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Sample records for schwannoma maligno epitelioide

  1. Schwannoma retroperitoneal maligno Malign retroperitoneal schwannoma

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    Rafael Pinilla González

    2009-12-01

    Full Text Available Los tumores del retroperitoneo son poco frecuentes y se clasifican según el tejido del que se originan. Se presenta el caso de una paciente con dolor en el hipocondrio derecho y tumor en esta zona, pérdida de peso y molestia dolorosa en la cara anterolateral del muslo derecho. En el examen físico se halló palidez cutáneo-mucosa y tumoración indolora en el hipocondrio y flanco derecho. El ultrasonido abdominal mostró una masa homogénea de 14,11 cm y la tomografía computarizada de abdomen permitió observar un tumor retroperitoneal derecho que rechazaba el riñón. El urograma excretor mostró rechazamiento anteromedial del riñón derecho. Se extirpó un tumor encapsulado con pocas adherencias peritumorales. Mediante estudio histológico se confirmó un tumor de células fusiformes con hipercromatismo y pleomorfismo nuclear, numerosas mitosis y áreas de necrosis y el diagnóstico de tumor maligno de la vaina de un nervio periférico.The retroperitoneal tumors are infrequent and are classified according to the original tissue. This is a case presentation of a patient presenting with pain in right hypochondrium and a tumor in this zone, weight loss and painful discomfort in the anterolateral face of right thigh. In physical examination we found cutaneous-mucous paleness and painless tumor in hypochondrium and right flank. Abdominal ultrasound (US showed a homogenous mass of 14,11 cm and abdominal computed tomography allows to see a right retroperitoneal tumor rejecting the kidney. Excretory urogram showed a anteromedial rejection of right kidney. An encapsulated tumor with a few peritumoral adherences was removed. By histological study it was possible to confirm a fusiform cells tumor with hyperchromatism and nuclear pleomorphism, numerous mitosis and areas of necrosis and in the diagnosis of malign tumor of the sheath of a peripheral nerve.

  2. Tumores malignos de la vaina nerviosa periférica como origen de dolor orofacial

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    Jorge Chaurand-Lara

    2016-07-01

    Full Text Available Los tumores malignos de la vaina nerviosa periférica (TMVNP, también llamados neurofribrosarcomas o schwannomas malignos, representan el 10% de todos los sarcomas de tejidos blandos. El tumor usualmente se encuentra en las extremidades inferiores, y solo del 10 al 20% de las lesiones ocurren en la región de cabeza y cuello, convirtiéndolas en una entidad rara. Los neurofibromas son tumores de la vaina nerviosa que aparecen comúnmente en la neurofibromatosis 1 o enfermedad de Von Recklinghausen. Se ha reportado que los individuos con antecedentes familiares de neurofibromatosis 1 tienen un riesgo incrementado de desarrollar TMVNP en el transcurso de sus vidas, sin embargo, esta asociación no se ha confirmado en TMVNP a nivel de los nervios craneales. En este artículo los autores analizaron la literatura actual con respecto a los TMVNP del nervio trigémino, así como la inclusión de un caso inusual que involucra las 3 ramas de dicho nervio.

  3. Malignant eccrine poroma Poroma ecrino maligno

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    Walter León

    1990-01-01

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    We report on the case of a 47 year-old man with the diagnosis of malignant eccrine poroma, located on the right foot; he died from metastatic lesions affecting inguinal region, lungs, liver and central nervous system. Clinical and histopathologic findings are discussed .A review Is Included on sweat gland carcinomas.

    Se presenta el caso de un hombre de 47 años a quien se le diagnosticó un poroma ecrlno maligno localizado en el dorso del pie derecho, con metástasis a región inguinal, pulmón, hígado y sistema nervioso central, que le produjeron la muerte. Se discuten los hallazgos clínicos e histopatológicos.

  4. Solitary eyelid schwannoma

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    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.

  5. Angiogenesis in vestibular schwannomas

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    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...

  6. Estudio sobre los tumores malignos maxilofaciales

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    Juan Carlos Quintana Díaz

    1998-08-01

    Full Text Available Se realizó un análisis durante el trienio 1994-1996 y se estudiaron los tumores malignos de la región maxilofacial tratados en el Servicio de Cirugía Maxilofacial de Artemisa. El sexo masculino fue más afectado que el femenino, los tumores de la piel fueron los más frecuentes, afectaron en elevado porcentaje a los pacientes de tez blanca, y el carcinoma basocelular fue el tipo histológico que más se observó. En cuanto a la localización más frecuente en la cavidad bucal fue el labio inferior, y el tipo histológico que más predominó fue el carcinoma epidermoide. El 3 % de todos los tumores encontrados correspondieron con metástasis, que debutaron por la zona bucofacial.An analytical study of the maxillofacial region malignant tumors treated in the Maxillofacial Surgery Service of Artemisa municipality was conducted from 1994-1996. Males were the most affected; skin tumors were the most frequent, a higher percentage of white people were affected and the most observed histological type was the basal cell carcinoma. The most common location in the oral cavity was the lower lip and the most predominant histological type was the epidermoid carcinoma. 3 % of all tumors found resulted in metastasis which started in the buccofacial area.

  7. 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)

  8. Deregulated genes in sporadic vestibular schwannomas

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    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....

  9. Lentigo maligno na face: um desafio na conduta

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    Cíntia da Silva Gomes

    Full Text Available Resumo O lentigo maligno é um melanoma in situ, de crescimento radial e lento, que acomete áreas fotoexpostas principalmente em idosos. Quando acomete a pálpebra, devido à proximidade a um órgão nobre, a conduta é controversa, porém a cirurgia é o método mais usado, com margens que variam de acordo com a referência utilizada. Terapias conservadoras são descritas, como o imiquimode 5% e a radioterapia. O presente relato tem como objetivo demonstrar a escassez de estudos sobre a margem cirúrgica e citar opções de tratamentos não cirúrgicos para o lentigo maligno da face.

  10. True incidence of vestibular schwannoma?

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    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....

  11. Schwannoma of the Colon

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    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.

  12. Tumores malignos primarios del hígado

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    Jaime de la Hoz de la Hoz; Jorge Brieva M.; José J. Arias A.; Pedro E. Morales M.

    1986-01-01

    Treinta y seis tumores malignos primarios del hígado fueron seleccionados de protocolos de patología en un periodo de 20 años, Los hepatomas continúan siendo bastante raros en el mundo occidental. Existen regiones del África y Asia en que es endémico. Aunque en la mayoría de los pacientes la consulta es debida a dolor y masa abdominal por crecimiento del tumor, gracias a los adelantos recientes en los métodos diagnósticos, pequeños tumores están siendo cada vez mas diagnosticados. La detec...

  13. 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...

  14. Vulval schwannoma: A cytological diagnosis

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    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.

  15. 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.

  16. Tongue schwannomas associated with neurofibromatosis type 2

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    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

  17. Tumores malignos de pálpebra Malignant eyelid tumors

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    Luis Henrique Schneider Soares

    2001-08-01

    Full Text Available Objetivos: Estudar a incidência de tumores malignos de pálpebra no Hospital Banco de Olhos de Porto Alegre. Métodos: Estudo retrospectivo dos casos de tumores malignos de pálpebra no período de 1985 a 1997, que tiveram diagnóstico confirmado por exame anátomopatológico. Resultados: Foram encontradas 54 neoplasias malignas, sendo 75,92% carcinoma basocelular, 12,96% carcinoma espinocelular, 7,40% melanoma e 1,85% lentigo maligna. A maioria dos pacientes apresentava mais de 40 anos e não houve prevalência de sexo. Conclusões: O tumor de pálpebra mais freqüente em nosso meio foi o carcinoma basocelular, seguido do carcinoma espinocelular. O melanoma foi o terceiro em freqüência mais encontrado em nossa pesquisa.Purposes: To study the incidence of eyelid malignant tumors in the Banco de Olhos Hospital of Porto Alegre from 1985 to 1997. Methods: We retrospectivelly analyzed clinical archives and in this study all cases of malignant eyelid tumors with histopathologic examination were included. Results: We found 54 eyelid tumors: 75.92% basal cell, 12.96% squamous cell, 7.40% melanoma, 1.85% undifferentiated carcinoma and 1.85% lentigo maligna. The majority of the patients was over 40 years old, 50% were male and 50% female. The diagnosis was confirmed in all cases through histopathologic examination. Conclusions: Basal cell carcinoma was the most frequent eyelid malignancy followed by squamous cell carcinoma. Melanoma was the third most frequently found tumor in our study.

  18. 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

  19. Retroperitoneal Schwannoma: A Rare Case

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    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.

  20. MR findings in intralabyrinthine schwannomas

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    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)

  1. 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)

  2. Atypical Manifestation of Vestibular Schwannoma

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    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.

  3. 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)

  4. AN INTERESTING CASE OF ANCIENT SCHWANNOMA

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    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

  5. Schwannomas of the head and neck

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    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.

  6. Schwannoma Originating From the Periphereral Intercostal Nerves

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    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.

  7. 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...

  8. 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...

  9. Schwannoma of the adrenal gland

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    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.

  10. 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.

  11. 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.

  12. A rare adrenal incidentaloma: adrenal schwannoma.

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    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.

  13. A case of a massive mandibular schwannoma

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    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.

  14. 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.

  15. 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.

  16. 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.

  17. 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

  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. Tratamiento del síndrome neuroléptico maligno

    OpenAIRE

    Franklin Escobar Córdoba; Irina Goretty Polanía-Dussán; Sandra Milena Toro-Herrera

    2011-01-01

    El síndrome neuroléptico maligno es una complicación grave del tratamiento con psicofármacos. La principal característica es la hipertermia, acompañada de hipertonía muscular, alteración del nivel de conciencia e inestabilidad autonómica. Identificar el tratamiento adecuado para los pacientes con síndrome neuroléptico maligno según la gravedad y la apropiada evaluación de riesgos y beneficios de las opciones terapéuticas. Se realizó una búsqueda en PubMed con los términos MESH: síndrome neuro...

  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. 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. 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

  3. THREE YEARS STUDY OF SCHWANNOMAS OF PERIPHERAL NERVES

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    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

  4. 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.

  5. 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.

  6. 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.

  7. 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.)

  8. Tratamiento del síndrome neuroléptico maligno

    Directory of Open Access Journals (Sweden)

    Franklin Escobar Córdoba

    2011-01-01

    Full Text Available El síndrome neuroléptico maligno es una complicación grave del tratamiento con psicofármacos. La principal característica es la hipertermia, acompañada de hipertonía muscular, alteración del nivel de conciencia e inestabilidad autonómica. Identificar el tratamiento adecuado para los pacientes con síndrome neuroléptico maligno según la gravedad y la apropiada evaluación de riesgos y beneficios de las opciones terapéuticas. Se realizó una búsqueda en PubMed con los términos MESH: síndrome neuroléptico maligno, tratamiento y terapia; utilizando como límites: ensayos clínicos controlados, metaanálisis, guías de práctica clínica, revisiones, población adulta e idiomas: inglés, francés y alemán. Se hallaron 25 artículos, los cuales fueron analizados, y se encontró que el tratamiento se fundamenta en la sospecha clínica precoz y en la suspensión inmediata de los neurolépticos, la hidratación, el apoyo hemodinámico, corregir el desequilibrio del estado ácido-base y la hipoxemia. La administración de agonistas de la dopamina, dantrolene y benzodiacepinas puede ser de utilidad en algunos casos. El tratamiento debe ser escogido de forma individualizada, con base en la severidad de la enfermedad. Para casos leves, el soporte hídrico y metabólico puede ser suficiente; en casos severos se deben tomar medidas que incluyen agentes farmacológicos, terapia electroconvulsiva y monitorización en cuidados intensivos.

  9. 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.

  10. Caracterización clinicopatológica de los tumores malignos palpebrales

    OpenAIRE

    Ramírez García, Lázara Kenia; Ortiz Ramos, Datia Liset; Gómez Cabrera, Clara Gisela; Vigoa Aranguren, Lázaro; Rojas Rondón, Irene; Abreu Perdomo, Franklyn Alain

    2014-01-01

    Objetivos: describir las características clinicopatológicas de los tumores malignos palpebrales. Métodos: estudio descriptivo y retrospectivo de pacientes con diagnóstico histopatológico de carcinoma basocelular, epidermoide y adenocarcinoma de glándulas sebáceas, atendidos en el Servicio de Oculoplastia del Instituto Cubano de Oftalmología, de enero de 2005 a diciembre de 2010. Se incluyó un total de 109 pacientes; se analizó la edad, el sexo, el color de la piel, las formas clínicas, la loc...

  11. 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)

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. 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 ...

  5. 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.

  6. 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

  7. 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....

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Síndrome Neuroléptico Maligno. Presentación de un Caso.

    Directory of Open Access Journals (Sweden)

    Luis Rafael González Díaz

    2007-06-01

    Full Text Available El Síndrome Neuroléptico Maligno es una entidad nosológica poco frecuentemente vista en la práctica clínica, nuestro paciente tuvo todos los elementos clínicos para plantear el diagnóstico, edad sexo, tratamiento con neuroléptico, fiebre mantenida resistente a antipiréticos, manifestaciones extrapiramidales, elevación de enzimas, insuficiencia renal como la complicación más frecuente, se descartaron la posibilidad de otros diagnósticos sobre todo causas sépticas y la respuesta al tratamiento empleado con Biperiden 4 Mg. cada 8 horas y Bromocriptina 25 Mg. por vía oral cada 12 horas fue favorable y se logró una posterior recuperación y egreso del paciente.

  13. 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...

  14. 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.

  15. 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

  16. 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.

  17. 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...

  18. 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.

  19. 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.

  20. 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.

  1. Caracterización clinicopatológica de los tumores malignos palpebrales

    Directory of Open Access Journals (Sweden)

    Lázara Kenia Ramírez García

    Full Text Available Objetivos: describir las características clinicopatológicas de los tumores malignos palpebrales. Métodos: estudio descriptivo y retrospectivo de pacientes con diagnóstico histopatológico de carcinoma basocelular, epidermoide y adenocarcinoma de glándulas sebáceas, atendidos en el Servicio de Oculoplastia del Instituto Cubano de Oftalmología, de enero de 2005 a diciembre de 2010. Se incluyó un total de 109 pacientes; se analizó la edad, el sexo, el color de la piel, las formas clínicas, la localización anatómica, el grado de diferenciación celular y la frecuencia anual. Resultados: el grupo de edad entre 60 y 79 años constituyó el 50,5 % de los casos. El sexo masculino constituyó el 47,7 % y el femenino el 52,3 %. El carcinoma basocelular se presentó en el 68,8 % de los pacientes, el carcinoma epidermoide en el 19,3 % y el adenocarcinoma de glándulas sebáceas en el 11,9 %. La piel blanca mostró el 88 % de los casos; el carcinoma basocelular nodular estuvo presente en el 53,3 % y la noduloulcerativa en 33,3 %. En el párpado inferior se presentó el carcinoma basocelular en el 69,3 % y el epidermoide en el 66,7 %. El 44,1 % de los diagnósticos histopatológicos fueron moderadamente diferenciados. Mostró 21 casos de carcinoma basocelular en el 2009; 7 de carcinoma epidermoide en el 2007 e igual número de casos de adenocarcinoma de glándulas sebáceas en el 2010. Conclusiones: más de la mitad de los pacientes que presentan tumores malignos palpebrales son adultos mayores, femeninos y blancos. Se evidencia la totalidad de las formas clínicas de presentación; predomina en el párpado inferior el carcinoma basocelular y el epidermoide. La mayoría de los casos muestra grado de diferenciación celular moderado y la frecuencia anual tiene disímil comportamiento.

  2. 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

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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...

  11. 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

  12. Síndrome neuroléptico maligno Neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    Ricardo J. Toro

    1989-02-01

    Full Text Available

    El síndrome neuroléptico maligno (SNM es una complicación rara, idiosincrática y potencialmente fatal, relacionada con el uso de drogas que afectan el sistema dopaminérgico; su cuadro clínico consiste en síntomas extrapiramidales, signos de disfunción autonómica y trastornos en el estado de conciencia, asociados a leucocitosis ya cifras muy elevadas de creatina fosfoquinasa. Reportamos el caso de un hombre de 32 años que presentó un síndrome catatónico severo después del uso intrahospitalario de antipsicóticos potentes a altas dosis para el control de una depresión psicótica. Se discuten las características clínicas del paciente y los hallazgos comunes en el SNM.

    The Neuroleptic Malignant Syndrome (NMS Is a rare, idiosyncratic and potentially fatal complication of therapy with many drugs affecting the dopaminergic system; It Includes extrapyramidal symptoms, signs of autonomic dysfunction, disorders of consciousness, leucocytosis and an increase in serum creatine phosphokinase .We report the case of a 32 years old man, who developed a severe catatonic syndrome after receiving high doses of potent neuroleptics to control a psychotic depression. Clinical features of this case and common findings of NMS are discussed.

  13. 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

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

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    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.

  15. 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

  16. 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)

  17. 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)

  18. 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.

  19. [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.

  20. 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.

  1. 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.

  2. 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.

  3. Adenoma maligno de células cromófobas da hipófise

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    Roberto Melaragno Filho

    1947-06-01

    Full Text Available Estudo anátomo-clínico de um caso de adenoma maligno de células cromófobas da hipófise, com hipertensão intracraniana, hemianopsia homônima esquerda, hemiparesia capsular esquerda, hipersônia, distúrbios da memória para fatos recentes, diminuição progressiva da potência coeundi e hipoacusia, sintomatologia essa de 2 anos, precedida, um ano antes, por algumas perturbações visuais passageiras; nos últimos 6 meses, juntaram-se ao quadro clínico crises uncinadas e escarros sanguinolentos. Essa sintomatologia encontra plena explicação no substrato morfológico observado pelo estudo radiográfico e anátomo-patológico do caso. Radiologicamente, foram constatadas a localização selar do tumor e a dilatação dos ventrículos laterais. Esses achados foram confirmados pela necrópsia, que revelou a grande extensão do tumor, com destruição das paredes da sela túrcica, partes adjacentes do corpo e das pequenas asas do esfenóide, bem como das pontas dos ossos petrosos. Expandindo-se, dum lado o tumor atravessou o osso esfenóide e fez saliência na abóbada faríngea e, doutro, invadiu e lesou, à direita, a área perfurada anterior, região pré-óptica, porções supra-óptica e tuberal do hipotálamo, tracto óptico, partes inferiores do núcleo lentiforme e do segmento lentículo-caudado da cápsula interna, e, no lobo temporal, o uncus e a porção adjacente do giro hipocampal. O quadro histológico do tumor difere do que se observa nos adenomas comuns de células cromófobas da hipófise, principalmente pelo grande polimorfismo celular, maior freqüência de figuras mitóticas, e menor regularidade do arranjo das células.

