliac screw fixation in S1 and S2 segments respectively is recommended. No matter which kind of sacroiliac screw is used, if only one screw can be implanted, the fixation in S2 segment is more recommended

  12. Incidence, treatment, and survival patterns for sacral chordoma in the United States, 1974-2011

    Directory of Open Access Journals (Sweden)

    Esther Yu

    2016-09-01

    Full Text Available IntroductionSacral chordomas represent one half of all chordomas, a rare neoplasm of notochordal remnants. Current NCCN guidelines recommend surgical resection with or without adjuvant radiotherapy, or definitive radiation for unresectable cases. Recent advances in radiation for chordomas include conformal photon and proton beam radiation. We investigated incidence, treatment, and survival outcomes to observe any trends in response to improvements in surgical and radiation techniques over a near 40 year time period.Materials and Methods345 microscopically confirmed cases of sacral chordoma were identified between 1974 and 2011 from the Surveillance, Epidemiology, and End Results (SEER program of the National Cancer Institute. Cases were divided into three cohorts by calendar year, 1974-1989, 1990-1999, and 2000-2011, as well as into two groups by age less than or equal to 65 versus greater than 65 to investigate trends over time and age via Chi-square analysis. Kaplan-Meier analyses were performed to determine effects of treatment on survival. Multivariate Cox regression analysis was performed to determine predictors of overall survival.Results5-year overall survival for the entire cohort was 60.0%. Overall survival correlated significantly with treatment modality, with 44% surviving at 5 years with no treatment, 52% with radiation alone, 82% surgery alone, and 78% surgery and radiation (p<.001. Age greater than 65 was significantly associated with non-surgical management with radiation alone or no treatment (p<.001. Relatively fewer patients received radiation between 2000 and 2011 compared to prior time periods (p=.03 versus surgery, for which rates which did not vary significantly over time (p=.55. However, 5-year overall survival was not significantly different by time period. Age group and treatment modality were predictive for overall survival on multivariate analysis (p<.001. ConclusionSurgery remains an important component in the

  13. A Randomized Comparison Between Ultrasound- and Fluoroscopy-Guided Sacral Lateral Branch Blocks.

    Science.gov (United States)

    Finlayson, Roderick J; Etheridge, John-Paul B; Elgueta, Maria Francisca; Thonnagith, Atikun; De Villiers, Frederick; Nelems, Bill; Tran, De Q

    This randomized trial compared ultrasound (US)- and fluoroscopy-guided sacral lateral branch (SLB) blocks. We hypothesized that US would require a shorter performance time. Forty patients who required unilateral sacral lateral branch blocks for chronic low back pain were randomized to US or fluoroscopy guidance. Before the performance of the assigned block, an investigator who was not involved in patient care carried out baseline analgesic testing. With US, the dorsal sacroiliac ligament, the sacroiliac joint, and the interosseous ligament were probed with a 22-gauge block needle. The patient was asked to rate the level of discomfort using an 11-point numerical rating scale.After the analgesic test, attending anesthesiologists or supervised trainees carried out the SLB blocks. The local anesthetic agent (lidocaine 2%) was identical in all subjects. In the US group, local anesthetic (1.5 mL) was first injected on the lateral crest at the mid-point between S2 and S3. Subsequently, 2 more injections of 0.5 mL were carried out on the lateral crest, immediately cephalad to S2 and at the S1 level. In the fluoroscopy group, SLB blocks were performed according to a previously described 17-injection technique, which involves 9 skin entry sites and the targeting of the L5 posterior root and S1-S3 sacral lateral branches. A 0.4-mL volume of local anesthetic was deposited at each target point. The performance time, number of needle passes, and the incidence of vascular breach were recorded during the performance of the block.Twenty minutes after the end of local anesthetic injection, the same investigator who performed preblock analgesic testing carried out postblock testing in an identical manner. Compared with fluoroscopy, the US technique was associated with a shorter performance time (267.5 ± 99.3 vs 628.7 ± 120.3 seconds; P < 0.001), fewer needle passes and a lower incidence of vascular breach (0 vs 10 occurrences; P = 0.001). However, the block effect (ie, the

  14. Schwanoma de laringe: relato de caso Schwannoma of the larynx: case report

    Directory of Open Access Journals (Sweden)

    Erich Christiano M. Melo

    2004-04-01

    Full Text Available Schwanomas são tumores benignos, de crescimento lento, encapsulados, que surgem da bainha das células de Schwann de nervos motores, sensitivos ou cranianos, não contendo elementos nervosos. A localização na laringe é extremamente rara, existindo relatos esporádicos na literatura mundial. O objetivo deste trabalho é relatar um caso de schwanoma laríngeo atendido em nosso meio. O paciente de 82 anos de idade, sexo feminino, procurou nosso serviço com queixa de disfagia para sólidos de longa data e sensação de globus faríngeo. A laringoscopia com telescópio rígido de 70º evidenciou um tumor submucoso, arredondado, na região interaritenóidea. A tomografia computadorizada de pescoço mostrou tratar-se de lesão aparentemente sólida, sem necrose central e sem extensão para planos profundos, medindo aproximadamente 2,5 cm no maior diâmetro. A paciente foi submetida a microcirurgia de laringe, com ressecção completa da lesão. O exame histopatológico revelou tratar-se de um schwanoma laríngeo. A paciente evoluiu bem, sem sinais de tumor residual ou recidiva em dois anos de seguimento clínico.Schwannomas are benign, slow-growing, encapsulated tumors, which appear on the sheath of sensitive or cranial motor nerves Schwann cells, and having no nervous elements. They rarely appear on the larynx, and there are sporadic reports in the literature. This work has as purpose to report a case of laryngeal schwannoma. A 82 years-old woman, born and residing in the city of Sao Paulo, SP, went to the Hospital, suffering from slowly progressive, long-term dysphagia for solids and globus sensation. The indirect laryngoscopy with a 70º rigid telescope revealed a submucous tumor, rounded, at the interarytenoid region. A neck computed tomography was made, revealing an apparently solid lesion, with no central necrosis and no extension to deeper levels, the greatest diameter of which was of 2.5 cm. The patient underwent a larynx microsurgery with

  15. Schwannoma intralaberíntico. Descripción de un caso

    Directory of Open Access Journals (Sweden)

    José Antonio CÁMARA-ARNAZ

    2016-03-01

    Full Text Available Introducción y objetivos: El schwannoma intralaberíntico es un tumor benigno muy infrecuente, de lento crecimiento extradural, localizado primariamente en el laberinto membranoso. A través de un caso clínico presentamos las características de su evolución, intentamos ofrecer una explicación fisiopatológica de la sintomatología y de los hallazgos audio-vestibulares y describimos finalmente, las diferentes opciones terapéuticas. Descripción: Se trata de una mujer de 59 años, que comienza con síntomas inespecíficos del oído izquierdo a los que posteriormente se añade una pérdida auditiva. Al confirmar que se trata de una hipoacusia unilateral no justificada, solicitamos una RM que pone de manifiesto la presencia de un pequeño tumor de 2-3 mm intravestibular, al que revisaremos periódicamente. Discusión: El origen y la prevalencia del schwannoma intralaberíntico son desconocidos. Aunque la clínica se confunde con la de otros procesos otológicos más frecuentes, la realización de RM incrementaría el número de casos diagnosticados. En función del paciente, de su sintomatología, de la evolución y de las características tumorales, se decide el tipo de tratamiento Conclusión: El schwannoma intralaberíntico debe formar parte del diagnóstico diferencial en pacientes con síntomas audio-vestibulares unilaterales y solicitar una RM de alta resolución para obtener el diagnóstico definitivo. Presentando un pronóstico excelente, la observación es considerada como la mejor opción terapéutica.