  4. Varied Presentation of Schwannoma – A Case Study

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    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.

  5. 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.

  6. 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

  7. 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)

  8. 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 ...

  9. 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.

  10. 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.

  11. 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.

  12. 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.

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

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    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.

  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. Clinical features and surgical treatment of cauda equina schwannoma

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    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.

  16. 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.

  17. 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

  18. 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.

  19. 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...

  20. 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...

  1. 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)

  2. [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.

  3. 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.

  4. 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.

  5. Glaucoma maligno en paciente con cirugía previa de catarata traumática e implante valvular: reporte de caso

    Directory of Open Access Journals (Sweden)

    Juan Carlos Serna-Ojeda

    2015-07-01

    Full Text Available El glaucoma maligno es un glaucoma secundario asociado con un bloqueo ciliar y dirección equivocada del flujo del humor acuoso. Se presenta el caso de un paciente masculino de 19 años con antecedente de explosión de filtro metálico en ojo derecho. Se encuentra con una presión intraocular de 52 mmHg y cristalino luxado a cámara anterior. Se inicia terapia máxima para glaucoma y se realiza facoemulsificación con posterior colocación de válvula de Ahmed, y 3 semanas después de la cirugía presenta hallazgos clínicos compatibles con glaucoma maligno. Se presenta el seguimiento del paciente y los estudios de imagen indicados

  6. 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 ...

  7. 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)

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. Utilidad del cisplatino intrapericárdico en el tratamiento del derrame pericárdico maligno

    Directory of Open Access Journals (Sweden)

    Marcelo Zylberman

    2010-01-01

    Full Text Available RESUMENIntroducciónEl derrame pericárdico maligno recidiva en hasta el 62% de los pacientes luego de unapericardiocentesis. Debido a ello, se ha intentado completar el tratamiento con la instilaciónintrapericárdica de drogas luego del drenaje de la cavidad. El cisplatino ha demostradoque es útil y seguro para ese propósito.ObjetivoPresentar la experiencia en nuestra institución del uso del cisplatino intrapericárdico en eltratamiento del derrame pericárdico maligno.Material y métodosSe incluyeron los pacientes ingresados en el Instituto Alexander Fleming entre enero de2005 y mayo de 2009 con diagnóstico de taponamiento cardíaco o de derrame pericárdicograve tratados con drenaje percutáneo e instilación de cisplatino intrapericárdico (10 mg en20 ml de solución fisiológica por 5 días. Se requirió: a confirmación citológica de malignidado b hallazgo ecocardiográfico de lesiones compatibles con invasión neoplásica del sacopericárdico y c poca expectativa de respuesta a un tratamiento sistémico.ResultadosSe incluyeron 9 pacientes (6 hombres y 3 mujeres, edad media 60 años (51-69. El tumorprimario fue pulmonar (n = 4, de mama (n = 1, de vejiga (n =1, de esófago (n = 1, deriñón (n = 1 y de próstata (n = 1. La citología fue positiva en 6 casos. El tiempo de permanenciadel catéter fue de 7 días. Hubo efectos adversos en tres casos: dolor, fiebre y fibrilaciónauricular. Un solo paciente tuvo recidiva del derrame al mes. Ocho pacientes fallecieron[tiempo medio a la muerte: 50 días (7-83] y uno vive.ConclusionesEl cisplatino intrapericárdico resulta factible de realizar, se tolera bien y se observa unporcentaje bajo de recidivas, lo cual cumple con el objetivo del tratamiento.REV ARGENT CARDIOL 2010;78:114-117.

  14. Malignant paraganglioma with vertebral metastasis: case report Paraganglioma maligno com metástase vertebral: relato de caso

    Directory of Open Access Journals (Sweden)

    Bruno Lázaro

    2003-06-01

    Full Text Available A paraganglioma is a rare tumor, composed of chromaffin cells, groups of cells associated to the autonomous system. When the tumor occurs in the adrenal gland, it is called pheochromocitoma. The malignant paraganglioma is a very rare presentation; it is diagnosed by local recurrence after total resection of the primary mass, or findings of distant metastases. We present a case report of a 29-year-old woman with cervico-brachial pain. In 1995 she underwent a carotid body tumor resection. Magnetic resonance imaging (MRI, plain X-rays and computerized tomography scan revealed multiple lesions in C5, T5 and T12. She underwent a surgical procedure to correct the cervical lesion. The histological and immunohistochemical assays revealed a malignant paraganglioma. She received adjuvant radiotherapy, showing clinical improvement after treatment, presenting no symptoms after one year. The therapeutic approach is based on the total resection of the tumor. The treatment of distant metastases can be made with adjuvant measures such as conventional radiotherapy, I¹³¹-MIBG, or chemotherapy, especially in malignant pheochromocitomas.O paraganglioma é tumor raro, composto de células cromafins, associado ao sistema nervoso autônomo. Quando localizado na glândula supra-renal, o tumor é chamado feocromocitoma. Descreve-se um caso de paciente do sexo feminino, 29 anos, que se apresentou com cervicobraquialgia e que havia sido operada em 1995 para exérese de tumor glômico da carótida cervical. RM, RX e TC revelaram múltiplas lesões acometendo o corpo vertebral de C5, T5 e T12. Foi submetida à ressecção cirúrgica radical da lesão cervical, com substituição do corpo vertebral por prótese de titânio. A histopatologia e o estudo imunohistoquímico da lesão confirmaram o diagnóstico de paraganglioma maligno. As outras lesões foram tratadas com radioterapia. Um ano após os procedimentos, a paciente apresenta-se assintomática. O tratamento destas

  15. Melanoma maligno anaplásico em um eqüino Anaplastic malignant melanoma in a horse

    Directory of Open Access Journals (Sweden)

    Daniel Ricardo Rissi

    2008-10-01

    Full Text Available Descreve-se um caso de melanoma maligno anaplásico em uma égua Crioula, tordilha, com 10 anos de idade, com histórico clínico de apatia, perda de peso progressiva, febre, anorexia e dispnéia. Múltiplas massas pigmentadas e não-pigmentadas, bem delimitadas ou infiltrativas, foram observadas no tecido subcutâneo e em vários órgãos. Histologicamente o neoplasma era composto de populações de células fusiformes, redondas ou poliédricas e, menos freqüentemente, de células multinucleadas e "células em anel de sinete". O diagnóstico foi realizado com base nos achados clinicopatológicos e confirmado pela microscopia eletrônica de transmissão.A case of anaplastic malignant melanoma in a 10-year-old gray mare is described. Clinical signs included depression, progressive weight loss, fever, anorexia, and dyspnea. Multiple circumscribed or infiltrative, pigmented, and non-pigmented tumors were observed in subcutaneous tissue and in several organs. Histological examination revealed a marked variation in neoplastic cell population, which was composed by spindle, round, polyhedrical, and less frequently, multinucleated or signet ring cells. The diagnostic was based up on clinical and pathological findings, and confirmed by transmission electronic microscopy.

  16. 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

  17. 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.

  18. 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

  19. 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.

  20. 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...

  1. 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.

  2. 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.

  3. 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...

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. 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.)

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. 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...

  15. 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.

  16. 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

  17. 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.

  18. 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

  19. Pode a gestação influenciar a evolução de nódulo tireoidiano maligno?

    Directory of Open Access Journals (Sweden)

    Lucy Kerr

    2012-02-01

    Full Text Available Os autores descrevem um nódulo tireoidiano com padrões ultrassonográfico e citopatológico benignos que diminuiu mais de 50% em três anos e se modificou durante a gestação, constatando-se que era carcinoma papilífero. Conclui-se que a gestação pode aumentar o risco de malignização ou acelerar o crescimento de nódulo tireoidiano maligno preexistente, corroborando dados da literatura.

  20. 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

  1. 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.

  2. 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

  3. 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...

  4. 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.

  5. 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...

  6. 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

  7. 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...

  8. 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.

  9. 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.

  10. 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

  11. 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

  12. [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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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...

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. 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.

  9. 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...

  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. 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

  12. Neurofibromatosis tipo 1 asociado a tumor maligno de la vaina de nervio periférico y a carcinoma de colon

    Directory of Open Access Journals (Sweden)

    Rubén Valle

    2009-09-01

    Full Text Available La neurofibromatosis tipo 1 es una enfermedad autosómica dominante, producida por la mutación del gen de la neurofibrina, localizado en el cromosoma 17q11.2. Esta enfermedad presenta una diversidad de manifestaciones clínicas y predisposición al desarrollo de tumores, lo cual explica la elevada mortalidad. Presentamos el caso de una paciente con diagnóstico de neurofibromatosis tipo 1, quién desarrolló un tumor maligno de la vaina del nervio periférico y cáncer de colon. Se revisa la literatura y los factores clínicos, de imagen e histológicos que se asocian a la transformación maligna de los neurofibromas.

  13. Tumores gástricos malignos en el Hospital San Juan de Dios y la Clínica Carlos Lleras Restrepo de Bogotá

    OpenAIRE

    Viviana L. Arias; Mauricio A. Paláu; Juan José Yunis; Diana Palacios; Orlando Ricaurte

    2001-01-01

    Se revisaron 9.349 informes de estudios de especímenes quirúrgicos del archivo del Departamento de Patología del Hospital San Juan de Dios y la Clínica Carlos Lleras Restrepo de Bogotá en el tiempo comprendido entre enero 1 de 1999 y mayo 31 de 2000. Se seleccionaron los especímenes con diagnóstico de tumores gástricos que correspondieron al 8,61% de los casos; 2,41% fueron tumores benignos y 6,2% malignos De éstos 91,67% fueron adenocarcinomas, 2,78 % linfomas, 1,85% tumores carcinoides y 1,...

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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).

  20. 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.

  1. 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.

  2. 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.)

  3. 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...

  4. 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...

  5. 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.

  6. 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.

  7. 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

  8. 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...

  9. 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

  10. 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

  11. 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

  12. 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.

  13. 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)

  14. 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.

  15. 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.

  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. Dermoscopic clues in the diagnosis of amelanotic and hypomelanotic malignant melanoma Pistas dermatoscópicas no diagnóstico de melanoma maligno amelanótico e hipomelanótico

    Directory of Open Access Journals (Sweden)

    Raquel Bissacotti Steglich

    2012-12-01

    Full Text Available The clinical identification of amelanotic malignant melanoma (AMM and hypomelanotic malignant melanoma (HMM becomes difficult due to the lack of pigmentation and to the diverse clinical presentations. Dermoscopy is very useful in these cases, increasing the level of suspicion of malignancy. We report 4 cases of amelanotic malignant melanoma and hypomelanotic malignant melanoma with characteristic dermoscopic findings. Dermoscopy under polarized light demonstrates vascular polymorphism, globules and milky-red areas, in addition to chrysalis and multiple blue-gray dots.A identificação clínica de melanoma maligno amelanótico e hipomelanótico torna-se difícil devido à falta de pigmentação e às diversas apresentações desse tipo de tumor. A dermatoscopia é muito útil nestes casos, aumentando o grau de suspeição de malignidade. Relatamos 4 casos de melanoma maligno amelanótico e melanoma maligno hipomelanótico com achados dermatoscópicos característicos. A dermatoscopia com luz polarizada demonstra polimorfismo vascular, glóbulos e áreas vermelholeitosas, assim como crisálides e múltiplos pontos azul-acinzentados.

  4. 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....

  5. Malignant eccrine spiradenoma of the nasolabial fold: A case report Espiradenoma ecrino maligno en el surco nasolabial: Caso clínico

    Directory of Open Access Journals (Sweden)

    Guillermo Gómez Oliveira

    2012-12-01

    Full Text Available Malignant eccrine spiradenoma (MES is a rare malignancy of the eccrine sweat glands. It usually presents as a small, firm, reddish painful and small solitary nodule. Head and neck are rare locations. Etiology is unknown although previous trauma is believed to be an implicated factor. MES arises over a prior benign spiradenoma. Clinical behavior is aggressive with a high rate of recurrences and distant metastases. Prognosis is poor. Diagnosis is based on histological findings and treatment must be aggressive from the beginning to achieve the best results. Since Kersting and Helwig first described the case in 1956, and Beekley et al., reported its malignant transformation in 1971, only a few cases can be found in the literature. Based on these particular features we report a case of a 75-year-old man diagnosed on a MES that arises in a very unusual location, with a peculiar histopathology and behavior.El espiradenoma ecrino maligno (EEM es un tumor maligno poco frecuente de las glándulas sudoríparas ecrinas. Suele presentarse como un pequeño nódulo eritematoso, firme, solitario y doloroso. La cabeza y el cuello son una localización excepcional. Se desconoce la etiología aunque se considera que un traumatismo previo es un factor implicado. El EEM se origina sobre un espiradenoma benigno previo. La conducta clínica es agresiva con una elevada tasa de recidivas y metástasis a distancia. El pronóstico es infausto. El diagnóstico se basa en los hallazgos histológicos y el tratamiento ha de ser agresivo desde el principio para obtener los mejores resultados. Desde que, en 1956, Kersting y Helwig describieran el primer caso, y, en 1971, Beekley y cols. documentaran su transformación maligna, sólo se han publicado unos pocos casos. En función de estas características específicas, describimos a un hombre de 75 años de edad, en el que se estableció el diagnóstico de este tumor, originado en una localización poco habitual, con una

  6. Técnica de Tenzel en la cirugía reconstructiva de los tumores malignos palpebrales Tenzel technique in the reconstructive surgery of the malignant eyelid tumors

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    Clara G. Gómez Cabrera

    2001-12-01

    Full Text Available Se realizó un estudio descriptivo de tipo restrospectivo en el período comprendido entre marzo de 1995 y diciembre del 2000, tomando como universo a 24 pacientes operados de tumor maligno de los párpados, a los cuales fue necesario realizar cirugía reconstructiva, utilizando para ello el injerto rotado de Tenzel. El 91,8 % de los pacientes fueron operados por carcinoma basocelular. El 70,8 % de los casos se encontraban en el estadio T2 y el 29,2 % en el estadio T3. Los resultados cosméticos fueron buenos en 22 pacientes para el 91,8 %. Las complicaciones, todas posoperatorias, incluyeron el ectropion marginal en 2 casos, uno de los cuales presentó además, persistencia tumoral, la dehiscencia de sutura solo se observó en 1 paciente. La recuperación quirúrgica fue de 10 días en 4 pacientes (16,7 %, de 15 días en 16 (66,7 %, de 20 días en 3 (12,5 % y solo 1 caso tardó 30 días para recuperarse. Fue posible realizar esta técnica en el 40 % de los pacientes operados por tumores malignos palpebrales. El resultado cosmético alcanzado con esta técnica es bueno y la recuperación quirúrgica fue posible en 15 días en más de la mitad de los pacientes.A descriptive and retrospective study that included 24 patients operated on of eyelid malignant tumor that had to undergo reconstructive surgery by Tenzel rotated graft was conducted from March, 1995, to December, 1999. 91.8 % of the patients were operated on due to basocelular carcinoma. 70.8 % of the cases were in stage T2 and 29.2 % in stage T3. The cosmetic results were good in 22 patients, accounting for 91.8 %. The complications, all of them postoperative, included the marginal ectropion in 2 cases. One of them also had tumoral persistence. Suture dehiscence was only observed in 1 patient. Surgical recovery was of 10 days in 4 patients (16.7 %, of 15 days in 16 (66.7 %, of 20 days in 3 (12.5 % and of 30 days in only l case. It was possible to use this technique in 40 % of the patients

  7. 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.)

  8. 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)

  9. Predictors of Preoperative Tinnitus in Unilateral Sporadic Vestibular Schwannoma

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    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

  10. 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

  11. CIRUGÍA MICROGRÁFICA DE MOHS. TRATAMIENTO DE LOS TUMORES MALIGNOS CUTÁNEOS DE ALTA AGRESIVIDAD Y COMPLEJIDAD. SEGUNDA PARTE

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    Michel Faizal

    2016-04-01

    Full Text Available

    RESUMEN

    La cirugía micrográfica de Mohs es el tratamiento quirúrgico con más altas tasas de curación de los tumores malignos cutáneos agresivos localmente invasivos, minimizando el sacrificio innecesario de tejidos peritumorales sanos. Los márgenes oncológicos son determinados en etapas sucesivas, los tejidos son evaluados en cortes histológicos horizontales en tres dimensiones, identificando con precisión la localización de la persistencia oncológica subsecuente escisión hasta la inexistencia del tumor respetando los tejidos sanos que no son removidos.

    MOHS MICROGRAPHIC SURGERY TREATMENT OF THE MALIGNANT CUTANEOUS TUMORS OF HIGH AGGRESSIVENESS AND COMPLEXITY (SECOND PART

    ABSTRACT

    Mohs micrographic surgery is the surgical treatment with higher cure rates of aggressive locally invasive skin malignancies, minimizing unnecessary slaughter of healthy peritumoral tissues. Oncologic margins are determined in successive stages, tissues are evaluated in horizontal histological sections in three dimensions, precisely identifying the location of oncological subsequent cleavage persistence to the absence of tumor respecting healthy tissues are not removed .

  12. 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...

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

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    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.

  14. 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

  15. 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.

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

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    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.

  17. 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.

  18. 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...

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

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

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    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.

  5. 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.

  6. Mesotelioma maligno: descripción clínica y radiológica de 45 casos con y sin exposición a asbestos

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    García-López Ma. del Pilar

    2000-01-01

    Full Text Available OBJETIVO: Identificar y caracterizar los principales síntomas, la presentación clínica y las alteraciones radiológicas de pacientes con mesotelioma maligno (MM, admitidos en una institución gubernamental especializada en enfermedades del tórax. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo en el cual se revisaron los registros médicos y radiológicos de pacientes diagnosticados con MM, admitidos en el Instituto Nacional de Enfermedades Respiratorias (INER, en la ciudad de México, de 1991 a 1998. Se incluyeron los siguientes datos: edad, ocupación, exposición a asbestos, latencia, historia familiar en relación con otras neoplasias, sintomatología clínica y alteraciones radiológicas. Se calcularon porcentajes por sexo y grupo de edad. RESULTADOS: Se encontraron 45 casos con MM, y en 80% de ellos no se pudo documentar historia exposicional a asbestos. El grupo de edad con mayor frecuencia se encontró entre los 51-60 años. Disnea y dolor torácico fueron los principales síntomas. Las anormalidades radiológicas estuvieron constituidas por derrame y engrosamiento pleural en 75% de los pacientes. CONCLUSIONES: La presentación clínica y las anormalidades radiológicas en pacientes con MM sin historia de exposición a asbestos fueron similares a las de los pacientes con antecedentes de exposición a asbestos.