  16. Slip Interface Imaging Predicts Tumor-Brain Adhesion in Vestibular Schwannomas.

    Science.gov (United States)

    Yin, Ziying; Glaser, Kevin J; Manduca, Armando; Van Gompel, Jamie J; Link, Michael J; Hughes, Joshua D; Romano, Anthony; Ehman, Richard L; Huston, John

    2015-11-01

    To test the clinical feasibility and usefulness of slip interface imaging (SII) to identify and quantify the degree of tumor-brain adhesion in patients with vestibular schwannomas. S With institutional review board approval and after obtaining written informed consent, SII examinations were performed in nine patients with vestibular schwannomas. During the SII acquisition, a low-amplitude mechanical vibration is applied to the head with a pillow-like device placed in the head coil and the resulting shear waves are imaged by using a phase-contrast pulse sequence with motion-encoding gradients synchronized with the applied vibration. Imaging was performed with a 3-T magnetic resonance (MR) system in less than 7 minutes. The acquired shear motion data were processed with two different algorithms (shear line analysis and calculation of octahedral shear strain [OSS]) to identify the degree of tumor-brain adhesion. Blinded to the SII results, neurosurgeons qualitatively assessed tumor adhesion at the time of tumor resection. Standard T2-weighted, fast imaging employing steady-state acquisition (FIESTA), and T2-weighted fluid-attenuated inversion recovery (FLAIR) imaging were reviewed to identify the presence of cerebral spinal fluid (CSF) clefts around the tumors. The performance of the use of the CSF cleft and SII to predict the degree of tumor adhesion was evaluated by using the κ coefficient and McNemar test. Among the nine patients, SII agreed with the intraoperative assessment of the degree of tumor adhesion in eight patients (88.9%; 95% confidence interval [CI]: 57%, 98%), with four of four, three of three, and one of two cases correctly predicted as no adhesion, partial adhesion, and complete adhesion, respectively. However, the T2-weighted, FIESTA, and T2-weighted FLAIR images that used the CSF cleft sign to predict adhesion agreed with surgical findings in only four cases (44.4% [four of nine]; 95% CI: 19%, 73%). The κ coefficients indicate good agreement (0

  17. [Association of intercalary cervical bone and occult lumbar and sacral spina bifida. Case report].

    Science.gov (United States)

    Ruiz-Osuna, César; Avila-Zamorano, Myrna Lizeth; Suárez-Ahedo, Carlos; Trueba-Davalillo, Cesáreo

    2009-01-01

    The defects of the spinal cord enclose diverse malformations that go from spina bifida to myelomeningocele but there is also a rare variant that is the intercalary bone. The incidence of this phenomenon may vary in 1 to 1,000 to 5,000. At our knowledge, there are no cases reported where it can be an association of intercalary bone and a bifid spine in different levels. In this article we report the case of one patient that coincide with an intercalary cervical bone, bifid spine in lumbar column and bifid spine in sacral column. The objective of this article is also to comment how the clinical symptoms are unspecific, the chronic pain is the frequent symptom, and how the physiotherapy and anti-inflammatory drugs can provide excellent results in a short and medium term.

  18. Sacral Fracture Nonunion Treated by Bone Grafting through a Posterior Approach

    Directory of Open Access Journals (Sweden)

    Sang Yang Lee

    2013-01-01

    Full Text Available Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery.

  19. The anatomy of the first sacral nerve root sheath shown by computed tomography.

    Science.gov (United States)

    Moore, N R; Dixon, A K; Freer, C E

    1989-08-01

    Analysis of 25 patients with normal computed tomographic appearances at the lumbosacral junction revealed wide variation in the anatomical level at which the first sacral nerve root sheaths were seen emerging from the theca. In nine patients (36%), the S1 nerve root sheaths were first recognized at the level of the lumbosacral disc. In 14 patients (56%), the sheaths emerged cranial to the disc; it is possible that these patients may be more prone to neurological complications related to disc or facet joint disease, especially if the sheath is laterally sited within the lateral recess. Conversely, that minority of patients (two, 8%) in whom the root sheaths emerge caudal to the disc level may be relatively protected from neurological complications.

  20. Development of Marjolin's ulcer following successful surgical treatment of chronic sacral pressure sore

    DEFF Research Database (Denmark)

    Knudsen, M.A.; Biering-Sørensen, Fin

    2008-01-01

    of surgical excision and successful closure of the wound, the patient developed Marjolin's ulcer 2.5 years later. Yet it illustrates the primary importance of preventing the development pressure sores, of aggressive (surgical) therapy with healing when they do arise and of taking frequent biopsies......STUDY DESIGN: Case report. OBJECTIVE: Report of an unusual case, where a Marjolin's ulcer that developed 2.5 years after surgical excision and successful closure. SETTING: Department of Plastic and Reconstructive Surgery and Burn Unit and the Clinic for Spinal Cord Injuries, Copenhagen University...... Hospital, Rigshospitalet, Copenhagen, Denmark. METHODS AND RESULTS: A 22-year-old man sustained a fracture with luxation of the 5th and 6th cervical vertebrae and loss of sensory and motor function after a diving accident (complete C8 lesion). During initial hospitalization, he developed a sacral ulcer...

  1. Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus.

    Science.gov (United States)

    Hur, Jian

    2015-06-01

    When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature. In the described case, scrub typhus probably induced sufficient stress to reactivate the varicella zoster virus. Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction. It is important that a diagnosis of herpes zoster be considered, especially in patients with sudden onset urinary retention.

  2. Bringing Low the Giants

    CERN Multimedia

    2001-01-01

    Their work goes on unseen, because they a hundred metres beneath your feet. But while the race against the clock to build the LHC has begun on the surface, teams underground are feverishly engaged to dismantle LEP and its experiments. Four months after the start of dismantling, the technical coordinators of the different experiments discuss the progress of work. Little men attack the giant ALEPH. The barrel and its two endcaps have been removed to the end of the cavern and stripped of their cables. The breaking up of the detector can now begin. At ALEPH, counting rooms removed all in one go Jean-Paul Fabre, technical coordinator at ALEPH:'After making safe the structure, the first step was to remove the wiring and cables. Some 210 cubic metres were brought out. Then the counting rooms all round the detector were taken out. They were brought up from the cavern all in one go, up through the shaft, which is 10 metres wide and 150 metres deep. They made it with 15 centimetres to spare. They have been emptied of...

  3. Giant high occipital encephalocele

    Directory of Open Access Journals (Sweden)

    Agrawal Amit

    2016-03-01

    Full Text Available Encephaloceles are rare embryological mesenchymal developmental anomalies resulting from inappropriate ossification in skull through with herniation of intracranial contents of the sac. Encephaloceles are classified based on location of the osseous defect and contents of sac. Convexity encephalocele with osseous defect in occipital bone is called occipital encephalocele. Giant occipital encephaloceles can be sometimes larger than the size of baby skull itself and they pose a great surgical challenge. Occipital encephaloceles (OE are further classified as high OE when defect is only in occipital bone above the foramen magnum, low OE when involving occipital bone and foramen magnum and occipito-cervical when there involvement of occipital bone, foramen magnum and posterior upper neural arches. Chiari III malformation can be associated with high or low occipital encephaloceles. Pre-operatively, it is essential to know the size of the sac, contents of the sac, relation to the adjacent structures, presence or absence of venous sinuses/vascular structures and osseous defect size. Sometimes it becomes imperative to perform both CT and MRI for the necessary information. Volume rendered CT images can depict the relation of osseous defect to foramen magnum and provide information about upper neural arches which is necessary in classifying these lesions.

  4. Anogenital giant seborrheic keratosis.

    Science.gov (United States)

    Wollina, Uwe; Chokoeva, Anastasiya; Tchernev, Georgi; Heinig, Birgit; Schönlebe, Jacqueline

    2017-08-01

    Seborrheic keratosis (SK) are very common benign epidermal tumors. Giant seborrheic keratosis (GSK) is a rare variant with clinical characteristics, which leads very often to misdiagnosis. A genital site of SK is very unusual clinical manifestation and although the cause is still unknown, current literature data point to a possible pathogenetic role of chronic friction and HPV infection. The rare genital localization makes Buschke-Löwenstein tumor and verrucous carcinoma important differential diagnoses. GSK may also show some clinical features of a melanoacanthoma, which makes cutaneous melanoma as another possible differential diagnosis. The clinical diagnosis of genital GSK is often a very difficult one, because the typical clinical features of GSK disappear and the most common dermoscopic features of GSK are usually not seen in the genital region lesions. The diagnosis of GSK of the anogenital area should be made only and always after the exact histological verification and variety of differential diagnosis should be carefully considered. The treatment of GSK is primary surgically. We present a rare case of GSK with concomitant HPV infection in the anogenital region of 72-year-old patient. Surgical approach was performed with excellent outcome.

  5. Psoas compartment and sacral plexus block via electrostimulation for pelvic limb amputation in dogs.

    Science.gov (United States)

    Congdon, Jonathon M; Boscan, Pedro; Goh, Clara S S; Rezende, Marlis

    2017-07-01

    To assess the efficacy of psoas compartment and sacral plexus block for pelvic limb amputation in dogs. Prospective clinical study. A total of 16 dogs aged 8±3 years and weighing 35±14 kg (mean±standard deviation). Dogs were administered morphine (0.5 mg kg -1 ) and atropine (0.02 mg kg -1 ); anesthesia was induced with propofol and maintained with isoflurane. Regional blocks were performed before surgery in eight dogs with bupivacaine (2.2 mg kg -1 ) and eight dogs were administered an equivalent volume of saline. The lumbar plexus within the psoas compartment was identified using electrolocation lateral to the lumbar vertebrae at the fourth-fifth, fifth-sixth and sixth-seventh vertebral interspaces. The sacral plexus, ventrolateral to the sacrum, was identified using electrolocation. Anesthesia was monitored using heart rate (HR), invasive blood pressure, electrocardiography, expired gases, respiratory frequency and esophageal temperature by an investigator unaware of the group allocation. Pelvic limb amputation by coxofemoral disarticulation was performed. Dogs that responded to surgical stimulation (>10% increase in HR or arterial pressure) were administered fentanyl (2 μg kg -1 ) intravenously for rescue analgesia. Postoperative pain was assessed at extubation; 30, 60 and 120 minutes; and the morning after surgery using a visual analog scale (VAS). The number of intraoperative fentanyl doses was fewer in the bupivacaine group (2.7±1.1 versus 6.0±2.2; pdogs at extubation (0.8±1.9 versus 3.8±2.5) and at 30 minutes (1.0±1.4 versus 4.3±2.1; pdogs. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

  6. Imaging appearances and clinical outcome following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, Marianna; Davies, A.M.; James, Steven L.J. [Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham (United Kingdom); Stirling, A.J.; Grainger, M. [Department of Spinal Surgery, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham (United Kingdom); Grimer, R.J. [Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham (United Kingdom)

    2014-02-15

    Sacrectomy and ilio-lumbar reconstruction is an uncommonly performed complex surgical procedure for the treatment of sacral neoplasia. There are many challenges in the post-operative period including the potential for tumor recurrence, infection, and construct failure. We present our experience of this patient cohort and describe the complications and imaging appearances that can be encountered during the follow-up period. Retrospective review of our Orthopaedic Oncology database was undertaken which has been collected over a 30-year period to identify patients that had undergone sacrectomy and ilio-lumbar reconstruction. Pre and post-operative imaging including radiographs, CT, and MRI was reviewed. These were viewed by two experienced musculoskeletal radiologists with consensus opinion if there was disagreement over the imaging findings. Data regarding patient demographics, tumor type, and dimensions was collected. Serial review of radiographs, CT, and MRI was performed to assess implant position and integrity, strut graft position and union, and for the presence of recurrence within the surgical bed. Five male and two female patients (mean age 36 years, age range 15-54 years) were treated with this procedure. Histological diagnoses included chordoma, chondrosarcoma, osteosarcoma, and spindle cell sarcoma. Mean maximal tumor size on pre-operative imaging was 10.7 cm (range, 6-16 cm). Post-operative follow-up ranged from 10-46 months. A total of 76 imaging studies were reviewed. Commonly identified complications included vertical rod and cross-connector fracture and screw loosening. Fibula strut graft non-union and fracture was also evident on imaging review. Two patients demonstrated disease recurrence during the follow-up period. This study demonstrates the spectrum and frequency of complications that can occur following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia. (orig.)

  7. An audit of the physiotherapy management of paraplegic patients with sacral pressure sores

    Directory of Open Access Journals (Sweden)

    D. Pather

    2013-01-01

    Full Text Available Introduction: Pressure sores are the most common complication post spinal cord injury that requires patients to be on bed rest. Patient bed rest delay rehabilitation and may lead to other complications associated with immobility. This study sought to establish the treatment interventions physiotherapists provide to patients with sacral pressure sores and the factors that they consider when deciding whether the patient should receive physiotherapy in the ward or gym. Methods: This was a questionnaire based survey of physiotherapists working in spinal cord injury rehabilitation units in South Africa. The self-designed questionnaire was sent to all the main spinal rehabilitation units in the country (14 located in Gauteng, Kwa-Zulu Natal, Western Cape, Eastern Cape and Free State provinces. Results: Thirty-nine physiotherapists from a total of 51 completed the questionnaires (76% response rate. The most common treatment practice for patients with sacral pressure sores was bed rest (98%. The most common physio-therapy practices (70% included were upper limb muscle strengthening, upper and lower limb passive movements, positioning into prone and side lying and passive stretching. The choice of treatment environment was influenced by doctors’ orders and the size, grade and duration of the pressure sores. Conclusion: Direct involvement in pressure sore management in South Africa seem to be less than in other parts of the world. If we are to minimise the pressure sore impact, it appears like we need more focus on gait re-education and standardised ADL programmes and patient treatment in the gym to possibly maximise healing and rehabilitation.

  8. The Unresolved Case of Sacral Chordoma: From Misdiagnosis to Challenging Surgery and Medical Therapy Resistance

    Science.gov (United States)

    Garofalo, Fabio; Christoforidis, Dimitrios; di Summa, Pietro G.; Gay, Béatrice; Cherix, Stéphane; Raffoul, Wassim; Matter, Maurice

    2014-01-01

    Purpose A sacral chordoma is a rare, slow-growing, primary bone tumor, arising from embryonic notochordal remnants. Radical surgery is the only hope for cure. The aim of our present study is to analyse our experience with the challenging treatment of this rare tumor, to review current treatment modalities and to assess the outcome based on R status. Methods Eight patients were treated in our institution between 2001 and 2011. All patients were discussed by a multidisciplinary tumor board, and an en bloc surgical resection by posterior perineal access only or by combined anterior/posterior accesses was planned based on tumor extension. Results Seven patients underwent radical surgery, and one was treated by using local cryotherapy alone due to low performance status. Three misdiagnosed patients had primary surgery at another hospital with R1 margins. Reresection margins in our institution were R1 in two and R0 in one, and all three recurred. Four patients were primarily operated on at our institution and had en bloc surgery with R0 resection margins. One had local recurrence after 18 months. The overall morbidity rate was 86% (6/7 patients) and was mostly related to the perineal wound. Overall, 3 out of 7 resected patients were disease-free at a median follow-up of 2.9 years (range, 1.6-8.0 years). Conclusion Our experience confirms the importance of early correct diagnosis and of an R0 resection for a sacral chordoma invading pelvic structures. It is a rare disease that requires a challenging multidisciplinary treatment, which should ideally be performed in a tertiary referral center. PMID:24999463