  7. Estudo comparativo da flarefotometria em pacientes com melanoma maligno e nevo de coróide Comparative study of flare photometry in patients with choroidal malignant melanoma and choroidal nevus

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    Priscilla Luppi Ballalai

    2002-01-01

    Full Text Available Introdução: Os tumores malignos intra-oculares estão associados com um aumento do "flare" na câmara anterior, causado por uma quebra na barreira hemato-aquosa, que pode ocorrer por vários mecanismos. Estudos utilizando a flarefotometria confirmam o aumento do "flare" em olhos com tumores intra-oculares malignos e benignos. Objetivo: Avaliar a flarefotometria como auxiliar no diagnóstico diferencial de melanoma maligno e nevo de coróide, comparando-se com olhos contralaterais normais. Métodos: Foram avaliados olhos com melanoma maligno e olhos com nevo de coróide diagnosticados por meio de oftalmoscopia indireta e/ou ultra-sonografia. Os olhos normais contralaterais foram utilizados como controles. A flarefotometria foi realizada em todos os pacientes, sob midríase bilateral, utilizando equipamento Laser Flare Meter (FC 500, Kowa. Foram aplicados os testes de Wilcoxon, Mann-Whitney, e Spearman para análise estatística. Resultados: A média da flarefotometria nos olhos com melanoma maligno de coróide foi 17,1 ph/ms e nos olhos normais contralaterais foi 4,06 ph/ms. Nos olhos com nevo de coróide o valor da flarefotometria foi 6,12 ph/ms e nos olhos contralaterais normais foi 4,47 ph/ms. O valor da flarefotometria foi maior nos olhos com melanoma maligno e nevo quando comparado com os olhos contralaterais normais (pIntroduction: Malignant intraocular tumors are associated with an increase in the aqueous flare, caused by alterations of the blood-ocular barriers through various mechanisms. Several studies have demonstrated an ocular flare increase using flare photometry in eyes with benign and malignant tumors. Purpose: To evaluate flare photometry as an adjunct method in the differential diagnosis of choroidal malignant melanoma and choroidal nevus comparing to normal control eyes. Methods: Eyes with melanoma and nevus were diagnosed by indirect binocular ophthalmoscopy and/or ultrasound were evaluated. The fellow normal eyes were used

  8. 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)

  9. Malignant transformation in a hybrid schwannoma/perineurioma: Addition to the spectrum of a malignant peripheral nerve sheath tumor

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    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.

  10. 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.

  11. 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.

  12. A Case of Action-Induced Clonus that Mimicked Action Tremors and was Associated with Cervical Schwannoma

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    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.

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

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    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.

  14. Comportamiento de los tumores malignos de los párpados en el Instituto Nacional de Oncología y Radiobiología

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    María de los Ángeles Melgares Ramos

    Full Text Available Objetivo: evaluar el comportamiento clínico-histopatológico de los tumores malignos palpebrales y las modalidades de tratamiento aplicadas en el Instituto Nacional de Oncología y Radiobiología. Métodos: se realizó un análisis retrospectivo de 255 pacientes tratados consecutivamente en el periodo de enero 1995 a julio 2010. Los casos fueron evaluados según localización del tumor, modalidad de tratamiento, recurrencias, recidivas, complicaciones y sobrevida. El estadiamiento se realizó según los criterios de la la Unión Internacional contra el Cáncer como T1N0M0, T2N0M0, T3N0M0, T4N0M0. Resultados: del total de pacientes, 54,1 % fueron masculinos y 45,9 % femeninos con rangos de edad entre 18 y 80 años. La localización más frecuente fue en el párpado inferior (35 %, y el canto externo, la variedad histopatológica predominante fue el carcinoma basocelular (47,8 %. El tratamiento de elección fue la cirugía, la que se realizó a 198 pacientes. El 50,2 % de los casos tratados tuvieron persistencia tumoral con infiltración de los bordes de sección quirúrgicos, los cuales recibieron tratamiento radiante adyuvante. Se presentaron recurrencias en el 3,5 % entre 3 y 5 meses y recidivas en el 7,1 % de los casos, a partir del primer año después de terminado el tratamiento inicial, las complicaciones más frecuentes encontradas fueron los pobres resultados cosméticos, disminución de la visión, úlceras corneales, entre otras. La sobrevida fue de 86,3 %. Conclusiones: se hace necesaria la introducción de modernos y conservadores tratamientos como alternativa a la cirugía que sean capaces de controlar el tumor y mejorar la calidad de vida de los pacientes con cáncer palpebral en casos específicos.

  15. Schwannoma do forame magno: revisão e relato de caso Foramen magnum schwannoma: review of the literature and report of a case

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    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

  16. Risk factors associated with vestibulocochlear nerve schwannoma: systematic review Fatores de risco associados ao Schwannoma do nervo vestibular: revisão sistemática

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    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

  17. 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

  18. Postural Stability Evaluation of Patients Undergoing Vestibular Schwannoma Microsurgery Employing the Inertial Measurement Unit

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    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

  19. 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.

  20. Schwanoma de plexo braquial: relato de dois casos Schwannoma of brachial plexus: report of two cases

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    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.

  1. 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.)

  2. 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.

  3. 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.

  4. 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.

  5. 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.”

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. 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.

  11. 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

  12. 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.

  13. 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...

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. 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)

  19. 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.

  20. [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.

  1. 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.

  2. 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).

  3. 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)

  4. 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)

  5. 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.

  6. 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.

  7. 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.

  8. CIRUGÍA MICROGRÁFICA DE MOHS TRATAMIENTO DE LOS TUMORES MALIGNOS CUTÁNEOS DE ALTA AGRESIVIDAD Y COMPLEJIDAD.

    Directory of Open Access Journals (Sweden)

    Michel Faizal Geagea

    2015-09-01

    Full Text Available

    La cirugía micrográfica de Mohs es el tratamiento quirúrgico con más altas tasas de curación de los tumores malignos cutáneos agresivos localmente invasivos, minimizando el sacrificio innecesario de tejidos peritumorales sanos. Los márgenes oncológicos son determinados en etapas sucesivas, los tejidos son evaluados en cortes histológicos horizontales en tres dimensiones, identificando con precisión la localización de la persistencia oncológica y subsecuente escisión hasta la inexistencia del tumor respetando los tejidos sanos que no son removidos. La conclusión diagnóstica de la evaluación de las neoplasias cutáneas, se deriva del laudo histopatológico el cual debe conducir en la elección de la mejor opción terapéutica. El tratamiento del cáncer cutáneo es realizado con métodos quirúrgicos o médicos, bien sea por la destrucción a ciegas o por la evaluación histológica de los márgenes oncológicos que determinan una porción de los límites del tumor. Las neoplasias malignas cutáneas que no han recibido tratamiento o las recurrentes consideraciones de alto riesgo por presentar características clínicas y/o histológicas agresivas, deben recibir la mejor opción terapéutica. Actualmente la cirugía micrográfica de Mohs ofrece la mejor curabilidad de los pacientes con tumores cutáneos, con un menor sacrificio de los tejidos perilesionales sanos, resultando en pequeños defectos quirúrgicos comparados con las consecuentes de resecciones quirúrgicas convencionales, repercutiendo en la complejidad de la reconstrucción. Las altas posibilidades de curación y los menores defectos quirúrgicos resultantes de la cirugía micrográfica de Mohs, crea un impacto costo-efectivo en la reducción de procedimientos quirúrgicos repetidos.

    MOHS SURGERY IN TREATING AGGRESSIVE SKIN CANCERS

    ABSTRACT

    Final diagnosis in assessing skin cancers derives from histopathology, then

  9. Complicações oftálmicas em pacientes com tumores malignos extra-orbitários Ophthalmic complications in patients with extraorbital malignant tumors

    Directory of Open Access Journals (Sweden)

    Ana Célia Baptista

    2003-10-01

    Full Text Available OBJETIVO: Correlacionar as complicações oftálmicas, presentes em pacientes portadores de tumores malignos extra-orbitários, com o sítio de origem e diagnóstico histopatológico destas neoplasias, por meio de tomografia computadorizada. MÉTODOS: Foram estudados retrospectivamente, por tomografia computadorizada, 29 pacientes com neoplasias malignas extra-orbitárias, sem qualquer tratamento prévio do tumor, e evidência clínico-radiológica de comprometimento orbitário associado. RESULTADOS: Houve predomínio do carcinoma epidermóide (28%, seguido pelo carcinoma basocelular (14%. As complicações oftálmicas mais comumente observadas foram proptose (38%, epífora (24% e dor ocular (24%. Redução da acuidade visual foi referida em 14 % dos casos. Os sítios de origem mais comuns das neoplasias foram o seio maxilar (28%, o seio etmoidal (17% e a pele e subcutâneo da face (17%. Proptose ocular foi causada predominantemente por tumores não carcinomatosos e tumores originados no seio etmoidal, ao passo que epífora ocorreu preferencialmente nos casos de tumores carcinomatosos e de neoplasias do seio maxilar. Redução da motilidade ocular, irritação ocular e secreção no olho foram as complicações oftálmicas mais freqüentes em pacientes com tumores dos anexos oculares, ao passo que dor ocular foi a complicação oftálmica dominante nos pacientes com neoplasias originadas na pele e subcutâneo da face. CONCLUSÕES: Os autores sugerem que, diante de paciente com epífora e massa maxilo-nasal, carcinoma do seio maxilar deve ser considerado primariamente no diagnóstico diferencial da lesão. Da mesma forma, tumores não carcinomatosos, como sarcomas e linfomas, devem ser considerados, sobretudo no diagnóstico de pacientes com proptose e massa naso-etmoidal.OBJECTIVE: To correlate the ophthalmic complications in patients with extra-orbital malignant tumors with the site of origin and histopathologic diagnosis of the tumors by

  10. 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

  11. Schwannoma intralaberíntico. Descripción de un caso

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    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.

  12. 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

  13. 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...

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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)

  1. 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

  2. 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)

  3. 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.

  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. 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.

  8. Marcadores morfológicos de prognóstico no mesotelioma maligno: um estudo de 58 casos Morphological aspects as prognostic factors in malignant mesothelioma: a study of 58 cases

    Directory of Open Access Journals (Sweden)

    Alexandre Bottrel Motta

    2006-08-01

    Full Text Available OBJETIVO: Diversos marcadores têm se mostrados promissórios como preditores do diagnóstico e prognóstico do mesotelioma maligno (MM. MÉTODO: Mediante estudo morfométrico e inmunomarcação de componentes estromais (calretinina, CEA, Leu-M1 e trombomodulina e nucleares (p53 e Ki-67, avaliamos a sobrevida após o diagnóstico de 58 pacientes com tumores malignos de pleura. RESULTADOS: O padrão histológico típico do mesotelioma maligno foi encontrado em 50 casos e o padrão atípico em 8 casos. Imunohistoquimicamente foram confirmados 40 casos como sendo mesoteliomas, 11 como adenocarcimonas e 7 casos do padrão atípico não puderam ser classificados. A análise multivariavel do Cox demonstrou a coexistência de um maior fator de risco de morte (476.2, nos pacientes com idade avançada, subtipo histológico bifásico e componentes de expressão nuclear. CONCLUSÃO: A calretinina foi o marcador inmunohistoquímico (IHQ mais útil para o diagnóstico do mesotelioma e o CEA para o de adenocarcinoma. A quantificação por IHQ da trombomodulina foi fundamental na diferenciação do mesotelioma quando este foi positivo tanto para calretinina e como para o CEA. A informação prognostica mais valiosa foi a fornecida pela análise rotineira histopatológica do tipo histológico tumoral. Um ponto importante, divisor natural, foi a idade com uma media de 55 anos e 30.5% de componentes nucleares de marcação IHQ, separando os pacientes em dois grupos: pacientes com uma sobrevivência curta contra pacientes com uma sobrevivência mais longa que a esperada. Assim, a análise histopatológica oferece uma arma poderosa e de elevado potencial para guiar no tratamento adjuvante de quimioterápicos após a retirada cirúrgica do mesotelioma.OBJECTIVE: Various markers have shown promise as diagnostic markers and prognostic predictors in malignant mesothelioma (MM. METHODS: Through morphometric and immunological studies of markers in stromal components

  9. Immunohistochemical profile of cytokines and growth factors expressed in vestibular schwannoma and in normal vestibular nerve tissue.

    Science.gov (United States)

    Taurone, Samanta; Bianchi, Enrica; Attanasio, Giuseppe; Di Gioia, Cira; Ierinó, Rocco; Carubbi, Cecilia; Galli, Daniela; Pastore, Francesco Saverio; Giangaspero, Felice; Filipo, Roberto; Zanza, Christian; Artico, Marco

    2015-07-01

    Vestibular schwannomas, also known as acoustic neuromas, are benign tumors, which originate from myelin-forming Schwann cells. They develop in the vestibular branch of the eighth cranial nerve in the internal auditory canal or cerebellopontine angle. The clinical progression of the condition involves slow and progressive growth, eventually resulting in brainstem compression. The objective of the present study was to investigate the expression level and the localization of the pro-inflammatory cytokines, transforming growth factor-β1 (TGF-β1) interleukin (IL)-1β, IL-6 and tumor necrosis factor-α (TNF-α), as well as the adhesion molecules, intracellular adhesion molecule-1 and vascular endothelial growth factor (VEGF), in order to determine whether these factors are involved in the transformation and development of human vestibular schwannoma. The present study investigated whether changes in inflammation are involved in tumor growth and if so, the mechanisms underlying this process. The results of the current study demonstrated that pro-inflammatory cytokines, including TGF-β1, IL-1β and IL-6 exhibited increased expression in human vestibular schwannoma tissue compared with normal vestibular nerve samples. TNF-α was weakly expressed in Schwann cells, confirming that a lower level of this cytokine is involved in the proliferation of Schwann cells. Neoplastic Schwann cells produce pro-inflammatory cytokines that may act in an autocrine manner, stimulating cellular proliferation. In addition, the increased expression of VEGF in vestibular schwannoma compared with that in normal vestibular nerve tissue, suggests that this factor may induce neoplastic growth via the promotion of angiogenesis. The present findings suggest that inflammation may promote angiogenesis and consequently contribute to tumor progression. In conclusion, the results of the present study indicated that VEGF and pro-inflammatory cytokines may be potential therapeutic targets in vestibular

  10. Timomas malignos – A experiência do IPO do Porto e revisão da literatura

    Directory of Open Access Journals (Sweden)

    Berta Sousa

    2007-07-01

    Full Text Available Resumo: Introdução: Os tumores epiteliais tímicos (TET, a maioria timomas, são neoplasias desenvolvidas a partir das células epiteliais do timo e constituem cerca de 30% das massas do mediastino anterior em adultos. Os timomas são constituídos por células sem características citológicas de malignidade, sendo o comportamento maligno determinado pela invasão da cápsula e estru-turas adjacentes. Estes tumores apresentam um amplo espectro de características clínicas e morfológicas, e as pequenas séries de doentes conhecidas tornam difícil o estabelecimento de um tratamento standard.Material e métodos: Efectuouse um estudo retrospectivo dos doentes admitidos com diagnóstico de ti moma no Instituto Português de Oncologia - Centro do Porto (IPO-Porto, de 1983 a 2004. Foram anali-sadas as suas características clínicas, classificação histológica segundo a OMS, o estadiamento de Masaoka, e a sua relação com as modalidades de tratamento. Procedeu-se à revisão dos registos clínicos destes doentes e revisão do material histológico para a classificação segundo critérios da OMS de 1999.Resultados: No IPO-Porto, entre 1983 e 2004, fo-ram tratados 28 doentes com TET. Destes, 21 eram timomas invasivos, sendo estes o objecto deste estudo. Dos dados demográficos salienta-se que eram 11 homens, 10 mulheres, com uma idade mediana de 55 anos (24-79 anos. A classificação histológica da OMS foi a seguinte: 2 doentes (9,5% Tipo A, 6 (28,6% tipo AB, 4 (19% tipo B1, 2 (9,5% tipo B2, 7 (33,4% tipo B3. O estadiamento segundo Masaoka foi 9 doentes (42,8% com estádio II, 6 (28,6% com estádio III e 6 (28,6% com estádio IVa. A maioria dos doentes apresentava sintomas locais à apresen-tação, com apenas 1 doente com diagnóstico de aplasia eritrocitária e 5 com Mastenia gravis (MG.Os 6 doentes submetidos apenas a ressecção cir

  11. Role of intracanalicular volumetric and dosimetric parameters on hearing preservation after vestibular schwannoma radiosurgery

    International Nuclear Information System (INIS)

    Massager, Nicolas; Nissim, Ouzi; Delbrouck, Carine; Devriendt, Daniel; David, Philippe; Desmedt, Francoise; Wikler, David; Hassid, Sergio; Brotchi, Jacques; Levivier, Marc

    2006-01-01

    Purpose: To analyze the relationship between hearing preservation after gamma knife radiosurgery (GKR) for vestibular schwannoma (VS) and some volumetric and dosimetric parameters of the intracanalicular components of VS. Methods and Materials: This study included 82 patients with a VS treated by GKR; all patients had no NF2 disease, a Gardner-Robertson hearing class 1-4 before treatment, a marginal dose of 12 Gy, and a radiologic and audiologic follow-up ≥1 year post-GKR. The volume of both the entire tumor and the intracanalicular part of the tumor and the mean and integrated dose of these two volumes were correlated to the auditory outcomes of patients. Results: At last hearing follow-up, 52 patients had no hearing worsening, and 30 patients had an increase of ≥1 class on Gardner-Robertson classification. We found that hearing preservation after GKR is significantly correlated with the intracanalicular tumor volume, as well as with the integrated dose delivered to the intracanalicular tumor volume. Conclusions: Some volumetric and dosimetric parameters of the intracanalicular part of the tumor influence hearing preservation after GKR of VS. Consequently, we advise the direct treatment of patients with preserved functional hearing and a VS including a small intracanalicular volume

  12. Hearing Outcomes After Stereotactic Radiosurgery for Unilateral Intracanalicular Vestibular Schwannomas: Implication of Transient Volume Expansion

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young-Hoon [Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Dong Gyu, E-mail: gknife@plaza.snu.ac.kr [Department of Neurosurgery, Seoul National University Hospital, Seoul (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Han, Jung Ho [Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Chung, Hyun-Tai; Kim, In Kyung; Song, Sang Woo [Department of Neurosurgery, Seoul National University Hospital, Seoul (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Jeong-Hoon [Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Jin Wook; Kim, Yong Hwy; Park, Chul-Kee [Department of Neurosurgery, Seoul National University Hospital, Seoul (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Chae-Yong [Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Paek, Sun Ha; Jung, Hee-Won [Department of Neurosurgery, Seoul National University Hospital, Seoul (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2013-01-01

    Purpose: We evaluated the prognostic factors for hearing outcomes after stereotactic radiosurgery (SRS) for unilateral sporadic intracanalicular vestibular schwannomas (IC-VSs) as a clinical homogeneous group of VSs. Methods and Materials: Sixty consecutive patients with unilateral sporadic IC-VSs, defined as tumors in the internal acoustic canal, and serviceable hearing (Gardner-Roberson grade 1 or 2) were treated with SRS as an initial treatment. The mean tumor volume was 0.34 {+-} 0.03 cm{sup 3} (range, 0.03-1.00 cm{sup 3}), and the mean marginal dose was 12.2 {+-} 0.1 Gy (range, 11.5-13.0 Gy). The median follow-up duration was 62 months (range, 36-141 months). Results: The actuarial rates of serviceable hearing preservation were 70%, 63%, and 55% at 1, 2, and 5 years after SRS, respectively. In multivariate analysis, transient volume expansion of {>=}20% from initial tumor size was a statistically significant risk factor for loss of serviceable hearing and hearing deterioration (increase of pure tone average {>=}20 dB) (odds ratio = 7.638; 95% confidence interval, 2.317-25.181; P=.001 and odds ratio = 3.507; 95% confidence interval, 1.228-10.018; P=.019, respectively). The cochlear radiation dose did not reach statistical significance. Conclusions: Transient volume expansion after SRS for VSs seems to be correlated with hearing deterioration when defined properly in a clinically homogeneous group of patients.