  9. Clinical Outcome of Sacral Chordoma With Carbon Ion Radiotherapy Compared With Surgery

    International Nuclear Information System (INIS)

    Nishida, Yoshihiro; Kamada, Tadashi; Imai, Reiko; Tsukushi, Satoshi; Yamada, Yoshihisa; Sugiura, Hideshi; Shido, Yoji; Wasa, Junji; Ishiguro, Naoki

    2011-01-01

    Purpose: To evaluate the efficacy, post-treatment function, toxicity, and complications of carbon ion radiotherapy (RT) for sacral chordoma compared with surgery. Methods and Materials: The records of 17 primary sacral chordoma patients treated since 1990 with surgery (n = 10) or carbon ion RT (n = 7) were retrospectively analyzed for disease-specific survival, local recurrence-free survival, complications, and functional outcome. The applied carbon ion dose ranged from 54.0 Gray equivalent (GyE) to 73.6 GyE (median 70.4). Results: The mean age at treatment was 55 years for the surgery group and 65 years for the carbon ion RT group. The median duration of follow-up was 76 months for the surgery group and 49 months for the carbon ion RT group. The local recurrence-free survival rate at 5 years was 62.5% for the surgery and 100% for the carbon ion RT group, and the disease-specific survival rate at 5 years was 85.7% and 53.3%, respectively. Urinary-anorectal function worsened in 6 patients (60%) in the surgery group, but it was unchanged in all the patients who had undergone carbon ion RT. Postoperative wound complications requiring reoperation occurred in 3 patients (30%) after surgery and in 1 patient (14%) after carbon ion RT. The functional outcome evaluated using the Musculoskeletal Tumor Society scoring system revealed 55% in the surgery group and 75% in the carbon ion RT group. Of the six factors in this scoring system, the carbon ion RT group had significantly greater scores in emotional acceptance than did the surgery group. Conclusion: Carbon ion RT results in a high local control rate and preservation of urinary-anorectal function compared with surgery.

  10. Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients

    DEFF Research Database (Denmark)

    Persson, Oscar; Bartek, Jiri; Shalom, Netanel Ben

    2017-01-01

    OBJECTIVE: Repeated controlled studies have revealed that stereotactic radiosurgery is better than microsurgery for patients with vestibular schwannoma (VS) ... to patients treated with fractionated stereotactic radiotherapy. RESULTS: No randomized controlled trial (RCT) was identified. None of the identified controlled studies comparing SRS with FSRT were eligible according to the inclusion criteria. Nineteen case series on SRS (n = 17) and FSRT (n = 2) were...... included in the systematic review. Loss of tumor control necessitating a new VS-targeted intervention was found in an average of 5.0% of the patients treated with SRS and in 4.8% treated with FSRT. Mean deterioration ratio for patients with serviceable hearing before treatment was 49% for SRS and 45...

  11. The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation

    Directory of Open Access Journals (Sweden)

    Eduardo A. S. Vellutini

    2014-12-01

    Full Text Available The classical surgical technique for the resection of vestibular schwannomas (VS has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor.

  12. Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results.

    Science.gov (United States)

    Tos, M; Charabi, S; Thomsen, J

    1998-01-01

    The Danish model for vestibular schwannoma (VS) surgery has been influenced by some historical otological events, taking its origin in the fact that the first attempt to remove CPA tumors was performed by an otologist in 1916. In approximately 50 years VS surgery was performed by neurosurgeons in a decentralized model. Highly specialized neuro- and otosurgeons have been included in our team since the early beginning of the centralized Danish model of VS surgery in 1976. Our surgical practice has always been performed on the basis of known and proven knowledge, but we spared no effort to search for innovative procedures. The present paper reflects the experience we have gained in two decades of VS surgery. Our studies on the incidence, symptomatology, diagnosis, expectancy and surgical results are presented.

  13. Diagnosis and surgical outcomes of intraparotid facial nerve schwannoma showing normal facial nerve function.

    Science.gov (United States)

    Lee, D W; Byeon, H K; Chung, H P; Choi, E C; Kim, S-H; Park, Y M

    2013-07-01

    The findings of intraparotid facial nerve schwannoma (FNS) using preoperative diagnostic tools, including ultrasonography (US)-guided fine needle aspiration biopsy, computed tomography (CT) scan, and magnetic resonance imaging (MRI), were analyzed to determine if there are any useful findings that might suggest the presence of a lesion. Treatment guidelines are suggested. The medical records of 15 patients who were diagnosed with an intraparotid FNS were retrospectively analyzed. US and CT scans provide clinicians with only limited information; gadolinium enhanced T1-weighted images from MRI provide more specific findings. Tumors could be removed successfully with surgical exploration, preserving facial nerve function at the same time. Gadolinium-enhanced T1-weighted MRI showed more characteristic findings for the diagnosis of intraparotid FNS. Intraparotid FNS without facial palsy can be diagnosed with MRI preoperatively, and surgical exploration is a suitable treatment modality which can remove the tumor and preserve facial nerve function. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  14. Predicting Nonauditory Adverse Radiation Effects Following Radiosurgery for Vestibular Schwannoma: A Volume and Dosimetric Analysis

    International Nuclear Information System (INIS)

    Hayhurst, Caroline; Monsalves, Eric; Bernstein, Mark; Gentili, Fred; Heydarian, Mostafa; Tsao, May; Schwartz, Michael; Prooijen, Monique van; Millar, Barbara-Ann; Ménard, Cynthia; Kulkarni, Abhaya V.; Laperriere, Norm; Zadeh, Gelareh

    2012-01-01

    Purpose: To define clinical and dosimetric predictors of nonauditory adverse radiation effects after radiosurgery for vestibular schwannoma treated with a 12 Gy prescription dose. Methods: We retrospectively reviewed our experience of vestibular schwannoma patients treated between September 2005 and December 2009. Two hundred patients were treated at a 12 Gy prescription dose; 80 had complete clinical and radiological follow-up for at least 24 months (median, 28.5 months). All treatment plans were reviewed for target volume and dosimetry characteristics; gradient index; homogeneity index, defined as the maximum dose in the treatment volume divided by the prescription dose; conformity index; brainstem; and trigeminal nerve dose. All adverse radiation effects (ARE) were recorded. Because the intent of our study was to focus on the nonauditory adverse effects, hearing outcome was not evaluated in this study. Results: Twenty-seven (33.8%) patients developed ARE, 5 (6%) developed hydrocephalus, 10 (12.5%) reported new ataxia, 17 (21%) developed trigeminal dysfunction, 3 (3.75%) had facial weakness, and 1 patient developed hemifacial spasm. The development of edema within the pons was significantly associated with ARE (p = 0.001). On multivariate analysis, only target volume is a significant predictor of ARE (p = 0.001). There is a target volume threshold of 5 cm3, above which ARE are more likely. The treatment plan dosimetric characteristics are not associated with ARE, although the maximum dose to the 5th nerve is a significant predictor of trigeminal dysfunction, with a threshold of 9 Gy. The overall 2-year tumor control rate was 96%. Conclusions: Target volume is the most important predictor of adverse radiation effects, and we identified the significant treatment volume threshold to be 5 cm3. We also established through our series that the maximum tolerable dose to the 5th nerve is 9 Gy.

  15. Predicting Nonauditory Adverse Radiation Effects Following Radiosurgery for Vestibular Schwannoma: A Volume and Dosimetric Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Hayhurst, Caroline; Monsalves, Eric; Bernstein, Mark; Gentili, Fred [Gamma Knife Unit, Division of Neurosurgery, University Health Network, Toronto (Canada); Heydarian, Mostafa; Tsao, May [Radiation Medicine Program, Princess Margaret Hospital, Toronto (Canada); Schwartz, Michael [Radiation Oncology Program and Division of Neurosurgery, Sunnybrook Hospital, Toronto (Canada); Prooijen, Monique van [Radiation Medicine Program, Princess Margaret Hospital, Toronto (Canada); Millar, Barbara-Ann; Menard, Cynthia [Radiation Oncology Program, Princess Margaret Hospital, Toronto (Canada); Kulkarni, Abhaya V. [Division of Neurosurgery, Hospital for Sick Children, University of Toronto (Canada); Laperriere, Norm [Radiation Oncology Program, Princess Margaret Hospital, Toronto (Canada); Zadeh, Gelareh, E-mail: Gelareh.Zadeh@uhn.on.ca [Gamma Knife Unit, Division of Neurosurgery, University Health Network, Toronto (Canada)

    2012-04-01

    Purpose: To define clinical and dosimetric predictors of nonauditory adverse radiation effects after radiosurgery for vestibular schwannoma treated with a 12 Gy prescription dose. Methods: We retrospectively reviewed our experience of vestibular schwannoma patients treated between September 2005 and December 2009. Two hundred patients were treated at a 12 Gy prescription dose; 80 had complete clinical and radiological follow-up for at least 24 months (median, 28.5 months). All treatment plans were reviewed for target volume and dosimetry characteristics; gradient index; homogeneity index, defined as the maximum dose in the treatment volume divided by the prescription dose; conformity index; brainstem; and trigeminal nerve dose. All adverse radiation effects (ARE) were recorded. Because the intent of our study was to focus on the nonauditory adverse effects, hearing outcome was not evaluated in this study. Results: Twenty-seven (33.8%) patients developed ARE, 5 (6%) developed hydrocephalus, 10 (12.5%) reported new ataxia, 17 (21%) developed trigeminal dysfunction, 3 (3.75%) had facial weakness, and 1 patient developed hemifacial spasm. The development of edema within the pons was significantly associated with ARE (p = 0.001). On multivariate analysis, only target volume is a significant predictor of ARE (p = 0.001). There is a target volume threshold of 5 cm3, above which ARE are more likely. The treatment plan dosimetric characteristics are not associated with ARE, although the maximum dose to the 5th nerve is a significant predictor of trigeminal dysfunction, with a threshold of 9 Gy. The overall 2-year tumor control rate was 96%. Conclusions: Target volume is the most important predictor of adverse radiation effects, and we identified the significant treatment volume threshold to be 5 cm3. We also established through our series that the maximum tolerable dose to the 5th nerve is 9 Gy.

  16. Long-term follow-up reveals low toxicity of radiosurgery for vestibular schwannoma

    International Nuclear Information System (INIS)

    Rutten, Isabelle; Baumert, Brigitta G.; Seidel, Laurence; Kotolenko, Snezana; Collignon, Jacques; Kaschten, Bruno; Albert, Adelin; Martin, Didier; Deneufbourg, Jean-Marie; Demanez, Jean-Pierre; Stevenaert, Achille

    2007-01-01

    Aim: The long-term effects of radiosurgery of vestibular schwannomas were investigated in a group of consecutively treated patients. Methods and materials: Between 1995 and 2001, 26 patients (median age: 67, range: 30-82) with a vestibular schwannoma were treated by Linac-based stereotactic radiosurgery (SRS). The median follow-up was 49 months (16-85 months). Only progressive tumours were treated. The median size of tumours was 18 mm (range 9-30 mm). Before SRS, 11 patients had a useful hearing (Gardner-Robertson classes 1 and 2). Single doses of 10-14 Gy were prescribed at the 80% isodose at the tumour margin. The follow-up consisted of regular imaging with MRI the first 3-6 months after the intervention, followed by additional yearly MRIs, a hearing test and a neurological examination. Result: The 5-year-probability of tumour control (defined as stabilization or decrease in size) was 95%. Five-year-probability of preservation of hearing and facial nerve function was 96% and 100%, respectively. Hearing was preserved in 10 out of 11 patients who had a normal or useful hearing at the time of treatment. Mild and transient trigeminal toxicity occurred in 2 (8%) patients. It appeared to be significantly correlated to the dose used (p = 0.044). However, only a tendency to significance could be demonstrated in the relationship between the two factors when using the Cox analysis (hazard ratio = 1.7; 95% CI: 0.7-3.9; p = 0.23). Conclusions: With the doses used, our study demonstrates that SRS provides an equivalent tumour control rate when compared to surgery, as well as on a long-term basis, an excellent preservation of the facial and the acoustic nerves. Although no permanent trigeminal toxicity was observed, our data confirm that doses below 14 Gy can avoid transient dysesthesias

  17. Hearing preservation after low-dose gamma knife radiosurgery of vestibular schwannomas

    International Nuclear Information System (INIS)

    Horiba, Ayako; Hayashi, Motohiro; Chernov, Mikhail; Kawamata, Takakazu; Okada, Yoshikazu

    2016-01-01

    The objective of the retrospective study was to evaluate the factors associated with hearing preservation after low-dose Gamma Knife radiosurgery (GKS) of vestibular schwannomas performed according to the modern standards. From January 2005 to September 2010, 141 consecutive patients underwent such treatment in Tokyo Women's Medical University. Mean marginal dose was 11.9 Gy (range, 11-12 Gy). The doses for the brain stem, cranial nerves (V, VII, and VHIII), and cochlea were kept below 14 Gy, 12 Gy, and 4 Gy, respectively. Out of the total cohort, 102 cases with at least 24 months follow-up were analyzed. Within the median follow-up of 56 months (range, 24-99 months) the crude tumor growth control was 92% (94 cases), whereas its actuarial rate at 5 years was 93%. Out of 49 patients with serviceable hearing on the side of the tumor before GKS, 28 (57%) demonstrated its preservation at the time of the last follow-up. No one evaluated factor, namely Gardner-Robertson hearing class before irradiation, Koos tumor stage, extension of the intrameatal part of the neoplasm up to fundus, nerve of tumor origin, presence of cystic changes in the neoplasm, and cochlea dose demonstrated statistically significant association with preservation of the serviceable hearing after radiosurgery. In conclusion, GKS of vestibular schwannomas performed according to the modern standards of treatment permits to preserve serviceable hearing on the side of the tumor in more than half of the patients. The actual causes of hearing deterioration after radiosurgery remain unclear. (author)

  18. Excitation of giant resonances in heavy ion collisions

    International Nuclear Information System (INIS)

    Kuehn, W.

    1991-01-01

    Introduction: What are Giant Resonances? General Features of Giant Resonances, Macroscopic Description and Classification, Basic Excitation Mechanisms, Decay Modes, Giant Resonances Built on Excited States, Relativistic Coulomb Excitation of Giant Resonances, Experimental Situation. (orig.)

  19. Post-operative complications after removal of sporadic vestibular schwannoma via retrosigmoid-suboccipital approach: current diagnosis and management.

    Science.gov (United States)

    Charalampakis, Stylianos; Koutsimpelas, Dimitrios; Gouveris, Haralampos; Mann, Wolf

    2011-05-01

    The retrosigmoid (suboccipital) approach is one of four surgical approaches for the treatment of vestibular schwannomas (acoustic neuromas). It is increasingly used by otologic surgeons, and in experienced hands is associated with improved results and more limited complications. Mortality rates are minimal and often zero, while postoperative sequelae, on the other hand, are not rare. In order to not only save the patient's life, but also to assure good quality of life after the surgery, one must consider many different aspects of management of the respective complications. In this review the issues of current management of CSF leak and meningitis, facial paresis, headache, hearing loss, unsteadiness, disequilibrium, vertigo, tinnitus, cerebellar and brain stem injuries or abscess, vascular complications and venous air embolism after retrosigmoid approach for removal of vestibular schwannomas are presented. © Springer-Verlag 2011

  20. Von Reckling-hausen disease associated to thyroid carcinoma and malignant schwannoma of the chest wall. A case

    International Nuclear Information System (INIS)

    Diaz P, J.; Tantalean, E.; Guzman, R.; Pomatanta P, J.; Grados M, J.; Vilela, C.