  13. Gamma Knife radiosurgery for large vestibular schwannomas greater than 3 cm in diameter.

    Science.gov (United States)

    Huang, Cheng-Wei; Tu, Hsien-Tang; Chuang, Chun-Yi; Chang, Cheng-Siu; Chou, Hsi-Hsien; Lee, Ming-Tsung; Huang, Chuan-Fu

    2018-05-01

    OBJECTIVE Stereotactic radiosurgery (SRS) is an important alternative management option for patients with small- and medium-sized vestibular schwannomas (VSs). Its use in the treatment of large tumors, however, is still being debated. The authors reviewed their recent experience to assess the potential role of SRS in larger-sized VSs. METHODS Between 2000 and 2014, 35 patients with large VSs, defined as having both a single dimension > 3 cm and a volume > 10 cm 3 , underwent Gamma Knife radiosurgery (GKRS). Nine patients (25.7%) had previously undergone resection. The median total volume covered in this group of patients was 14.8 cm 3 (range 10.3-24.5 cm 3 ). The median tumor margin dose was 11 Gy (range 10-12 Gy). RESULTS The median follow-up duration was 48 months (range 6-156 months). All 35 patients had regular MRI follow-up examinations. Twenty tumors (57.1%) had a volume reduction of greater than 50%, 5 (14.3%) had a volume reduction of 15%-50%, 5 (14.3%) were stable in size (volume change 3 cm and a volume > 10 cm 3 and tolerable mass effect can be managed satisfactorily with GKRS. Tumor volume ≥ 15 cm 3 is a significant factor predicting poor tumor control following GKRS.

  14. MRI textures as outcome predictor for Gamma Knife radiosurgery on vestibular schwannoma

    Science.gov (United States)

    Langenhuizen, P. P. J. H.; Legters, M. J. W.; Zinger, S.; Verheul, H. B.; Leenstra, S.; de With, P. H. N.

    2018-02-01

    Vestibular schwannomas (VS) are benign brain tumors that can be treated with high-precision focused radiation with the Gamma Knife in order to stop tumor growth. Outcome prediction of Gamma Knife radiosurgery (GKRS) treatment can help in determining whether GKRS will be effective on an individual patient basis. However, at present, prognostic factors of tumor control after GKRS for VS are largely unknown, and only clinical factors, such as size of the tumor at treatment and pre-treatment growth rate of the tumor, have been considered thus far. This research aims at outcome prediction of GKRS by means of quantitative texture feature analysis on conventional MRI scans. We compute first-order statistics and features based on gray-level co- occurrence (GLCM) and run-length matrices (RLM), and employ support vector machines and decision trees for classification. In a clinical dataset, consisting of 20 tumors showing treatment failure and 20 tumors exhibiting treatment success, we have discovered that the second-order statistical metrics distilled from GLCM and RLM are suitable for describing texture, but are slightly outperformed by simple first-order statistics, like mean, standard deviation and median. The obtained prediction accuracy is about 85%, but a final choice of the best feature can only be made after performing more extensive analyses on larger datasets. In any case, this work provides suitable texture measures for successful prediction of GKRS treatment outcome for VS.

  15. Role of Adjuvant Radiosurgery after Thoracoscopic Microsurgical Resection of a Spinal Schwannoma

    Directory of Open Access Journals (Sweden)

    Toba N. Niazi

    2012-01-01

    Full Text Available Stereotactic radiosurgery to benign tumors of the spine has not been advocated as a primary treatment modality because of the favorable prognosis for these lesions after gross-total resection. There is even less evidence regarding its use as an adjuvant to neurosurgical resection of benign recurrent spinal disease. We describe the case of a 30-year-old man with a thoracic spinal schwannoma who had an interval increase of his lesion five months after thoracoscopic microsurgical resection. The patient opted for noninvasive stereotactic radiosurgery in lieu of additional surgical excision and has had stable disease 15 months after radiosurgical treatment with the linear accelerator (LINAC system. In this setting, stereotactic radiosurgery provided a useful adjunct to thoracoscopic microsurgical resection. Future Class I and II evidence should be sought to evaluate the utility of stereotactic radiosurgery as a primary treatment modality or as an adjuvant for microneurosurgical resection of benign spinal lesions in patients who want noninvasive treatment after disease recurrence or who harbor medical comorbidities that would preclude them from being safe surgical candidates.

  16. 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.

  17. Increased growth rate of vestibular schwannoma after resection of contralateral tumor in neurofibromatosis type 2

    Science.gov (United States)

    Peyre, Matthieu; Goutagny, Stephane; Imbeaud, Sandrine; Bozorg-Grayeli, Alexis; Felce, Michele; Sterkers, Olivier; Kalamarides, Michel

    2011-01-01

    Surgical management of bilateral vestibular schwannomas (VS) in neurofibromatosis type 2 (NF2) is often difficult, especially when both tumors threaten the brainstem. When the largest tumor has been removed, the management of the contralateral VS may become puzzling. To give new insights into the growth pattern of these tumors and to determine the best time point for treatment (surgery or medical treatment), we studied radiological growth in 11 VS (11 patients with NF2) over a long period (mean duration, 7.6 years), before and after removal of the contralateral tumor while both were threatening the brainstem. We used a quantitative approach of the radiological velocity of diametric expansion (VDE) on consecutive magnetic resonance images. Before first surgery, growth patterns of both tumors were similar in 9 of 11 cases. After the first surgery, VDE of the remaining VS was significantly elevated, compared with the preoperative period (2.5 ± 2.2 vs 4.4 ± 3.4 mm/year; P = .01, by Wilcoxon test). Decrease in hearing function was associated with increased postoperative growth in 3 cases. Growth pattern of coexisting intracranial meningiomas was not modified by VS surgery on the first side. In conclusion, removal of a large VS in a patient with NF2 might induce an increase in the growth rate of the contralateral medium or large VS. This possibility should be integrated in NF2 patient management to adequately treat the second VS. PMID:21798887

  18. Small Submucosal Tumors of the Stomach: Differentiation of Gastric Schwannoma from Gastrointestinal Stromal Tumor with CT

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Wook; Choi, Dong Gil; Kim, Kyoung Mee; Sohn, Tae Sung; Lee, Jun Haeng; Kim, Hee Jung; Lee, Soon Jin [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2012-07-15

    To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors. We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time. Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004). Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.

  19. Small Submucosal Tumors of the Stomach: Differentiation of Gastric Schwannoma from Gastrointestinal Stromal Tumor with CT

    International Nuclear Information System (INIS)

    Choi, Jin Wook; Choi, Dong Gil; Kim, Kyoung Mee; Sohn, Tae Sung; Lee, Jun Haeng; Kim, Hee Jung; Lee, Soon Jin

    2012-01-01

    To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors. We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time. Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004). Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.

  20. Gamma Knife Treatment of Growing Vestibular Schwannoma in Norway: A Prospective Study

    International Nuclear Information System (INIS)

    Varughese, Jobin Kotakkathu; Wentzel-Larsen, Tore; Pedersen, Paal-Henning; Mahesparan, Ruby; Lund-Johansen, Morten

    2012-01-01

    Purpose: Gamma Knife radiosurgery (GKRS) has been increasingly used in the treatment of vestibular schwannoma (VS). Very few studies relate tumor control and post-treatment growth rates to pretreatment growth rates. Methods and Materials: We prospectively included 45 consecutive VS patients who were initially treated conservatively and then received GKRS between 2000 and 2007 because of demonstrated tumor growth. Pretreatment and post-treatment tumor volumes were estimated. Patients underwent audiograms, reported their symptoms, and responded to the Short Form General Health Survey (SF-36) questionnaire on each visit. Results: Volume doubling times before and after treatment were 1.36 years (95% confidence intervals, 1.14-1.68) and −13.1 years (95% confidence intervals, −111.0 to −6.94), respectively. Tumor control, defined as a post-GKRS growth rate ≤0, was achieved in 71.1% of patients, with highest odds for tumor control among older patients and those with larger tumors. The 5-year retreatment-free survival rate was 93.9% (95% confidence intervals, 76.5-98.5). None of the clinical endpoints investigated showed statistically significant changes after GKRS, but improvement was seen in a few SF-36 parameters. Conclusions: GKRS alters the natural course of the tumor by reducing growth. Mathematic models yield poorer tumor control rates than those found by clinical assessment. Symptoms were unaffected by treatment, but quality of life was improved.

  1. Auditory adaptation testing as a tool for investigating tinnitus origin: two patients with vestibular schwannoma.

    Science.gov (United States)

    Silverman, Carol A; Silman, Shlomo; Emmer, Michele B

    2017-06-01

    To enhance the understanding of tinnitus origin by disseminating two case studies of vestibular schwannoma (VS) involving behavioural auditory adaptation testing (AAT). Retrospective case study. Two adults who presented with unilateral, non-pulsatile subjective tinnitus and bilateral normal-hearing sensitivity. At the initial evaluation, the otolaryngologic and audiologic findings were unremarkable, bilaterally. Upon retest, years later, VS was identified. At retest, the tinnitus disappeared in one patient and was slightly attenuated in the other patient. In the former, the results of AAT were positive for left retrocochlear pathology; in the latter, the results were negative for the left ear although a moderate degree of auditory adaptation was present despite bilateral normal-hearing sensitivity. Imaging revealed a small VS in both patients, confirmed surgically. Behavioural AAT in patients with tinnitus furnishes a useful tool for exploring tinnitus origin. Decrease or disappearance of tinnitus in patients with auditory adaptation suggests that the tinnitus generator is the cochlea or the cochlear nerve adjacent to the cochlea. Patients with unilateral tinnitus and bilateral, symmetric, normal-hearing thresholds, absent other audiovestibular symptoms, should be routinely monitored through otolaryngologic and audiologic re-evaluations. Tinnitus decrease or disappearance may constitute a red flag for retrocochlear pathology.

  2. Hearing Outcomes After Stereotactic Radiosurgery for Unilateral Intracanalicular Vestibular Schwannomas: Implication of Transient Volume Expansion

    International Nuclear Information System (INIS)

    Kim, Young-Hoon; Kim, Dong Gyu; Han, Jung Ho; Chung, Hyun-Tai; Kim, In Kyung; Song, Sang Woo; Park, Jeong-Hoon; Kim, Jin Wook; Kim, Yong Hwy; Park, Chul-Kee; Kim, Chae-Yong; Paek, Sun Ha; Jung, Hee-Won

    2013-01-01

    Purpose: We evaluated the prognostic factors for hearing outcomes after stereotactic radiosurgery (SRS) for unilateral sporadic intracanalicular vestibular schwannomas (IC-VSs) as a clinical homogeneous group of VSs. Methods and Materials: Sixty consecutive patients with unilateral sporadic IC-VSs, defined as tumors in the internal acoustic canal, and serviceable hearing (Gardner-Roberson grade 1 or 2) were treated with SRS as an initial treatment. The mean tumor volume was 0.34 ± 0.03 cm 3 (range, 0.03-1.00 cm 3 ), and the mean marginal dose was 12.2 ± 0.1 Gy (range, 11.5-13.0 Gy). The median follow-up duration was 62 months (range, 36-141 months). Results: The actuarial rates of serviceable hearing preservation were 70%, 63%, and 55% at 1, 2, and 5 years after SRS, respectively. In multivariate analysis, transient volume expansion of ≥20% from initial tumor size was a statistically significant risk factor for loss of serviceable hearing and hearing deterioration (increase of pure tone average ≥20 dB) (odds ratio = 7.638; 95% confidence interval, 2.317-25.181; P=.001 and odds ratio = 3.507; 95% confidence interval, 1.228-10.018; P=.019, respectively). The cochlear radiation dose did not reach statistical significance. Conclusions: Transient volume expansion after SRS for VSs seems to be correlated with hearing deterioration when defined properly in a clinically homogeneous group of patients.

  3. Microsurgical Resection of a Common Peroneal Nerve Schwannoma: A 3-Dimensional Operative Video.

    Science.gov (United States)

    Budohoski, Karol P; Guilfoyle, Mathew R; Kenyon, Olivia; Barone, Damiano G; Santarius, Thomas; Trivedi, Rikin A

    2018-01-01

    Peripheral nerve sheath tumors are benign entities that manifest with pain or neurological deficits from mass effect. Treatment is mostly surgical, however, the aggressiveness of treatment needs to be carefully considered with respect to preserving function. We present a case of a 62-year-old male with a 2-year history of left lower extremity pain radiating toward the dorsolateral foot. There was a tender and palpable mass in the lateral popliteal fossa with imaging consistent with Schwannoma of the common peroneal nerve. The patient was counseled for surgery and informed consent was obtained. Microsurgical resection was undertaken and gross total resection was achieved without compromise of function. We demonstrate the placement of neurophysiological monitoring electrodes in all 3 compartment of the calf as well as the use of stimulation to identify a nonfunctioning area for entering the nerve sheath. Anatomy of the popliteal fossa and microsurgical technique for resection of nerve sheath tumors are discussed. When dealing with these pathologies, it is important to use intraoperative neurophysiology as well as careful technique in order to achieve maximal resection without compromising neurological function. Copyright © 2017 by the Congress of Neurological Surgeons.

  4. Gamma Knife Treatment of Growing Vestibular Schwannoma in Norway: A Prospective Study

    Energy Technology Data Exchange (ETDEWEB)

    Varughese, Jobin Kotakkathu, E-mail: jobinv@gmail.com [Institute of Surgical Sciences, University of Bergen, Bergen (Norway); Wentzel-Larsen, Tore [Centre for Clinical Research, Haukeland University Hospital, Bergen (Norway); Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo (Norway); Norwegian Centre for Violence and Traumatic Stress Studies, Oslo (Norway); Pedersen, Paal-Henning [Institute of Surgical Sciences, University of Bergen, Bergen (Norway); Department of Neurosurgery, Haukeland University Hospital, Bergen (Norway); Mahesparan, Ruby [Department of Neurosurgery, Haukeland University Hospital, Bergen (Norway); Lund-Johansen, Morten [Institute of Surgical Sciences, University of Bergen, Bergen (Norway); Department of Neurosurgery, Haukeland University Hospital, Bergen (Norway)

    2012-10-01

    Purpose: Gamma Knife radiosurgery (GKRS) has been increasingly used in the treatment of vestibular schwannoma (VS). Very few studies relate tumor control and post-treatment growth rates to pretreatment growth rates. Methods and Materials: We prospectively included 45 consecutive VS patients who were initially treated conservatively and then received GKRS between 2000 and 2007 because of demonstrated tumor growth. Pretreatment and post-treatment tumor volumes were estimated. Patients underwent audiograms, reported their symptoms, and responded to the Short Form General Health Survey (SF-36) questionnaire on each visit. Results: Volume doubling times before and after treatment were 1.36 years (95% confidence intervals, 1.14-1.68) and -13.1 years (95% confidence intervals, -111.0 to -6.94), respectively. Tumor control, defined as a post-GKRS growth rate {<=}0, was achieved in 71.1% of patients, with highest odds for tumor control among older patients and those with larger tumors. The 5-year retreatment-free survival rate was 93.9% (95% confidence intervals, 76.5-98.5). None of the clinical endpoints investigated showed statistically significant changes after GKRS, but improvement was seen in a few SF-36 parameters. Conclusions: GKRS alters the natural course of the tumor by reducing growth. Mathematic models yield poorer tumor control rates than those found by clinical assessment. Symptoms were unaffected by treatment, but quality of life was improved.

  5. Spinal cord neuronotrophic factors (SCNTFs): I. Bioassay of schwannoma and other conditioned media.

    Science.gov (United States)

    Longo, F M; Manthorpe, M; Varon, S

    1982-02-01

    We present a procedure for the dissociation and growth in serum-free defined culture medium of 4-day chick embryo lumbar spinal cord (LC4) neurons. LC4 neurons will not survive for even 24 h without the addition of trophic supplements (putative spinal cord neuronotrophic factors, SCNTFs). Serum-free medium conditioned over chick embryo heart and skeletal muscle, mouse Schwann and rat RN22 Schwannoma cell cultures were found to contain SCNTF activity which could be quantitated using a convenient neuronal survival bioassay. RN22 conditioned medium also contains polyornithine-binding neurite promoting factors (PNPFs) which can be physically separated from SCNTF. When SCNTF and PNPF were presented to LC4 neurons individually or in combination (i) SCNTF, but not PNPF, supported neuronal survival whereas (ii) PNPF, but not SCNTF, induced neurite production. When LC4 neurons were grown in SCNTF alone, nearly all of them exhibited a flattened, circular, 'fried-egg' morphology. The subsequent addition of PNPF caused these cells to extend long neurites with characteristic terminal growth-cone-like structures.

  6. [Video-nystagmography and vibration test in the diagnosis of vestibular schwannoma. Review of 100 cases].

    Science.gov (United States)

    Négrevergne, M; Ribeiro, S; Moraes, C L; Maunsell, R; Morata, G Celis; Darrouzet, V

    2003-01-01

    To evaluate informations given by the combination of videonystagmography (VNG) including vibratory tests and auditory brainstem responses (ABR) in patients suffering vestibular schwannoma (VS) and try to find the most conclusive test(s). Combination of different functional tests is supposed to improve diagnosis and preoperative evaluation and precise indication for magnetic resonance imaging (MRI) facing audiological and vestibular symptoms. A prospective study of 100 patients with VS. All patients underwent a preoperative work-up including complete audiometry, auditory brainstem response (ABR) and videonystagmography (VNG). VNG protocol included caloric testing, rotatory tests, oculometry tests (saccade testing, optokinetic testing) and spontaneous and gaze-evoked nystagmus. From these six tests a score of positivity could be set, from 0 to 6. The vibratory test is non invasive and easy to realize. Were observed: 1/ a good sensitivity in vibratory test to elicit nystagmus in this context. 2/ a good correlation between subliminal rotatory chair tests and vibratory tests 3/ a better control of caloric testing using vibratory test. 4/ a good but deficient sensitivity of ABR alone with regard to VS (95%) 5/ an increase of sensitivity of VNG when coupling it with ABR and using as a criterion the score of positivity: no patient had all tests negative. The vibratory test is a non-invasive, fast examination with an easy execution. It reinforces VNG-ABR association screening power to diagnose VS. It constitutes, combined to caloric testing a good tool to diagnose and evaluate unilateral vestibular weakness.

  7. Our experience with facial nerve monitoring in vestibular schwannoma surgery under partial neuromuscular blockade.

    Science.gov (United States)

    Vega-Céliz, Jorge; Amilibia-Cabeza, Emili; Prades-Martí, José; Miró-Castillo, Nuria; Pérez-Grau, Marta; Pintanel Rius, Teresa; Roca-Ribas Serdà, Francesc

    2015-01-01

    Facial nerve monitoring is fundamental in the preservation of the facial nerve in vestibular schwannoma surgery. Our objective was to analyse the usefulness of facial nerve monitoring under partial neuromuscular blockade. This was a retrospective analysis of 69 patients operated in a tertiary hospital. We monitored 100% of the cases. In 75% of the cases, we could measure an electromyographic response after tumour resection. In 17 cases, there was an absence of electromyographic response. Fifteen of them had an anatomic lesion with loss of continuity of the facial nerve and, in 2 cases, there was a lesion with preservation of the nerve. Preoperative facial palsy (29% 7%; P=.0349), large tumour size (88 vs. 38%; P=.0276), and a non-functional audition (88 vs. 51%; P=.0276) were significantly related with an absence of electromyographic response. Facial nerve monitoring under neuromuscular blockade is possible and safe in patients without previous facial palsy. If the patient had an electromyographic response after tumour excision, they developed better facial function in the postoperative period and after a year of follow up. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  8. Long-Term Facial Nerve Outcomes after Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy.

    Science.gov (United States)

    Mooney, Michael A; Hendricks, Benjamin; Sarris, Christina E; Spetzler, Robert F; Almefty, Kaith K; Porter, Randall W

    2018-06-01

    Objectives  This study aimed at evaluating facial nerve outcomes in vestibular schwannoma patients presenting with preoperative facial nerve palsy. Design  A retrospective review. Setting  Single-institution cohort. Participants  Overall, 368 consecutive patients underwent vestibular schwannoma resection. Patients with prior microsurgery or radiosurgery were excluded. Main Outcome Measures  Incidence, House-Brackmann grade. Results  Of 368 patients, 9 had confirmed preoperative facial nerve dysfunction not caused by prior treatment, for an estimated incidence of 2.4%. Seven of these nine patients had Koos grade 4 tumors. Mean tumor diameter was 3.0 cm (range: 2.1-4.4 cm), and seven of nine tumors were subtotally resected. All nine patients were followed up clinically for ≥ 6 months. Of the six patients with a preoperative House-Brackmann grade of II, two improved to grade I, three were stable, and one patient worsened to grade III. Of the three patients with grade III or worse, all remained stable at last follow-up. Conclusions  Preoperative facial nerve palsy is rare in patients with vestibular schwannoma; it tends to occur in patients with relatively large lesions. Detailed long-term outcomes of facial nerve function after microsurgical resection for these patients have not been reported previously. We followed nine patients and found that eight (89%) of the nine patients had either stable or improved facial nerve outcomes after treatment. Management strategies varied for these patients, including rates of subtotal versus gross-total resection and the use of stereotactic radiosurgery in patients with residual tumor. These results can be used to help counsel patients preoperatively on expected outcomes of facial nerve function after treatment.

  9. Intra- and Extramedullary Dumbbell-Shaped Schwannoma of the Medulla Oblongata: A Case Report and Review of the Literature.

    Science.gov (United States)

    Zhang, Qing; Ni, Ming; Liu, Wei-Ming; Jia, Wang; Jia, Gui-Jun; Zhang, Jun-Ting

    2017-02-01

    Brainstem intramedullary schwannomas (ISs) are extremely rare. Various theories have been suggested to explain its origin. It was first speculated that ISs arise from the region where the nerve roots lose their sheaths on penetrating the pia mater. Later, it was further predicted that ISs would contain both intra- and extramedullary parts and would be shaped like a dumbbell. However, no cases reported previously can support this assumption adequately. A 40-year-old woman presented with constant cervical pain, accompanied by progressive weakness of upper extremities and glove distribution numbness. Magnetic resonance imaging of the brain revealed a rare intra- and extramedullary dumbbell-shaped lesion of the medulla oblongata, which was partially removed via a midline suboccipital craniectomy. Histologic and immunohistochemical examinations confirmed the diagnosis of schwannoma. Routine imaging performed 20 months after the initial resection revealed a regrowth of the intramedullary part, which was subsequently partially removed through a far-lateral approach, with symptoms alleviated. At 2-year follow-up, there continued to be no radiologic or clinical evidence of regrowth. To date and to our knowledge, there are only 16 reported cases of brainstem ISs, none of which contained both intra- and extramedullary components. We believe this is the first report of dumbbell schwannoma of the medulla oblongata with adequate radiologic evidence. The relevant literature is reviewed, and an assumption has been proposed that dumbbell or surfacing ISs arising near entry zones of sensory nerves, mixed cranial nerves, or ventral root may originate from the aberrant Schwann cells. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate.

    Science.gov (United States)

    Linskey, Mark E

    2013-12-01

    By definition, the term "radiosurgery" refers to the delivery of a therapeutic radiation dose in a single fraction, not simply the use of stereotaxy. Multiple-fraction delivery is better termed "stereotactic radiotherapy." There are compelling radiobiological principles supporting the biological superiority of single-fraction radiation for achieving an optimal therapeutic response for the slowly proliferating, late-responding, tissue of a schwannoma. It is axiomatic that complication avoidance requires precise three-dimensional conformality between treatment and tumor volumes. This degree of conformality can only be achieved through complex multiisocenter planning. Alternative radiosurgery devices are generally limited to delivering one to four isocenters in a single treatment session. Although they can reproduce dose plans similar in conformality to early gamma knife dose plans by using a similar number of isocenters, they cannot reproduce the conformality of modern gamma knife plans based on magnetic resonance image--targeted localization and five to 30 isocenters. A disturbing trend is developing in which institutions without nongamma knife radiosurgery (GKS) centers are championing and/or shifting to hypofractionated stereotactic radiotherapy for vestibular schwannomas. This trend appears to be driven by a desire to reduce complication rates to compete with modern GKS results by using complex multiisocenter planning. Aggressive advertising and marketing from some of these centers even paradoxically suggests biological superiority of hypofractionation approaches over single-dose radiosurgery for vestibular schwannomas. At the same time these centers continue to use the term radiosurgery to describe their hypofractionated radiotherapy approach in an apparent effort to benefit from a GKS "halo effect." It must be reemphasized that as neurosurgeons our primary duty is to achieve permanent tumor control for our patients and not to eliminate complications at the

  11. Long-Term Follow-up of Acoustic Schwannoma Radiosurgery With Marginal Tumor Doses of 12 to 13 Gy

    International Nuclear Information System (INIS)

    Chopra, Rahul; Kondziolka, Douglas; Niranjan, Ajay; Lunsford, L. Dade; Flickinger, John C.

    2007-01-01

    Purpose: To define long-term tumor control and clinical outcomes of radiosurgery with marginal tumor doses of 12 to 13 Gy for unilateral acoustic schwannoma. Methods and Materials: A total of 216 patients with previously untreated unilateral acoustic schwannoma underwent Gamma Knife radiosurgery between 1992 and 2000 with marginal tumor doses of 12 to 13 Gy (median, 13 Gy). Median follow-up was 5.7 years (maximum, 12 years; 41 patients with >8 years). Treatment volumes were 0.08-37.5 cm 3 (median, 1.3 cm 3 ). Results: The 10-year actuarial resection-free control rate was 98.3% ± 1.0%. Three patients required tumor resection: 2 for tumor growth and 1 partial resection for an enlarging adjacent subarachnoid cyst. Among 121 hearing patients with >3 years of follow-up, crude hearing preservation rates were 71% for keeping the same Gardner-Robertson hearing level, 74% for serviceable hearing, and 95% for any testable hearing. For 25 of these patients with intracanalicular tumors, the respective rates for preserving the same Gardner-Robertson level, serviceable hearing, and testable hearing were 80%, 88%, and 96%. Ten-year actuarial rates for preserving the same Gardner-Robertson hearing levels, serviceable hearing, any testable hearing, and unchanged facial and trigeminal nerve function were 44.0% ± 11.7%, 44.5% ± 10.5%, 85.3% ± 6.2%, 100%, and 94.9% ± 1.8%, respectively. Conclusions: Acoustic schwannoma radiosurgery with 12 to 13 Gy provides high rates of long-term tumor control and cranial nerve preservation after long-term follow-up

  12. Myelin structure is a key difference in the x-ray scattering signature between meningioma, schwannoma and glioblastoma multiforme

    International Nuclear Information System (INIS)

    Falzon, G; Pearson, S; Murison, R; Hall, C; Siu, K; Round, A; Schueltke, E; Kaye, A H; Lewis, R

    2007-01-01

    Small angle x-ray scattering (SAXS) patterns of benign and malignant brain tumour tissue were examined. Independent component analysis was used to find a feature set representing the images collected. A set of coefficients was then used to describe each image, which allowed the use of the statistical technique of flexible discriminant analysis to discover a hidden order in the data set. The key difference was found to be in the intensity and spectral content of the second and fourth order myelin scattering peaks. This has clearly demonstrated that significant differences in the structure of myelin exist in the highly malignant glioblastoma multiforme as opposed to the benign: meningioma and schwannoma

  13. Learning from eponyms: Jose Verocay and Verocay bodies, Antoni A and B areas, Nils Antoni and Schwannomas

    Directory of Open Access Journals (Sweden)

    Rajiv Joshi

    2012-01-01

    Full Text Available Schwannomas are benign peripheral nerve sheath neoplasms composed almost entirely of Schwann cells and are diagnosed histopathologically by the presence of singular architectural patterns called Antoni A and Antoni B areas. These were described first in 1920 by the Swedish neurologist Nils Antoni. The Antoni A tissue is highly cellular and made up of palisades of Schwann cell nuclei, a pattern first described in 1910 by the Uruguayan neuro-pathologist Jose Verocay and are known as Verocay bodies. This article describes the structure and appearance of Verocay bodies and Antoni A and B areas with a brief biographical introduction of the men who described these patterns.

  14. Subdural fluid collection and hydrocephalus following cervical schwannoma resection: hydrocephalus resolution after spinal pseudomeningocele repair: case report.

    Science.gov (United States)

    Benedetto, Nicola; Cagnazzo, Federico; Gambacciani, Carlo; Perrini, Paolo

    2016-12-01

    The authors report the case of a 31-year-old man who developed neck pain and headache 2 months after the uncomplicated resection of a cervical schwannoma. MR imaging revealed infratentorial subdural fluid collections and obstructive hydrocephalus associated with cervical pseudomeningocele. The clinical symptoms, subdural fluid collections, and ventricular dilation resolved after surgical correction of the pseudomeningocele. This report emphasizes that hydrocephalus may be related to disorders of cerebrospinal fluid flow dynamics induced by cervical pseudomeningocele. In these rare cases, both the hydrocephalus and the symptoms are resolved by the simple correction of the pseudomeningocele.

  15. Cochlear Implantation in Patients with Neurofibromatosis Type 2 and Patients with Vestibular Schwannoma in the Only Hearing Ear

    Directory of Open Access Journals (Sweden)

    Erika Celis-Aguilar

    2012-01-01

    Full Text Available Cochlear implants are a new surgical option in the hearing rehabilitation of patients with neurofibromatosis type 2 (NF2 and patients with vestibular schwannoma (VS in the only hearing ear. Auditory brainstem implant (ABI has been the standard surgical treatment for these patients. We performed a literature review of patients with NF2 and patients with VS in the only hearing ear. Cochlear implantation (CI provided some auditory benefit in all patients. Preservation of cochlear nerve integrity is crucial after VS resection. Results ranged from environmental sound awareness to excellent benefit with telephone use. Promontory stimulation is recommended although not crucial. MRI can be performed safely in cochlear implanted patients.

  16. Gamma Knife radiosurgery for treatment of growing vestibular schwannomas in patients with neurofibromatosis Type 2: a matched cohort study with sporadic vestibular schwannomas.

    Science.gov (United States)

    Kruyt, Ivo J; Verheul, Jeroen B; Hanssens, Patrick E J; Kunst, Henricus P M

    2018-01-01

    OBJECTIVE Neurofibromatosis Type 2 (NF2) is a tumor syndrome characterized by an autosomal dominant pattern of inheritance. The hallmark of NF2 is the development of bilateral vestibular schwannomas (VSs), generally by 30 years of age. One of the first-line treatment options for small to medium-large VSs is radiosurgery. Although radiosurgery shows excellent results in sporadic VS, its use in NF2-related VS is still a topic of dispute. The aim of this study was to evaluate long-term tumor control, hearing preservation rates, and factors influencing outcome of optimally dosed, contemporary Gamma Knife radiosurgery (GKRS) for growing VSs in patients with NF2 and compare the findings to data obtained in patients with sporadic VS also treated by means of GKRS. METHODS The authors performed a retrospective analysis of 47 growing VSs in 34 NF2 patients who underwent GKRS treatment performed with either the Model C or Perfexion Leksell Gamma Knife, with a median margin dose of 11 Gy. Actuarial tumor control rates were estimated using the Kaplan-Meier method. For patient- and treatment-related factors, a Cox proportional hazards model was used to identify predictors of outcome. Trigeminal, facial, and vestibulocochlear nerve function were assessed before and after treatment. NF2-related VS patients were matched 1:1 with sporadic VS patients who were treated in the same institute, and the same indications for treatment, definitions, and dosimetry were used in order to compare outcomes. RESULTS Actuarial tumor control rates in NF2 patients after 1, 3, 5, and 8 years were 98%, 89%, 87%, and 87%, respectively. Phenotype and tumor volume had significant hazard rates of 0.086 and 22.99, respectively, showing that Feiling-Gardner phenotype and a tumor volume not exceeding 6 cm 3 both were associated with significantly better outcome. Actuarial rates of serviceable hearing preservation after 1, 3, 5, and 7 years were 95%, 82%, 59%, and 33%, respectively. None of the patients

  17. Analysis of vestibular schwannoma size in multiple dimensions: a comparative cohort study of different measurement techniques.

    Science.gov (United States)

    Varughese, J K; Wentzel-Larsen, T; Vassbotn, F; Moen, G; Lund-Johansen, M

    2010-04-01

    In this volumetric study of the vestibular schwannoma, we evaluated the accuracy and reliability of several approximation methods that are in use, and determined the minimum volume difference that needs to be measured for it to be attributable to an actual difference rather than a retest error. We also found empirical proportionality coefficients for the different methods. DESIGN/SETTING AND PARTICIPANTS: Methodological study with investigation of three different VS measurement methods compared to a reference method that was based on serial slice volume estimates. These volume estimates were based on: (i) one single diameter, (ii) three orthogonal diameters or (iii) the maximal slice area. Altogether 252 T1-weighted MRI images with gadolinium contrast, from 139 VS patients, were examined. The retest errors, in terms of relative percentages, were determined by undertaking repeated measurements on 63 scans for each method. Intraclass correlation coefficients were used to assess the agreement between each of the approximation methods and the reference method. The tendency for approximation methods to systematically overestimate/underestimate different-sized tumours was also assessed, with the help of Bland-Altman plots. The most commonly used approximation method, the maximum diameter, was the least reliable measurement method and has inherent weaknesses that need to be considered. This includes greater retest errors than area-based measurements (25% and 15%, respectively), and that it was the only approximation method that could not easily be converted into volumetric units. Area-based measurements can furthermore be more reliable for smaller volume differences than diameter-based measurements. All our findings suggest that the maximum diameter should not be used as an approximation method. We propose the use of measurement modalities that take into account growth in multiple dimensions instead.

  18. Conservative management of vestibular schwannoma--a prospective cohort study: treatment, symptoms, and quality of life.