    1999-01-01

    The multiple neurofibromatosis is an autosomal dominant hereditary disease associated to malignant schwannoma in about 3% of the cases and very rarely to others cancers. The study provides information on the case of a 32 year-old woman who suffers from this disease and presented two synchronous cancers: a papillary carcinoma of thyroid and a malignant schwannoma of the chest wall. The thyroid tumour was managed with hemithyroidectomy, hormonotherapy and radiotherapy, and the lesion of the thoracic wall was treated with local radical resection application of Marlex mesh and rotation of a musculocutaneous flap of the dorsal muscle. A review of the literature on the clinical aspects of this association and the surgical techniques employed to cover the defect of the chest wall is presented. (authors)

  1. Cervical sympathetic chain schwannoma masquerading as a carotid body tumour with a postoperative complication of first-bite syndrome.

    LENUS (Irish Health Repository)

    Casserly, Paula

    2012-01-31

    Carotid body tumours (CBT) are the most common tumours at the carotid bifurcation. Widening of the bifurcation is usually demonstrated on conventional angiography. This sign may also be produced by a schwannoma of the cervical sympathetic plexus. A 45-year-old patient presented with a neck mass. Investigations included contrast-enhanced CT, MRI and magnetic resonance arteriography with contrast enhancement. Radiologically, the mass was considered to be a CBT due to vascular enhancement and splaying of the internal and external carotid arteries. Intraoperatively, it was determined to be a cervical sympathetic chain schwannoma (CSCS). The patient had a postoperative complication of first-bite syndrome (FBS).Although rare, CSCS should be considered in the differential diagnosis for tumours at the carotid bifurcation. Damage to the sympathetic innervation to the parotid gland can result in severe postoperative pain characterised by FBS and should be considered in all patients undergoing surgery involving the parapharyngeal space.

  2. Formation of giant planets

    International Nuclear Information System (INIS)

    Perri, F.

    1975-01-01

    When a planetary core composed of condensed matter is accumulated in the primitive solar nebula, the gas of the nebula becomes gravitationally concentrated as an envelope surrounding the planetary core. Models of such gaseous envelopes have been constructed subject to the assumption that the gas everywhere is on the same adiabat as that in the surrounding nebula. The gaseous envelope extends from the surface of the core to the distance at which the gravitational attraction of core plus envelope becomes equal to the gradient of the gravitational potential in the solar nebula; at this point the pressure and temperature of the gas in the envelope are required to attain the background values characteristic of the solar nebula. In general, as the mass of the condensed core increases, increasing amounts of gas became concentrated in the envelope, and these envelopes are stable against hydrodynamic instabilities. However, the core mass then goes through a maximum and starts to decrease. In most of the models tested the envelopes were hydrodynamically unstable beyond the peak in the core mass. An unstable situation was always created if it was insisted that the core mass contain a larger amount of matter than given by these solutions. For an initial adiabat characterized by a temperature of 450 0 K and a pressure of 5 x 10 -6 atmospheres, the maximum core mass at which instability occurs is approximately 115 earth masses. It is concluded that the giant planets obtained their large amounts of hydrogen and helium by a hydrodynamic collapse process in the solar nebula only after the nebula had been subjected to a considerable period of cooling

  3. SU-E-J-125: A Novel IMRT Planning Technique to Spare Sacral Bone Marrow in Pelvic Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    McGuire, S; Bhatia, S; Sun, W; Menda, Y; Ponto, L; Gross, B; Buatti, J [University Of Iowa, Iowa City, IA (United States)

    2015-06-15

    Purpose: Develop an IMRT planning technique that can preferentially spare sacral bone marrow for pelvic cancer patients. Methods: Six pelvic cancer patients (two each with anal, cervical, and rectal cancer) were enrolled in an IRB approved protocol to obtain FLT PET images at simulation, during, and post chemoradiation therapy. Initially, conventional IMRT plans were created to maintain target coverage and reduce dose to OARs such as bladder, bowel, rectum, and femoral heads. Simulation FLT PET images were used to create IMRT plans to spare bone marrow identified as regions with SUV of 2 or greater (IMRT-BMS) within the pelvic bones from top of L3 to 5mm below the greater trochanter without compromising PTV coverage or OAR sparing when compared to the initial IMRT plan. IMRT-BMS plans used 8–10 beam angles that surrounded the subject. These plans were used for treatment. Retrospectively, the same simulation FLT PET images were used to create IMRT plans that spared bone marrow located in the sacral pelvic bone region (IMRT-FAN) also without compromising PTV coverage or OAR sparing. IMRT-FAN plans used 16 beam angles every 12° anteriorly from 90° – 270°. Optimization objectives for the sacral bone marrow avoidance region were weighted to reduce ≥V10. Results: IMRT-FAN reduced dose to the sacral bone marrow for all six subjects. The average V5, V10, V20, and V30 differences from the IMRT-BMS plan were −2.2 ± 1.7%, −11.4 ± 3.6%, −17.6 ± 5.1%, and −19.1 ± 8.1% respectively. Average PTV coverage change was 0.5% ± 0.8% from the conventional IMRT plan. Conclusion: An IMRT planning technique that uses beams from the anterior and lateral directions reduced the volume of sacral bone marrow that receives ≤10Gy while maintaining PTV coverage and OAR sparing. Additionally, the volume of sacral bone marrow that received 20 or 30 Gy was also reduced.

  4. Assessment of tumor blood flow and its correlation with histopathologic features in skull base meningiomas and schwannomas by using pseudo-continuous arterial spin labeling images

    International Nuclear Information System (INIS)

    Yamamoto, Tatsuya; Takeuchi, Hiroaki; Kinoshita, Kazuyuki; Kosaka, Nobuyuki; Kimura, Hirohiko

    2014-01-01

    Objective: We aimed to investigate whether pseudo-continuous arterial spin labeling (pcASL)-MRI can adequately evaluate tumor perfusion even if the tumors are located in the skull base region and evaluate the correlation between tumor blood flow (TBF) and the histopathologic features of skull base meningiomas and schwannomas. Materials and methods: We enrolled 31 patients with skull base meningioma (n = 14) and schwannoma (n = 17) who underwent surgical resection. TBF was calculated from pcASL. Tissue sections were stained with CD34 to evaluate microvessel area (MVA). TBF and MVA ratio were compared between meningiomas and schwannomas using Mann–Whitney U-test. The correlations between MVA ratio and TBF were evaluated in each tumor by using single linear regression analysis and Spearman's rank correlation coefficients (r s ). Results: MVA ratio and TBF were significantly higher in meningioma than in schwannoma (both p < 0.01). Correlation analyses revealed significant positive correlations between MVA ratio and both mean and max TBF for meningiomas (r s = 0.89, 0.81, both p < 0.01). There was a weak positive correlation between MVA ratio and mean TBF for schwannomas (r s = 0.43, p = 0.04). However, no significant correlation was found between MVA ratio and max TBF for schwannoma. Conclusions: pcASL-MRI is useful for evaluating tumor perfusion even if the tumors are located in the skull base region. Moreover, pcASL-TBF was significantly higher in most meningiomas compared to schwannomas, which can help in the differential diagnosis of the 2 tumor types even without the use of contrast material

  5. Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma

    OpenAIRE

    Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M.; Ginsberg, Lawrence E.; Gidley, Paul W.