    Science.gov (United States)

    Breivik, Cathrine Nansdal; Varughese, Jobin K; Wentzel-Larsen, Tore; Vassbotn, Flemming; Lund-Johansen, Morten

    2012-05-01

    One hundred ninety-three patients with sporadic unilateral vestibular schwannoma given conservative management were enrolled in a prospective study. To evaluate the efficacy of conservative management and to determine the effect of an initial conservative management on the quality of life (QOL) and severity of audio vestibular symptoms. The patients underwent magnetic resonance imaging scans, clinical examination, and QOL assessment by 2 validated questionnaires, the Short Form-36 (SF-36) and Glasgow Benefit Inventory (GBI). Using regression analysis of clustered data, we analyzed possible associations between tumor growth and symptoms and tested whether our earlier finding that vertigo is associated with reduced QOL could be verified. The median follow-up time was 43 months (range, 9-115 months; SD, 21.48 months). Results are based on 703 clinical controls and 642 (SF-36) and 638 (GBI) questionnaires. Seven patients were lost to follow-up. Approximately 40% of patients were in need of treatment during follow-up. We found a statistically significant association between tinnitus and vertigo and tumor growth. Vertigo was found to significantly reduce QOL. There was a significant drop in the Social Function subscales of both SF-36 and GBI, possibly attributable to progressive hearing loss. Otherwise, there was no overall trend toward any change in QOL during the observation period. In addition, QOL seemed to be little affected by treatment. There was a small but statistically significant improvement in vestibular complaints and no change in the occurrence of tinnitus. Except for hearing loss caused by surgery, treatment did not affect symptoms or QOL significantly. Growth was associated with the occurrence of tinnitus and balance problems.

  19. Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery.

    Science.gov (United States)

    Myrseth, Erling; Møller, Per; Pedersen, Paal-Henning; Vassbotn, Flemming S; Wentzel-Larsen, Tore; Lund-Johansen, Morten

    2005-05-01

    The aim of the present study was to evaluate the overall treatment efficacy (tumor control, facial nerve function, complications) and quality of life for patients treated primarily for unilateral vestibular schwannomas of 30 mm or less, either by microsurgery or by gamma knife (GK) radiosurgery. The results for the two treatment groups are compared with each other, with main emphasis on the long-term quality of life. This is a retrospective study of 189 consecutive patients, 86 treated by microsurgery and 103 by gamma knife. The mean observation time was 5.9 years. All patients had a magnetic resonance imaging scan and clinical evaluation performed toward the end of the study. To evaluate the quality of life, we used two standardized questionnaires, the Glasgow Benefit Inventory and Short-Form 36. The questionnaires were sent to the 168 living patients. The reply rate was 83.3%. A total of 79.8% of the patients in the microsurgery group and 94.8% of the GK patients had a good facial nerve function (House-Brackmann Grade 1-2). Hearing was usually lost after microsurgery, whereas the GK patients had preserved hearing, which often became reduced over the years after the treatment. The treatment efficacy, defined as no need for additional treatment, was similar for the two treatment modalities. Quality of life was reduced compared with normative data, being most reduced in the microsurgery group. Some of the quality of life questions showed an association with facial nerve function and sex. Posttreatment facial nerve function, hearing, complication rates, and quality of life were all significantly in favor of GK radiosurgery.

  20. 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.

  1. Development of an evidence-based decision pathway for vestibular schwannoma treatment options.

    Science.gov (United States)

    Linkov, Faina; Valappil, Benita; McAfee, Jacob; Goughnour, Sharon L; Hildrew, Douglas M; McCall, Andrew A; Linkov, Igor; Hirsch, Barry; Snyderman, Carl

    To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS). This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS. Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model. The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives. Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Pretreatment Growth Rate Predicts Radiation Response in Vestibular Schwannomas

    Energy Technology Data Exchange (ETDEWEB)

    Niu, Nina N. [Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (United States); Harvard Medical School, Department of Medicine, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Niemierko, Andrzej [Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (United States); Larvie, Mykol [Harvard Medical School, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (United States); Curtin, Hugh [Harvard Medical School, Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (United States); Loeffler, Jay S. [Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (United States); McKenna, Michael J. [Harvard Medical School, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (United States); Shih, Helen A., E-mail: hshih@partners.org [Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2014-05-01

    Purpose: Vestibular schwannomas (VS) are often followed without initial therapeutic intervention because many tumors do not grow and radiation therapy is associated with potential adverse effects. In an effort to determine whether maximizing initial surveillance predicts for later treatment response, the predictive value of preirradiation growth rate of VS on response to radiation therapy was assessed. Methods and Materials: Sixty-four patients with 65 VS were treated with single-fraction stereotactic radiation surgery or fractionated stereotactic radiation therapy. Pre- and postirradiation linear expansion rates were estimated using volumetric measurements on sequential magnetic resonance images (MRIs). In addition, postirradiation tumor volume change was classified as demonstrating shrinkage (ratio of volume on last follow-up MRI to MRI immediately preceding irradiation <80%), stability (ratio 80%-120%), or expansion (ratio >120%). The median pre- and postirradiation follow-up was 20.0 and 27.5 months, respectively. Seven tumors from neurofibromatosis type 2 (NF2) patients were excluded from statistical analyses. Results: In the 58 non-NF2 patients, there was a trend of correlation between pre- and postirradiation volume change rates (slope on linear regression, 0.29; P=.06). Tumors demonstrating postirradiation expansion had a median preirradiation growth rate of 89%/year, and those without postirradiation expansion had a median preirradiation growth rate of 41%/year (P=.02). As the preirradiation growth rate increased, the probability of postirradiation expansion also increased. Overall, 24.1% of tumors were stable, 53.4% experienced shrinkage, and 22.5% experienced expansion. Predictors of no postirradiation tumor expansion included no prior surgery (P=.01) and slower tumor growth rate (P=.02). The control of tumors in NF2 patients was only 43%. Conclusions: Radiation therapy is an effective treatment for VS, but tumors that grow quickly preirradiation may be

  3. Working disability in Norwegian patients with vestibular schwannoma: vertigo predicts future dependence.

    Science.gov (United States)

    Breivik, Cathrine Nansdal; Nilsen, Roy Miodini; Myrseth, Erling; Finnkirk, Monica Katrine; Lund-Johansen, Morten

    2013-12-01

    We examined whether reduced hearing, tinnitus, dizziness, and unsteadiness affected the patients' ability to maintain work within a time frame of 2-10 years after diagnosis. A total of 434 consecutive patients were followed at regular intervals. Data on symptoms were scored prospectively and dichotomized by visual analog scales for tinnitus and vertigo. Study design is retrospective. Hearing acuity was scored according to the Gardner-Robertson scale, and unsteadiness was measured on a balance platform. Patients were asked about working status, and scored as receiving governmental compensation for disability. Two hundred six patients were eligible for study. Of these, one died and nine were lost to follow-up. Ninety-seven patients received conservative management, 49 patients recieved gamma knife radiosurgery, and 50 patients were treated by microsurgery. Mean follow-up time was 58.7 months (range, 20-132 months). There was a significant increase in the number of individuals receiving compensation during the study period (P < 0.0001). At baseline, the proportion of pension receivers was within same range as that of the age- and sex-matched Norwegian population (5.61% vs. 6.91%; case-control odds ratio, 0.82; 95% confidence interval 0.45-1.49; P = 0.51, not significant). At the final time point, the increase in the number of receivers deviated significantly from the reference population (case-control odds ratio, 3.80; 95% confidence interval 2.71-5.33; P ≤ 0.001). Examining symptoms at first presentation as predictors of future dependence revealed that vertigo and higher mean age were associated with a higher risk (P < 0.001 and P = 0.015, respectively). No other symptoms were predictive of dependence. In a prospectively followed cohort of Norwegian patients with vestibular schwannoma, vestibular complaints were significant predictors for becoming dependant of disability pension. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life.

    Science.gov (United States)

    Breivik, Cathrine Nansdal; Nilsen, Roy Miodini; Myrseth, Erling; Pedersen, Paal Henning; Varughese, Jobin K; Chaudhry, Aqeel Asghar; Lund-Johansen, Morten

    2013-07-01

    There are few reports about the course of vestibular schwannoma (VS) patients following gamma knife radiosurgery (GKRS) compared with the course following conservative management (CM). In this study, we present prospectively collected data of 237 patients with unilateral VS extending outside the internal acoustic canal who received either GKRS (113) or CM (124). The aim was to measure the effect of GKRS compared with the natural course on tumor growth rate and hearing loss. Secondary end points were postinclusion additional treatment, quality of life (QoL), and symptom development. The patients underwent magnetic resonance imaging scans, clinical examination, and QoL assessment by SF-36 questionnaire. Statistics were performed by using Spearman correlation coefficient, Kaplan-Meier plot, Poisson regression model, mixed linear regression models, and mixed logistic regression models. Mean follow-up time was 55.0 months (26.1 standard deviation, range 10-132). Thirteen patients were lost to follow-up. Serviceable hearing was lost in 54 of 71 (76%) (CM) and 34 of 53 (64%) (GKRS) patients during the study period (not significant, log-rank test). There was a significant reduction in tumor volume over time in the GKRS group. The need for treatment following initial GKRS or CM differed at highly significant levels (log-rank test, P < .001). Symptom and QoL development did not differ significantly between the groups. In VS patients, GKRS reduces the tumor growth rate and thereby the incidence rate of new treatment about tenfold. Hearing is lost at similar rates in both groups. Symptoms and QoL seem not to be significantly affected by GKRS.

  5. Mapping clinical outcomes expectations to treatment decisions: an application to vestibular schwannoma management.

    Science.gov (United States)

    Cheung, Steven W; Aranda, Derick; Driscoll, Colin L W; Parsa, Andrew T

    2010-02-01

    Complex medical decision making obligates tradeoff assessments among treatment outcomes expectations, but an accessible tool to perform the necessary analysis is conspicuously absent. We aimed to demonstrate methodology and feasibility of adapting conjoint analysis for mapping clinical outcomes expectations to treatment decisions in vestibular schwannoma (VS) management. Prospective. Tertiary medical center and US-based otologists/neurotologists. Treatment preference profiles among VS stakeholders-61 younger and 74 older prospective patients, 61 observation patients, and 60 surgeons-were assessed for the synthetic VS case scenario of a 10-mm tumor in association with useful hearing and normal facial function. Treatment attribute utility. Conjoint analysis attribute levels were set in accordance to the results of a meta-analysis. Forty-five case series were disaggregated to formulate microsurgery facial nerve and hearing preservation outcomes expectations models. Attribute utilities were computed and mapped to the realistic treatment choices of translabyrinthine craniotomy, middle fossa craniotomy, and gamma knife radiosurgery. Among the treatment attributes of likelihoods of causing deafness, temporary facial weakness for 2 months, and incurable cancer within 20 years, and recovery time, permanent deafness was less important to tumor surgeons, and temporary facial weakness was more important to tumor surgeons and observation patients (Wilcoxon rank-sum, p knife radiosurgery. Mapping clinical outcomes expectations to treatment decisions for a synthetic clinical scenario revealed inhomogeneous drivers of choice selection among study cohorts. Medical decision engines that analyze personal preferences of outcomes expectations for VS and many other diseases may be developed to promote shared decision making among health care stakeholders and transparency in the informed consent process.

  6. Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review.

    Science.gov (United States)

    Persson, Oscar; Bartek, Jiri; Shalom, Netanel Ben; Wangerid, Theresa; Jakola, Asgeir Store; Förander, Petter

    2017-06-01

    Repeated controlled studies have revealed that stereotactic radiosurgery is better than microsurgery for patients with vestibular schwannoma (VS) 18 years) patients with unilateral VS, followed for a median of >5 years, were eligible for inclusion. After screening titles and abstracts of the 1094 identified articles and systematically reviewing 98 of these articles, 19 were included. Patients with unilateral VS treated with radiosurgery were compared to patients treated with fractionated stereotactic radiotherapy. 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% for FSRT, respectively. The risk for facial nerve deterioration was 3.6% for SRS and 11.2% for FSRT and for trigeminal nerve deterioration 6.0% for SRS and 8.4% for FSRT. Since these results were obtained from case series, a regular meta-analysis was not attempted. SRS and FSRT are both noninvasive treatment alternatives for patients with VS with low rates of treatment failure in need of rescue therapy. In this selection of patients, the progression-free survival rates were on the order of 92-100% for both treatment options. There is a lack of high-quality studies comparing radiation therapy alternatives for patients with VS. Finally, 19 articles reported long-term tumor control after SRS, while only 2 articles reported long-term FSRT results, making effect estimates more uncertain for FSRT.

  7. Knowledge silos: assessing knowledge sharing between specialties through the vestibular schwannoma literature.

    Science.gov (United States)

    Schnurman, Zane; Golfinos, John G; Roland, J Thomas; Kondziolka, Douglas

    2017-12-01

    OBJECTIVE It is common for a medical disorder to be managed or researched by individuals who work within different specialties. It is known that both neurosurgeons and neurotologists manage vestibular schwannoma (VS) patients. While overlap in specialty focus has the potential to stimulate multidisciplinary collaboration and innovative thinking, there is a risk of specialties forming closed-communication loops, called knowledge silos, which may inhibit knowledge diffusion. This study quantitatively assessed knowledge sharing between neurosurgery and otolaryngology on the subject of VS. METHODS A broad Web of Science search was used to download details for 4439 articles related to VS through 2016. The publishing journal's specialty and the authors' specialties (based on author department) were determined for available articles. All 114,647 of the article references were categorized by journal specialty. The prevalence of several VS topics was assessed using keyword searches of titles. RESULTS For articles written by neurosurgeons, 44.0% of citations were from neurosurgery journal articles and 23.4% were from otolaryngology journals. The citations of otolaryngology authors included 11.6% neurosurgery journals and 56.5% otolaryngology journals. Both author specialty and journal specialty led to more citations of the same specialty, though author specialty had the largest effect. Comparing the specialties' literature, several VS topics had significantly different levels of coverage, including radiosurgery and hearing topics. Despite the availability of the Internet, there has been no change in the proportions of references for either specialty since 1997 (the year PubMed became publicly available). CONCLUSIONS Partial knowledge silos are observed between neurosurgery and otolaryngology on the topic of VS, based on the peer-reviewed literature. The increase in access provided by the Internet and searchable online databases has not decreased specialty reference bias

  8. Endolympathic hydrops in patients with vestibular schwannoma: visualization by non-contrast-enhanced 3D FLAIR

    International Nuclear Information System (INIS)

    Naganawa, Shinji; Kawai, Hisashi; Sone, Michihiko; Nakashima, Tsutomu; Ikeda, Mitsuru

    2011-01-01

    Signal intensity of ipsilateral labyrinthine lymph fluid has been reported to increase in most cases with vestibular schwannoma (VS) on 3D fluid attenuated inversion recovery (FLAIR). The purpose of this study was twofold, (1) to evaluate if endolymphatic space can be recognized in the patients with VS on non-contrast-enhanced 3D-FLAIR images and (2) to know if the vertigo in the patients with VS correlates to vestibular endolymphatic hydrops. From the introduction of 32-channel head coil at 3 T in May 2008 to June 2010, 15 cases with unilateral VS were identified in the radiology report database. The two cases without a significant signal increase on 3D FLAIR were excluded. Resting 13 cases were retrospectively analyzed in regard to the recognition of endolymphatic hydrops in the cochlea and vestibule and to the correlation between the patients' symptoms and endolymphatic hydrops. In all cases, vestibular endolymphatic space can be recognized on non-contrast-enhanced 3D FLAIR. Cochlear endolymphatic space can be identified only in one case with significant hydrops. Vestibular hydrops was identified in four cases. Among these four cases, three had vertigo, and one had no vertigo. In those nine cases without hydrops, two had vertigo, and seven did not have vertigo. No significant correlation between vertigo and vestibular hydrops was found. Vestibular endolymphatic space can be recognized on non-contrast-enhanced 3D FLAIR. In some patients with VS, vestibular hydrops is seen; however, endolymphatic hydrops in the vestibule might not be the only responsible cause of vertigo in the patients with VS. (orig.)

  9. Pretreatment Growth Rate Predicts Radiation Response in Vestibular Schwannomas

    International Nuclear Information System (INIS)

    Niu, Nina N.; Niemierko, Andrzej; Larvie, Mykol; Curtin, Hugh; Loeffler, Jay S.; McKenna, Michael J.; Shih, Helen A.

    2014-01-01

    Purpose: Vestibular schwannomas (VS) are often followed without initial therapeutic intervention because many tumors do not grow and radiation therapy is associated with potential adverse effects. In an effort to determine whether maximizing initial surveillance predicts for later treatment response, the predictive value of preirradiation growth rate of VS on response to radiation therapy was assessed. Methods and Materials: Sixty-four patients with 65 VS were treated with single-fraction stereotactic radiation surgery or fractionated stereotactic radiation therapy. Pre- and postirradiation linear expansion rates were estimated using volumetric measurements on sequential magnetic resonance images (MRIs). In addition, postirradiation tumor volume change was classified as demonstrating shrinkage (ratio of volume on last follow-up MRI to MRI immediately preceding irradiation <80%), stability (ratio 80%-120%), or expansion (ratio >120%). The median pre- and postirradiation follow-up was 20.0 and 27.5 months, respectively. Seven tumors from neurofibromatosis type 2 (NF2) patients were excluded from statistical analyses. Results: In the 58 non-NF2 patients, there was a trend of correlation between pre- and postirradiation volume change rates (slope on linear regression, 0.29; P=.06). Tumors demonstrating postirradiation expansion had a median preirradiation growth rate of 89%/year, and those without postirradiation expansion had a median preirradiation growth rate of 41%/year (P=.02). As the preirradiation growth rate increased, the probability of postirradiation expansion also increased. Overall, 24.1% of tumors were stable, 53.4% experienced shrinkage, and 22.5% experienced expansion. Predictors of no postirradiation tumor expansion included no prior surgery (P=.01) and slower tumor growth rate (P=.02). The control of tumors in NF2 patients was only 43%. Conclusions: Radiation therapy is an effective treatment for VS, but tumors that grow quickly preirradiation may be

  10. Endolympathic hydrops in patients with vestibular schwannoma: visualization by non-contrast-enhanced 3D FLAIR

    Energy Technology Data Exchange (ETDEWEB)

    Naganawa, Shinji; Kawai, Hisashi [Nagoya University Graduate School of Medicine, Department of Radiology, Nagoya (Japan); Sone, Michihiko; Nakashima, Tsutomu [Nagoya University Graduate School of Medicine, Department of Otorhinolaryngology, Nagoya (Japan); Ikeda, Mitsuru [Nagoya University School of Health Sciences, Department of Radiological Technology, Nagoya (Japan)

    2011-12-15

    Signal intensity of ipsilateral labyrinthine lymph fluid has been reported to increase in most cases with vestibular schwannoma (VS) on 3D fluid attenuated inversion recovery (FLAIR). The purpose of this study was twofold, (1) to evaluate if endolymphatic space can be recognized in the patients with VS on non-contrast-enhanced 3D-FLAIR images and (2) to know if the vertigo in the patients with VS correlates to vestibular endolymphatic hydrops. From the introduction of 32-channel head coil at 3 T in May 2008 to June 2010, 15 cases with unilateral VS were identified in the radiology report database. The two cases without a significant signal increase on 3D FLAIR were excluded. Resting 13 cases were retrospectively analyzed in regard to the recognition of endolymphatic hydrops in the cochlea and vestibule and to the correlation between the patients' symptoms and endolymphatic hydrops. In all cases, vestibular endolymphatic space can be recognized on non-contrast-enhanced 3D FLAIR. Cochlear endolymphatic space can be identified only in one case with significant hydrops. Vestibular hydrops was identified in four cases. Among these four cases, three had vertigo, and one had no vertigo. In those nine cases without hydrops, two had vertigo, and seven did not have vertigo. No significant correlation between vertigo and vestibular hydrops was found. Vestibular endolymphatic space can be recognized on non-contrast-enhanced 3D FLAIR. In some patients with VS, vestibular hydrops is seen; however, endolymphatic hydrops in the vestibule might not be the only responsible cause of vertigo in the patients with VS. (orig.)