    2014-01-01

    Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomograph...

  6. Preclinical Validation of Anti-Nuclear Factor Kappa B Therapy Against Vestibular Schwannoma and Neurofibromatosis Type II

    Science.gov (United States)

    2016-06-01

    renal failure. Pharmacologic treatment of NF2 represents a major unmet medical need. The hallmark of NF2 is bilateral vestibular schwannomas (VSs...it to test our leading hypothesis over the next year. Innovation: Our focus on NFκB as a potent pharmacologic target for NF2 is novel. Our work...diagnostic awareness among clinicians (4,5). Contrast-enhanced magnetic resonance imaging ( MRI ) of the brain is currently the gold standard for

  7. On Landau Vlasov simulations of giant resonances

    International Nuclear Information System (INIS)

    Pi, M.; Schuck, P.; Suraud, E.; Gregoire, C.; Remaud, B.; Sebille, F.

    1987-05-01

    We present VUU calculations of giant resonances obtained in energetic heavy ion collisions. Also is considered the case of the giant dipole in 40 Ca and the possibility of studying the effects of rotation on such collective modes

  8. Imperfuração anal associada à agenesia parcial do sacro e lipoma pré-sacral: síndrome de Currarino Imperforate anus associated with partial sacral agenesis and presacral lipoma: Currarino syndrome

    Directory of Open Access Journals (Sweden)

    Paulo Ricardo G. Zen

    2010-09-01

    Full Text Available OBJETIVO: Relatar o caso de uma criança com síndrome de Currarino diagnosticada após avaliação por episódios recorrentes de infecção urinária. DESCRIÇÃO DE CASO: Menina branca de dois anos, única filha de pais hígidos e sem história familiar de defeitos congênitos. A criança nasceu com imperfuração anal e com fístula retovestibular diagnosticadas no primeiro dia de vida. Por volta dos sete meses, começou a apresentar episódios recorrentes de infecção urinária, estabelecendo-se o diagnóstico de bexiga neurogênica. Na mesma ocasião, foi constatada a presença de agenesia parcial do sacro. A avaliação pela tomografia computadorizada e ressonância nuclear magnética de coluna identificou presença de fístula coincidente com a fosseta da transição lombo-sacral, observada ao exame físico; amputação da porção inferior da medula, com diminuição do número de raízes nervosas da cauda equina e massa pré-sacral de aspecto lipomatoso. Esta foi confirmada durante a cirurgia de correção do ânus imperfurado. A criança não apresentava outras dismorfias e a avaliação radiológica dos pais não identificou anormalidades sacrais. COMENTÁRIOS: A síndrome de Currarino é uma doença genética autossômica, dominante e rara caracterizada pela tríade formada por atresia anal, agenesia parcial do sacro e tumoração pré-sacral. Inclui teratomas, meningoceles, cistos entéricos e lipomas, como observado em nossa paciente. Crianças apresentando anormalidades anorretais deveriam ser sempre cuidadosamente avaliadas quanto à presença da síndrome de Currarino. A agenesia parcial do sacro é um forte indicativo da doença.OBJECTIVE: To report a patient with Currarino syndrome diagnosed after evaluation for recurrent urinary infections. CASE DESCRIPTION: This is a Caucasian two-year-old girl, the only daughter of healthy unrelated parents with no family history of congenital defects. The patient was born with imperforate

  9. Giant lobelias exemplify convergent evolution

    Directory of Open Access Journals (Sweden)

    Givnish Thomas J

    2010-01-01

    Full Text Available Abstract Giant lobeliads on tropical mountains in East Africa and Hawaii have highly unusual, giant-rosette growth forms that appear to be convergent on each other and on those of several independently evolved groups of Asteraceae and other families. A recent phylogenetic analysis by Antonelli, based on sequencing the widest selection of lobeliads to date, raises doubts about this paradigmatic example of convergent evolution. Here I address the kinds of evidence needed to test for convergent evolution and argue that the analysis by Antonelli fails on four points. Antonelli's analysis makes several important contributions to our understanding of lobeliad evolution and geographic spread, but his claim regarding convergence appears to be invalid. Giant lobeliads in Hawaii and Africa represent paradigmatic examples of convergent evolution.

  10. CMB lensing and giant rings

    Energy Technology Data Exchange (ETDEWEB)

    Rathaus, Ben; Itzhaki, Nissan, E-mail: nitzhaki@post.tau.ac.il, E-mail: ben.rathaus@gmail.com [Raymond and Beverly Sackler Faculty of Exact Sciences, School of Physics and Astronomy, Tel-Aviv University, Ramat-Aviv, 69978 (Israel)

    2012-05-01

    We study the CMB lensing signature of a pre-inationary particle (PIP), assuming it is responsible for the giant rings anomaly that was found recently in the WMAP data. Simulating Planck-like data we find that generically the CMB lensing signal to noise ratio associated with such a PIP is quite small and it would be difficult to cross correlate the temperature giant rings with the CMB lensing signal. However, if the pre-inationary particle is also responsible for the bulk flow measured from the local large scale structure, which happens to point roughly at the same direction as the giant rings, then the CMB lensing signal to noise ratio is fairly significant.

  11. Prevalence of sacral dysmorphia in a prospective trauma population: Implications for a "safe" surgical corridor for sacro-iliac screw placement.

    Science.gov (United States)

    Hasenboehler, Erik A; Stahel, Philip F; Williams, Allison; Smith, Wade R; Newman, Justin T; Symonds, David L; Morgan, Steven J

    2011-05-10

    Percutaneous sacro-iliac (SI) screw fixation represents a widely used technique in the management of unstable posterior pelvic ring injuries and sacral fractures. The misplacement of SI-screws under fluoroscopic guidance represents a critical complication for these patients. This study was designed to determine the prevalence of sacral dysmorphia and the radiographic anatomy of surgical S1 and S2 corridors in a representative trauma population. Prospective observational cohort study on a consecutive series of 344 skeletally mature trauma patients of both genders enrolled between January 1, 2007, to September 30, 2007, at a single academic level 1 trauma center. Inclusion criteria included a pelvic CT scan as part of the initial diagnostic trauma work-up. The prevalence of sacral dysmorphia was determined by plain radiographic pelvic films and CT scan analysis. The anatomy of sacral corridors was analyzed on 3 mm reconstruction sections derived from multislice CT scan, in the axial, coronal, and sagittal plane. "Safe" potential surgical corridors at S1 and S2 were calculated based on these measurements. Radiographic evidence of sacral dysmorphia was detected in 49 patients (14.5%). The prevalence of sacral dysmorphia was not significantly different between male and female patients (12.2% vs. 19.2%; P = 0.069). In contrast, significant gender-related differences were detected with regard to radiographic analysis of surgical corridors for SI-screw placement, with female trauma patients (n = 99) having significantly narrower corridors at S1 and S2 in all evaluated planes (axial, coronal, sagittal), compared to male counterparts (n = 245; P dysmorphia. These findings emphasize a high prevalence of sacral dysmorphia in a representative trauma population and imply a higher risk of SI-screw misplacement in female patients. Preoperative planning for percutaneous SI-screw fixation for unstable pelvic and sacral fractures must include a detailed CT scan analysis to determine

  12. A Large Asymptomatic Thoracic Spine Schwannoma Detected Incidentally by {sup 18}F-FDG PET/CT: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Seoul Sungae Hospital, Seoul (Korea, Republic of); Yoo, Ie Ryung [Catholic University Medical School Hospital, Seoul (Korea, Republic of)

    2008-10-15

    Schwannoma is not a rare tumor occurring anywhere where sheathed nerve fibers present. However the spinal involvement has been noted to be uncommon. The use of PET in the diagnosis of spinal schwannomas seemed to have only sporadically been reported and standardized uptake values (SUV) measured in peripheral nerves schwannomas varied according to cellularity. Most reported spinal schwannoms were symptomatic and relatively hypometabolic but ours differed in that despite considerable compression of the spinal cord it did not produce clinical symptoms or signs and had a relatively high FDG uptake value. The spine was operated. On opening a 1.0x1.5 cm tumor was found to be encapsulated and located in the right posterolateral aspect of the intradural space at the 4th thoracic spine level. It was completely resected along with the rootlet from which the tumor seemed to have originated not damaging the cord or causing bleeding. The spinal medulla compressed by and adherent to the tumor was decompressed and released following arachnoid adhesiolysis. The hospital stay was uneventful. Patient was discharged and is well and fine without complication eight months after surgery.

  13. Imaging of giant pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Majos, C.; Coll, S.; Aguilera, C.; Pons, L.C. [Bellvitge Univ., Barcelona (Spain). Inst. de Diagnostice per la Imatge; Acebes, J.J. [Department of Neurosurgery, Ciutat Sanitaria i Universitaria de Bellvitge, L`Hospitalet de Llobregat, Barcelona (Spain)

    1998-10-01

    We present five proven giant pituitary adenomas studied by CT and MRI, and review the clinical and imaging findings. Our aim was to examine the radiologic appearances and to search for criteria useful in distinguishing these tumors from other sellar and suprasellar tumours, mainly craniopharyngioma. The main differences from small adenomas were high prevalence of macrocysts, a more invasive behaviour and a clinical picture dominated by mass effect rather than endocrine disturbance. Factors supporting the diagnosis of pituitary adenoma in a giant intra- and suprasellar mass include: infrasellar extension, absence of calcification and presence of low-signal cysts on T1-weighted images. (orig.) (orig.) With 4 figs., 2 tabs., 9 refs.

  14. [Giant intradiploic infratentorial epidermoid cyst].

    Science.gov (United States)

    Alberione, F; Caire, F; Fischer-Lokou, D; Gueye, M; Moreau, J J

    2007-10-01

    Epidermoid cysts are benign, uncommon lesions (1% of all intracranial tumors). Their localization is intradiploic in 25% of cases, and exceptionally subtentorial. We report here a rare case of giant intradiploic infratentorial epidermoid cyst. A 74-year old patient presented with recent diplopia and sindrome cerebellar. CT scan and MR imaging revealed a giant osteolytic extradural lesion of the posterior fossa (5.2 cm x 3.8 cm) with a small area of peripheral enhancement after contrast injection. Retrosigmoid suboccipital craniectomy allowed a satisfactory removal of the tumor, followed by an acrylic cranioplasty. The outcome was good. Neuropathological examination confirmed an epidermoid cyst. We review the literature and discuss our case.

  15. Percolation with multiple giant clusters

    International Nuclear Information System (INIS)

    Ben-Naim, E; Krapivsky, P L

    2005-01-01

    We study mean-field percolation with freezing. Specifically, we consider cluster formation via two competing processes: irreversible aggregation and freezing. We find that when the freezing rate exceeds a certain threshold, the percolation transition is suppressed. Below this threshold, the system undergoes a series of percolation transitions with multiple giant clusters ('gels') formed. Giant clusters are not self-averaging as their total number and their sizes fluctuate from realization to realization. The size distribution F k , of frozen clusters of size k, has a universal tail, F k ∼ k -3 . We propose freezing as a practical mechanism for controlling the gel size. (letter to the editor)

  16. Statistical decay of giant resonances

    International Nuclear Information System (INIS)

    Dias, H.; Teruya, N.; Wolynec, E.

    1986-01-01

    Statistical calculations to predict the neutron spectrum resulting from the decay of Giant Resonances are discussed. The dependence of the resutls on the optical potential parametrization and on the level density of the residual nucleus is assessed. A Hauser-Feshbach calculation is performed for the decay of the monople giant resonance in 208 Pb using the experimental levels of 207 Pb from a recent compilation. The calculated statistical decay is in excelent agreement with recent experimental data, showing that the decay of this resonance is dominantly statistical, as predicted by continuum RPA calculations. (Author) [pt

  17. Giant resonances: reaction theory approach

    International Nuclear Information System (INIS)

    Toledo Piza, A.F.R. de; Foglia, G.A.

    1989-09-01

    The study of giant resonances through the use of reaction theory approach is presented and discussed. Measurements of cross-sections to the many available decay channels following excitation of giant multipole resonances (GMR) led one to view these phenomena as complicated dynamical syndromes so that theoretical requirements for their study must be extended beyond the traditional bounds of nuclear structure models. The spectra of decay products following GMR excitation in heavy nuclei are well described by statistical model (Hauser-Feshback, HF) predictions indicated that spreading of the collective modes plays a major role in shaping exclusive cross-sections. (A.C.A.S.) [pt

  18. Statistical decay of giant resonances

    International Nuclear Information System (INIS)

    Dias, H.; Teruya, N.; Wolynec, E.

    1986-02-01

    Statistical calculations to predict the neutron spectrum resulting from the decay of Giant Resonances are discussed. The dependence of the results on the optical potential parametrization and on the level density of the residual nucleus is assessed. A Hauser-Feshbach calculation is performed for the decay of the monopole giant resonance in 208 Pb using the experimental levels of 207 Pb from a recent compilation. The calculated statistical decay is in excellent agreement with recent experimental data, showing that decay of this resonance is dominantly statistical, as predicted by continuum RPA calculations. (Author) [pt

  19. Migration of accreting giant planets

    Science.gov (United States)

    Robert, C.; Crida, A.; Lega, E.; Méheut, H.

    2017-09-01

    Giant planets forming in protoplanetary disks migrate relative to their host star. By repelling the gas in their vicinity, they form gaps in the disk's structure. If they are effectively locked in their gap, it follows that their migration rate is governed by the accretion of the disk itself onto the star, in a so-called type II fashion. Recent results showed however that a locking mechanism was still lacking, and was required to understand how giant planets may survive their disk. We propose that planetary accretion may play this part, and help reach this slow migration regime.

  20. Evaluation of the diagnostic accuracy of four-view radiography and conventional computed tomography analysing sacral and pelvic fractures in dogs.

    Science.gov (United States)

    Stieger-Vanegas, S M; Senthirajah, S K J; Nemanic, S; Baltzer, W; Warnock, J; Bobe, G

    2015-01-01

    The purpose of our study was (1) to determine whether four-view radiography of the pelvis is as reliable and accurate as computed tomography (CT) in diagnosing sacral and pelvic fractures, in addition to coxofemoral and sacroiliac joint subluxation or luxation, and (2) to evaluate the effect of the amount of training in reading diagnostic imaging studies on the accuracy of diagnosing sacral and pelvic fractures in dogs. Sacral and pelvic fractures were created in 11 canine cadavers using a lateral impactor. In all cadavers, frog-legged ventro-dorsal, lateral, right and left ventro-45°-medial to dorsolateral oblique frog leg ("rollover 45-degree view") radiographs and a CT of the pelvis were obtained. Two radiologists, two surgeons and two veterinary students classified fractures using a confidence scale and noted the duration of evaluation for each imaging modality and case. The imaging results were compared to gross dissection. All evaluators required significantly more time to analyse CT images compared to radiographic images. Sacral and pelvic fractures, specifically those of the sacral body, ischiatic table, and the pubic bone, were more accurately diagnosed using CT compared to radiography. Fractures of the acetabulum and iliac body were diagnosed with similar accuracy (at least 86%) using either modality. Computed tomography is a better method for detecting canine sacral and some pelvic fractures compared to radiography. Computed tomography provided an accuracy of close to 100% in persons trained in evaluating CT images.