  11. Impacts of small vestibular schwannoma on community ambulation, postural, and ocular control.

    Science.gov (United States)

    Low Choy, Nancy L; Lucey, Mary-Therese M; Lewandowski, Susan L; Panizza, Benedict J

    2017-05-01

    To investigate balance, community mobility, gaze instability, and dizziness handicap and assess falls risk in people who are conservatively managed with small vestibular schwannoma (VS). Cross-sectional study with controls. The study involved 18 people (mean age 58.7 ± 12.2 years) diagnosed with VS (<12 mm) and 22 age-matched controls (mean age 56.9 ± 8.0 years). Measures included standing on firm and foam surfaces with feet apart, then together with eyes open and closed, Timed Up and Go (TUG) test and dual TUG test, Dynamic Gait Index, 6-Minute Walk Test, Halmagyi Impulse Test, Dynamic Visual Acuity Test, and the Dizziness Handicap Inventory. The clinical group failed more trials standing feet together on foam with eyes closed (P < .05); had inferior mobility and walked more slowly with divided attention (P < .05); had more difficulty walking with head movement, negotiating obstacles, and using stairs (P < .01); and walked shorter distances (P < .001) than controls. Reduced gaze stability (P < .01) and higher total (P = .007) and subcategory dizziness handicap scores (P < .05) were revealed compared to age-matched controls. Although outcomes for the clinical group are inferior to the control group across all measures and the dizziness impact is higher, the results fall in the low-risk category for falls. Preliminary data (level 4 evidence) support using a suite of clinical measures to monitor people with VS during conservative management. 4 Laryngoscope, 127:1147-1152, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Long-Term Outcomes of Vestibular Schwannomas Treated With Fractionated Stereotactic Radiotherapy: An Institutional Experience

    International Nuclear Information System (INIS)

    Kapoor, Sumit; Batra, Sachin; Carson, Kathryn; Shuck, John; Kharkar, Siddharth; Gandhi, Rahul; Jackson, Juan; Wemmer, Jan; Terezakis, Stephanie; Shokek, Ori; Kleinberg, Lawrence; Rigamonti, Daniele

    2011-01-01

    Purpose: We assessed clinical outcome and long-term tumor control after fractionated stereotactic radiotherapy (FSRT) for unilateral schwannoma. Methods and Materials: Between 1995 and 2007, 496 patients were treated with fractionated stereotactic radiotherapy at Johns Hopkins Hospital (Baltimore, MD); 385 patients had radiologic follow-up that met the inclusion criteria. The primary endpoint was treatment failure. Secondary endpoints were radiologic progression and clinical outcome. Logistic regression analysis assessed the association of age, race, tumor side, sex, and pretreatment symptoms. Results: In 11 patients (3%) treatment failed, and they required salvage (microsurgical) treatment. Radiologic progression was observed in 116 patients (30.0%), including 35 patients (9%) in whom the treatment volume more than doubled during the follow-up period, although none required surgical resection. Tumors with baseline volumes of less than 1 cm 3 were 18.02 times more likely to progress than those with tumor volumes of 1 cm 3 or greater (odds ratio, 18.02; 95% confidence interval, 4.25-76.32). Treatment-induced neurologic morbidity included 8 patients (1.6%) with new facial weakness, 12 patients (2.8%) with new trigeminal paresthesias, 4 patients (0.9%) with hydrocephalus (1 communicating and 3 obstructive), and 2 patients (0.5%) with possibly radiation-induced neoplasia. Conclusions: Although the rate of treatment failure is low (3%), careful follow-up shows that radiologic progression occurs frequently. When reporting outcome, the 'no salvage surgery needed' and 'no additional treatment needed' criteria for treatment success need to be complemented by the radiologic data.

  13. What Is the Safety and Efficacy of Chemical Venous Thromboembolism Prophylaxis Following Vestibular Schwannoma Surgery?

    Science.gov (United States)

    Casazza, Geoffrey C; Bowers, Christian A; MacDonald, Joel D; Couldwell, William T; Shelton, Clough; Gurgel, Richard K

    2018-02-01

    The benefit of routine chemical prophylaxis use for venous thromboembolism (VTE) prevention in skull base surgery is controversial. Chemical prophylaxis can prevent undue morbidity and mortality, however there are risks for hemorrhagic complications. Retrospective case-control. A retrospective chart review of patients who underwent surgery for vestibular schwannoma from 2011 to 2016 was performed. Patients were divided by receipt of chemical VTE prophylaxis. Number of VTEs and hemorrhagic complications (intracranial hemorrhage, abdominal hematoma, and postauricular hematoma) were recorded. One hundred twenty-six patients were identified, 55 received chemical prophylaxis, and 71 did not. All the patients received mechanical prophylaxis. Two patients developed a deep vein thrombosis (DVT) and one patient developed a pulmonary embolism (PE). All patients who developed a DVT or PE received chemical prophylaxis. There was no difference in DVT (p = 0.1886) or PE (p = 0.4365) between those who received chemical prophylaxis and those who did not. Five patients developed a hemorrhagic complication, two intracranial hemorrhage, three abdominal hematoma, and zero postauricular hematoma. All five patients with a complication received chemical prophylaxis (p = 0.00142). The relative risk of a hemorrhagic complication was 14.14 (95% CI = 0.7987-250.4307; p = 0.0778). There was a significant difference between the number of hemorrhagic complications but not between numbers of DVT or PE. Mechanical and chemical prophylaxis may lower the risk of VTE but in our series, hemorrhagic complications were observed. These measures should be used selectively in conjunction with early ambulation.

  14. Primary culture of human Schwann and schwannoma cells: improved and simplified protocol.

    Science.gov (United States)

    Dilwali, Sonam; Patel, Pratik B; Roberts, Daniel S; Basinsky, Gina M; Harris, Gordon J; Emerick, Kevin S; Stankovic, Konstantina M

    2014-09-01

    Primary culture of human Schwann cells (SCs) and vestibular schwannoma (VS) cells are invaluable tools to investigate SC physiology and VS pathobiology, and to devise effective pharmacotherapies against VS, which are sorely needed. However, existing culture protocols, in aiming to create robust, pure cultures, employ methods that can lead to loss of biological characteristics of the original cells, potentially resulting in misleading biological findings. We have developed a minimally manipulative method to culture primary human SC and VS cells, without the use of selective mitogens, toxins, or time-consuming and potentially transformative laboratory techniques. Schwann cell purity was quantified longitudinally using S100 staining in SC cultures derived from the great auricular nerve and VS cultures followed for 7 and 12 weeks, respectively. SC cultures retained approximately ≥85% purity for 2 weeks. VS cultures retained approximately ≥80% purity for the majority of the span of 12 weeks, with maximal purity of 87% at 2 weeks. The VS cultures showed high level of biological similarity (68% on average) to their respective parent tumors, as assessed using a protein array featuring 41 growth factors and receptors. Apoptosis rate in vitro negatively correlated with tumor volume. Our results, obtained using a faster, simplified culturing method than previously utilized, indicate that highly pure, primary human SC and VS cultures can be established with minimal manipulation, reaching maximal purity at 2 weeks of culture. The VS cultures recapitulate the parent tumors' biology to a great degree, making them relevant models to investigate VS pathobiology. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Quality of life in patients with unilateral vestibular schwannoma on wait and see - strategy.

    Science.gov (United States)

    Klersy, P C; Arlt, F; Hofer, M; Meixensberger, J

    2018-01-01

    A 'wait and see' strategy is an option when managing patients with small vestibular schwannomas (VS). A risk of growth and worsening of hearing may influence a patient's daily quality of life (QOL). Therefore, the present study focused on QOL parameters in patients who are on a 'wait and see' strategy following magnetic resonance imaging (MRI)-based diagnosis of small unilateral VS. Sixty-five patients (mean age 64.4 years; male:female, 32:33) who suffered from a small unilateral VS (9.34 mm, range 1.5-23 mm) between 2013 and 2016 were included in a prospective single center study. During follow-up, in addition to clinical and neurological examinations and MRI imaging, all patients answered the Short Form 36 questionnaire once to characterize QOL. Additionally, the severity of tinnitus was determined by the Mini-TQ-12 from Hiller and Goebel. It was found during follow-up that there was no lowering of QOL in patients with small VS who were on 'wait and see' strategy compared with Germany's general population and no tumor growth was detected in 53 patients (81.5%). Patients with a tumor diameter larger than 10 mm did not suffer from stronger tinnitus, vertigo or unsteadiness than the group with an average tumor size, which is smaller than 10 mm. Sixty-two patients (95.4%) showed ipsilateral hearing loss and three of these reported deafness (4.6%). Severe vertigo or tinnitus is connected with lower levels of mental component scale and physical component scale. These findings reduced the QOL (p = 0.05). In our series, QOL is not influenced in patients with unilateral untreated small VS in comparison to Germany's general population. This is helpful information when advising patients during follow-up and finding out the optimal timing of individual treatment.

  16. Volume Changes After Stereotactic LINAC Radiotherapy in Vestibular Schwannoma: Control Rate and Growth Patterns

    International Nuclear Information System (INIS)

    Langenberg, Rick van de; Dohmen, Amy J.C.; Bondt, Bert J. de; Nelemans, Patty J.; Baumert, Brigitta G.; Stokroos, Robert J.

    2012-01-01

    Purpose: The purpose of this study was to evaluate the control rate of vestibular schwannomas (VS) after treatment with linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) or radiotherapy (SRT) by using a validated volumetric measuring tool. Volume-based studies on prognosis after LINAC-based SRS or SRT for VS are reported scarcely. In addition, growth patterns and risk factors predicting treatment failure were analyzed. Materials and Methods: Retrospectively, 37 VS patients treated with LINAC based SRS or SRT were analyzed. Baseline and follow-up magnetic resonance imaging scans were analyzed with volume measurements on contrast enhanced T1-weighted magnetic resonance imaging. Absence of intervention after radiotherapy was defined as “no additional intervention group, ” absence of radiological growth was defined as “radiological control group. ” Significant growth was defined as a volume change of 19.7% or more, as calculated in a previous study. Results: The cumulative 4-year probability of no additional intervention was 96.4% ± 0.03; the 4-year radiological control probability was 85.4% ± 0.1). The median follow-up was 40 months. Overall, shrinkage was seen in 65%, stable VS in 22%, and growth in 13%. In 54% of all patients, transient swelling was observed. No prognostic factors were found regarding VS growth. Previous treatment and SRS were associated with transient swelling significantly. Conclusions: Good control rates are reported for LINAC based SRS or SRT in VS, in which the lower rate of radiological growth control is attributed to the use of the more sensitive volume measurements. Transient swelling after radiosurgery is a common phenomenon and should not be mistaken for treatment failure. Previous treatment and SRS were significantly associated with transient swelling.

  17. A comparison of semi-automated volumetric vs linear measurement of small vestibular schwannomas.

    Science.gov (United States)

    MacKeith, Samuel; Das, Tilak; Graves, Martin; Patterson, Andrew; Donnelly, Neil; Mannion, Richard; Axon, Patrick; Tysome, James

    2018-04-01

    Accurate and precise measurement of vestibular schwannoma (VS) size is key to clinical management decisions. Linear measurements are used in routine clinical practice but are prone to measurement error. This study aims to compare a semi-automated volume segmentation tool against standard linear method for measuring small VS. This study also examines whether oblique tumour orientation can contribute to linear measurement error. Experimental comparison of observer agreement using two measurement techniques. Tertiary skull base unit. Twenty-four patients with unilateral sporadic small (linear dimension following reformatting to correct for oblique orientation of VS. Intra-observer ICC was higher for semi-automated volumetric when compared with linear measurements, 0.998 (95% CI 0.994-0.999) vs 0.936 (95% CI 0.856-0.972), p linear measurements, 0.989 (95% CI 0.975-0.995) vs 0.946 (95% CI 0.880-0.976), p = 0.0045. The intra-observer %SDD was similar for volumetric and linear measurements, 9.9% vs 11.8%. However, the inter-observer %SDD was greater for volumetric than linear measurements, 20.1% vs 10.6%. Following oblique reformatting to correct tumour angulation, the mean increase in size was 1.14 mm (p = 0.04). Semi-automated volumetric measurements are more repeatable than linear measurements when measuring small VS and should be considered for use in clinical practice. Oblique orientation of VS may contribute to linear measurement error.

  18. Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management.

    Science.gov (United States)

    Babu, Ranjith; Sharma, Richa; Bagley, Jacob H; Hatef, Jeffrey; Friedman, Allan H; Adamson, Cory

    2013-07-01

    There are a variety of treatment options for the management of vestibular schwannomas (VSs), including microsurgical resection, radiotherapy, and observation. Although the choice of treatment is dependent on various patient factors, physician bias has been shown to significantly affect treatment choice for VS. In this study the authors describe the current epidemiology of VS and treatment trends in the US in the modern era. They also illustrate patient and tumor characteristics and elucidate their effect on tumor management. Patients diagnosed with VS were identified through the Surveillance, Epidemiology, and End Results database, spanning the years 2004-2009. Age-adjusted incidence rates were calculated and adjusted using the 2000 US standard population. The chi-square and Student t-tests were used to evaluate differences between patient and tumor characteristics. Multivariate logistic regression was performed to determine the effects of various patient and tumor characteristics on the choice of tumor treatment. A total of 6225 patients with VSs treated between 2004 and 2009 were identified. The overall incidence rate was 1.2 per 100,000 population per year. The median age of patients with VS was 55 years, with the majority of patients being Caucasian (83.16%). Of all patients, 3053 (49.04%) received surgery only, with 1466 (23.55%) receiving radiotherapy alone. Both surgery and radiation were only used in 123 patients (1.98%), with 1504 patients not undergoing any treatment (24.16%). Increasing age correlated with decreased use of surgery (OR 0.95, 95% CI 0.95-0.96; pmanagement (OR 1.04, 95% CI 1.04-1.05; pmanaged conservatively despite presenting with larger tumors. Further studies are needed to elucidate the reasons for treatment disparities and investigate the nationwide trend of resection for the treatment of small VSs.

  19. Delivery of Therapeutic Proteins via Extracellular Vesicles: Review and Potential Treatments for Parkinson's Disease, Glioma, and Schwannoma.

    Science.gov (United States)

    Hall, Justin; Prabhakar, Shilpa; Balaj, Leonora; Lai, Charles P; Cerione, Richard A; Breakefield, Xandra O

    2016-04-01

    Extracellular vesicles present an attractive delivery vehicle for therapeutic proteins. They intrinsically contain many proteins which can provide information to other cells. Advantages include reduced immune reactivity, especially if derived from the same host, stability in biologic fluids, and ability to target uptake. Those from mesenchymal stem cells appear to be intrinsically therapeutic, while those from cancer cells promote tumor progression. Therapeutic proteins can be loaded into vesicles by overexpression in the donor cell, with oligomerization and membrane sequences increasing their loading. Examples of protein delivery for therapeutic benefit in pre-clinical models include delivery of: catalase for Parkinson's disease to reduce oxidative stress and thus help neurons to survive; prodrug activating enzymes which can convert a prodrug which crosses the blood-brain barrier into a toxic chemotherapeutic drug for schwannomas and gliomas; and the apoptosis-inducing enzyme, caspase-1 under a Schwann cell specific promoter for schwannoma. This therapeutic delivery strategy is novel and being explored for a number of diseases.

  20. Serial MRI of vestibular schwannoma presenting transient enlargement associated with intratumoral hemorrhage following radiosurgery. Two case reports

    International Nuclear Information System (INIS)

    Kikuchi, Yasuhiro; Watanabe, Kazuo; Goto, Hiromi; Isaki, Kenji; Sato, Sonomi

    2010-01-01

    Two cases of vestibular schwannoma showing transient enlargement with hemorrhage that was recognized on T2 or T2*-weighted MR image are reported. Case 1: A 72-year-old woman had a recurrent cystic lesion after resection and stereotactic radiosurgery (SRS). After retreatment by gamma knife radiosurgery, the cystic component further expanded with a fluid-fluid level, and T2 or T2*-weighted image showed markedly-low signal in the parenchymal component. Chronic hemorrhage from the cyst wall injured by irradiation is probably related to expansion of the cyst. Case 2: A 59-year-old woman received SRS. Serial MRI scans demonstrated a lesion continually expanding with homogeneous contrast enhancement on T1-weighted images. At 64 months after treatment, a central portion with high blood flow surrounded by a markedly-low intensity component of apparent hemorrhage on T2*-weighted MRI was identified. The lesion decreased in size after 73 months. Hemorrhage might occur from the neogenetic angioma-like tissue induced by irradiation effect in the tumor. Based on these observations, microvasculopathy associated with irradiation is a probable mechanism that induces bleeding in vestibular schwannoma following radiosurgery. (author)

  1. Hearing preservation and facial nerve function after microsurgery for intracanalicular vestibular schwannomas: comparison of middle fossa and retrosigmoid approaches.

    Science.gov (United States)

    Noudel, R; Gomis, P; Duntze, J; Marnet, D; Bazin, A; Roche, P H

    2009-08-01

    Therapeutic options for vestibular schwannomas (VS) include microsurgery, stereotactic radiosurgery and conservative management. Early treatment of intracanalicular vestibular schwannomas (IVS) may be advisable because their spontaneous course will show hearing loss in most cases. Advanced microsurgical techniques and continuous intraoperative monitoring of cranial nerves may allow hearing preservation (HP) without facial nerve damage. However, there are still controversies about the definition of hearing preservation, and the best surgical approach that should be used. In this study, we reviewed the main data from the recent literature on IVS surgery and compared hearing, facial function and complication rates after the retrosigmoid (RS) and middle fossa (MF) approaches, respectively. The results showed that the average HP rate after IVS surgery ranged from 58% (RS) to 62% (MF). HP varied widely depending on the audiometric criteria that were used for definition of serviceable hearing. There was a trend to show that the MF approach offered a better quality of postoperative hearing (not statistically significant), whereas the RS approach offered a better facial nerve preservation and fewer complications (not statistically significant). We believe that the timing of treatment in the course of the disease and selection between radiosurgical versus microsurgical procedure are key issues in the management of IVS. Preservation of hearing and good facial nerve function in surgery for VS is a reasonable goal for many patients with intracanalicular tumors and serviceable hearing. Once open surgery has been decided, selection of the approach mainly depends on individual anatomical considerations and experience of the surgeon.

  2. Cost-effectiveness analysis of a non-contrast screening MRI protocol for vestibular schwannoma in patients with asymmetric sensorineural hearing loss

    International Nuclear Information System (INIS)

    Crowson, Matthew G.; Rocke, Daniel J.; Kaylie, David M.; Hoang, Jenny K.; Weissman, Jane L.

    2017-01-01

    We aimed to determine if a non-contrast screening MRI is cost-effective compared to a full MRI protocol with contrast for the evaluation of vestibular schwannomas. A decision tree was constructed to evaluate full MRI and screening MRI strategies for patients with asymmetric sensorineural hearing loss. If a patient were to have a positive screening MRI, s/he received a full MRI. Vestibular schwannoma prevalence, MRI specificity and sensitivity, and gadolinium anaphylaxis incidence were obtained through literature review. Institutional charge data were obtained using representative patient cohorts. One-way and probabilistic sensitivity analyses were completed to determine CE model threshold points for MRI performance characteristics and charges. The mean charge for a full MRI with contrast was significantly higher than a screening MRI ($4089 ± 1086 versus $2872 ± 741; p < 0.05). The screening MRI protocol was more cost-effective than a full MRI protocol with a willingness-to-pay from $0 to 20,000 USD. Sensitivity analyses determined that the screening protocol dominated when the screening MRI charge was less than $4678, and the imaging specificity exceeded 78.2%. The screening MRI protocol also dominated when vestibular schwannoma prevalence was varied between 0 and 1000 in 10,000 people. A screening MRI protocol is more cost-effective than a full MRI with contrast in the diagnostic evaluation of a vestibular schwannoma. A screening MRI likely also confers benefits of shorter exam time and no contrast use. Further investigation is needed to confirm the relative performance of screening protocols for vestibular schwannomas. (orig.)

  3. Cost-effectiveness analysis of a non-contrast screening MRI protocol for vestibular schwannoma in patients with asymmetric sensorineural hearing loss

    Energy Technology Data Exchange (ETDEWEB)

    Crowson, Matthew G.; Rocke, Daniel J.; Kaylie, David M. [Duke University Medical Center, Division of Otolaryngology-Head and Neck Surgery, Durham, NC (United States); Hoang, Jenny K. [Duke University Medical Center, Department of Radiology, Durham, NC (United States); Weissman, Jane L. [Oregon Health Sciences University, Professor Emerita of Diagnostic Radiology, Portland, OR (United States)

    2017-08-15

    We aimed to determine if a non-contrast screening MRI is cost-effective compared to a full MRI protocol with contrast for the evaluation of vestibular schwannomas. A decision tree was constructed to evaluate full MRI and screening MRI strategies for patients with asymmetric sensorineural hearing loss. If a patient were to have a positive screening MRI, s/he received a full MRI. Vestibular schwannoma prevalence, MRI specificity and sensitivity, and gadolinium anaphylaxis incidence were obtained through literature review. Institutional charge data were obtained using representative patient cohorts. One-way and probabilistic sensitivity analyses were completed to determine CE model threshold points for MRI performance characteristics and charges. The mean charge for a full MRI with contrast was significantly higher than a screening MRI ($4089 ± 1086 versus $2872 ± 741; p < 0.05). The screening MRI protocol was more cost-effective than a full MRI protocol with a willingness-to-pay from $0 to 20,000 USD. Sensitivity analyses determined that the screening protocol dominated when the screening MRI charge was less than $4678, and the imaging specificity exceeded 78.2%. The screening MRI protocol also dominated when vestibular schwannoma prevalence was varied between 0 and 1000 in 10,000 people. A screening MRI protocol is more cost-effective than a full MRI with contrast in the diagnostic evaluation of a vestibular schwannoma. A screening MRI likely also confers benefits of shorter exam time and no contrast use. Further investigation is needed to confirm the relative performance of screening protocols for vestibular schwannomas. (orig.)

  4. Grading of vestibular schwannomas and corresponding tumor volumes: ramifications for radiosurgery.

    Science.gov (United States)

    Mindermann, T; Schlegel, I

    2013-01-01

    Patients with vestibular schwannomas (VS) are either assigned to watchful waiting, microsurgical resection, or radiosurgery. Decision making on how to proceed is based on parameters such as age, tumor growth, loss of hearing, and the tumor's Koos grading. In order to correlate Koos grading with tumor volume, patient records of 235 patients with VS who underwent Gamma Knife radiosurgery (GKRS) were retrospectively reviewed. From 1994 to 2009, 235 consecutive patients underwent GKRS for sporadic VS at the Zurich Gamma Knife Center. Median follow up was 62.8 ± 33.0 months. Of the 235 tumors, 32 (13.6 %) were graded Koos I with a volume of 0.25 ± 0.3 cc; 71 (30.2 %) were graded Koos II with a volume of 0.57 ± 0.54 cc; 70 (29.8 %) were graded Koos III with a volume of 1.82 ± 1.88 cc; and 62 (26.4 %) were graded Koos IV with a volume of 4.17 ± 2.75 cc. Tumor progression was defined as a volume increase > 20 % at 2 years or later following GKRS. Overall tumor progression occurred in 21/235 (8.9 %) patients at 3.4 ± 0.9 years. Tumor progression did not differ statistically significantly in the various Koos grades: 1/32 (3.1 %) patients with VS Koos Grade I, 7/71 (9.8 %) patients with VS Koos Grade II, 6/70 (8.6 %) patients with VS Koos Grade III, and 7/62 (11.3 %) patients with VS Koos Grade IV. To our knowledge, this is the first work correlating the various Koos grades of VS to their respective tumor volumes. In our patients, tumor volumes of VS Koos Grade IV were limited because all of our patients were eligible for radiosurgery. In our series, the outcome following GKRS for patients with VS Koos Grade IV tumors did not differ from patients with VS Koos Grades I-III. We therefore suggest to limit Koos Grade IV VS to tumor volumes 6 cc that may not be eligible for radiosurgery.

  5. Dosimetric Comparison of Helical Tomotherapy and Dynamic Conformal Arc Therapy in Stereotactic Radiosurgery for Vestibular Schwannomas

    International Nuclear Information System (INIS)

    Lee, Tsair-Fwu; Chao, Pei-Ju; Wang, Chang-Yu; Lan, Jen-Hong; Huang, Yu-Je; Hsu, Hsuan-Chih; Sung, Chieh-Cheng; Su, Te-Jen; Lian, Shi-Long; Fang, Fu-Min

    2011-01-01

    The dosimetric results of stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) performed using dynamic conformal arc therapy (DCAT) with the Novalis system and helical TomoTherapy (HT) were compared using plan quality indices. The HT plans were created for 10 consecutive patients with VS previously treated with SRS using the Novalis system. The dosimetric indices used to compare the techniques included the conformity index (CI) and homogeneity index (HI) for the planned target volume (PTV), the comprehensive quality index (CQI) for nine organs at risk (OARs), gradient score index (GSI) for the dose drop-off outside the PTV, and plan quality index (PQI), which was verified using the plan quality discerning power (PQDP) to incorporate 3 plan indices, to evaluate the rival plans. The PTV ranged from 0.27-19.99 cm 3 (median 3.39 cm 3 ), with minimum required PTV prescribed doses of 10-16 Gy (median 12 Gy). Both systems satisfied the minimum required PTV prescription doses. HT conformed better to the PTV (CI: 1.51 ± 0.23 vs. 1.94 ± 0.34; p < 0.01), but had a worse drop-off outside the PTV (GSI: 40.3 ± 10.9 vs. 64.9 ± 13.6; p < 0.01) compared with DCAT. No significant difference in PTV homogeneity was observed (HI: 1.08 ± 0.03 vs. 1.09 ± 0.02; p = 0.20). HT had a significantly lower maximum dose in 4 OARs and significant lower mean dose in 1 OAR; by contrast, DCAT had a significantly lower maximum dose in 1 OAR and significant lower mean dose in 2 OARs, with the CQI of the 9 OARs = 0.92 ± 0.45. Plan analysis using PQI (HT 0.37 ± 0.12 vs. DCAT 0.65 ± 0.08; p < 0.01), and verified using the PQDP, confirmed the dosimetric advantage of HT. However, the HT system had a longer beam-on time (33.2 ± 7.4 vs. 4.6 ± 0.9 min; p < 0.01) and consumed more monitor units (16772 ± 3803 vs. 1776 ± 356.3; p < 0.01). HT had a better dose conformity and similar dose homogeneity but worse dose gradient than DCAT. Plan analysis confirmed the dosimetric advantage of HT

  6. Annual rate of hearing loss falls after fractionated stereotactic irradiation for vestibular schwannoma

    International Nuclear Information System (INIS)

    Sakamoto, Touru; Shirato, Hiroki; Takeichi, Norihito; Aoyama, Hidefumi; Fukuda, Satoshi; Miyasaka, Kazuo

    2001-01-01

    Purpose: The rate of hearing loss in a population before and after irradiation was investigated to determine the effect of irradiation on hearing impairment. Methods and materials: In 72 patients with vestibular schwannoma who received fractionated stereotactic irradiation from 1992 to 1999, 21 had had their hearing levels examined 3 months or more before the treatment. The mean time between the initial examination and treatment was 18.6 months (range: 3-89 months), and the mean time between treatment and the last follow-up was 24.2 months (12-69 months). Thirty-six to 50 Gy in 20-25 fractions over 5 to 6 weeks was given using an X-ray beam from a linear accelerator. Pure tone average (PTA) was measured using the mean hearing level at five frequencies, and the annual rate of hearing loss was defined as [(hearing loss in PTA(dB))/(follow-up period (months)x12)]. Results: The actual cumulative curve of decrease in tumor size of 2 mm or more was 38.3% at 2 years and 80.0% at 3 years. The mean of hearing loss in PTA was 11.6±10.3 dB (-1 to 35 dB) from the initial examination to the start of irradiation and 11.9±14.4 dB (-14 to 37 dB) from the start of irradiation to the last follow-up. The mean annual rates of hearing loss before irradiation and in the 1st, 2nd, 3rd and 4th years after irradiation were, respectively, 18.6, 11.2, 6.2, 5.1, and 5.0 dB/year. The annual rates of hearing loss in the 2nd year (P=0.025) and 3rd year (P=0.018) were significantly slower than the rate before irradiation. Conclusions: The mean annual rate of hearing loss was higher before irradiation than after irradiation, and hearing loss slowed rather than accelerated after irradiation. Although hearing loss after the treatment was usually permanent, fractionated stereotactic irradiation was suggested to be effective to lower the rate of hearing loss

  7. Audiological assessment before and after fractionated stereotactic irradiation for vestibular schwannoma

    International Nuclear Information System (INIS)

    Sakamoto, T.; Sato, N.; Inuyama, Y.; Shirato, H.; Kagei, K.; Fukuda, S.; Miyasaka, K.; Sawamura, Y.; Suzuki, K.; Takizawa, H.; Hokunan, K.; Isu, T.

    1998-01-01

    Purpose: To find the audiological outcome after LINAC-based fractionated stereotactic irradiation (STI). Materials and methods: Twenty-four patients with vestibular schwannoma treated by fractionated STI between 1991 and 1997 had measurable hearing before STI and were followed audiologically for more than 6 months. The pure tone average (PTA) was measured by averaging the air-conduction threshold for five main frequencies (250-4000 Hz) before and periodically after STI in the 24 patients. Several possible prognostic factors for hearing preservation (defined as a PTA change at the last follow-up of less than 10 dB) were investigated. The median follow-up time was 22 months, ranging from 5 to 69 months. The irradiation schedule was 36 Gy in 20 fractions in 5 weeks to 44 Gy in 22 fractions in 6 weeks followed by 4 Gy/1 fraction boost. Results: The pure tone average before STI was distributed from 7 to 73 dB. Fifty percent of patients showed a change in PTA of less than 10 dB, 79.2% of patients showed a change in PTA of less than 20 dB and 20.8% of patients showed a change in PTA of more than 21 dB at the last follow-up. Only one patient (4%) became deaf. Cases with a sudden loss of hearing were more likely to experience hearing preservation than those with gradual loss of hearing (P<0.05). The mean age was younger in patients whose hearing was preserved (P<0.05). Poor pretreatment PTA appeared to linearly correspond to the changes in PTA (regression coefficient 0.78). The size of the tumor was not related to the change in PTA. No relationship was observed between the maximum or peripheral dose and the PTA change. The real benefit of stereotactic boost after small-field fractionated irradiation was not certain. Conclusion: Fractionated STI produced a hearing preservation rate compatible with meticulously collimated multi-spots single fraction irradiation. Further follow-up is required to confirm the long-term benefits of fractionation. (Copyright (c) 1998 Elsevier

  8. Linear accelerator radiosurgery for vestibular schwannomas: Results of medium-term follow-up.

    Science.gov (United States)

    Ellenbogen, Jonathan R; Waqar, Mueez; Kinshuck, Andrew J; Jenkinson, Michael D; Lesser, Tristram H J; Husband, David; Javadpour, Mohsen

    2015-01-01

    To examine tumour control, via volume changes, and the complications of linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) treatment of vestibular schwannomas (VSs) on medium-term follow-up. Between September 2003 and November 2009 fifty consecutive patients with VSs treated with SRS using a marginal dose of 12.5 Gy utilizing a LINAC equipped with a micro-multileaf collimator were identified. Evaluation included serial magnetic resonance imaging (MRI), and neurological and hearing examinations. The median tumour volume at treatment was 2.4 (range: 0.24-10.59) cm3. The intracranial diameter of the tumours ranged between 7.7 and 28.7 (median: 15.8) mm. Follow-up MRI was available for analysis on 49 patients. The median radiological follow-up period was 5.8 (range: 1.4-9.2) years. The median tumour volume at last follow-up was 1.1 (range: 0.03-5.3) cm3. VS decreased in size in 45 (90%) patients, with a median reduction in tumour volume of 1.46 (range: 0.06-9.29) cm3 or a median tumour size reduction of 59% of the baseline (range: 6-90%) in these patients. VS remained stable in 2 patients and increased in size in 2 patients. Only 1 patient (2%) required additional intervention (surgery). 15 patients had useful hearing pre-treatment; 10 post-treatment pure-tone audiograms of these patients were available. 5 (50%) patients still had useful hearing post treatment. Non-auditory adverse radiation effects included new (House-Brackmann grade II) or worsened facial nerve palsy (House-Brackmann grade II to grade V) in 2 (4%) patients and trigeminal sensory disturbance in 2 (4%) patients. At medium term, the vast majority of VSs treated with LINAC-based SRS exhibit tumour shrinkage. The slightly higher rate of facial nerve palsy compared with Gamma Knife surgery (GKS) results may be related to the learning curve. Other complications were similar to reported GKS results for VSs of comparable sizes.

  9. Clinicopathological variables of sporadic schwannomas of peripheral nerve in 291 patients and expression of biologically relevant markers.

    Science.gov (United States)

    Young, Eric D; Ingram, Davis; Metcalf-Doetsch, William; Khan, Dilshad; Al Sannaa, Ghadah; Le Loarer, Francois; Lazar, Alexander J F; Slopis, John; Torres, Keila E; Lev, Dina; Pollock, Raphael E; McCutcheon, Ian E

    2017-09-08

    OBJECTIVE While sporadic peripheral schwannomas (SPSs) are generally well treated with surgery, their biology is not well understood. Consequently, treatment options are limited. The aim of this study was to provide a comprehensive description of SPS. The authors describe clinicopathological features and treatment outcomes of patients harboring these tumors, and they assess expression of biomarkers using a clinically annotated tissue microarray. Together, these data give new insight into the biology and management of SPS. METHODS Patients presenting with a primary SPS between 1993 and 2011 (n = 291) were selected from an institutional registry to construct a clinical database. All patients underwent follow-up, and short- and long-term outcomes were assessed. Expression of relevant biomarkers was assessed using a new tissue microarray (n = 121). RESULTS SPSs were generally large (mean 5.5 cm) and frequently painful at presentation (55%). Most patients were treated with surgery (80%), the majority of whom experienced complete resolution (52%) or improvement (18%) of their symptoms. Tumors that were completely resected (85%) did not recur. Some patients experienced short-term (16%) and long-term (4%) complications postoperatively. Schwannomas expressed higher levels of platelet-derived growth factor receptor-β (2.1) than malignant peripheral nerve sheath tumors (MPNSTs) (1.5, p = 0.004) and neurofibromas (1.33, p = 0.007). Expression of human epidermal growth factor receptor-2 was greater in SPSs (0.91) than in MPNSTs (0.33, p = 0.002) and neurofibromas (0.33, p = 0.026). Epidermal growth factor receptor was expressed in far fewer SPS cells (10%) than in MPNSTs (58%, p SPSs more frequently expressed cytoplasmic survivin (66% of tumor cells) than normal nerve (46% of cells), but SPS expressed nuclear survivin in fewer tumor cells than in MPNSTs (24% and 50%, respectively; p = 0.018). CONCLUSIONS Complete resection is curative for SPS. Left untreated, however, these

  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. Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma.

    Science.gov (United States)

    Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M; Ginsberg, Lawrence E; Gidley, Paul W

    2014-08-01

    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 tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy.

  12. Repeated delayed onset cerebellar radiation injuries after linear accelerator-based stereotactic radiosurgery for vestibular schwannoma. Case report

    International Nuclear Information System (INIS)

    Ujifuku, Kenta; Matsuo, Takayuki; Toyoda, Keisuke

    2012-01-01

    A 63-year-old woman presented with right hearing disturbance and vertigo. Magnetic resonance (MR) imaging revealed the presence of right vestibular schwannoma (VS). Stereotactic radiosurgery (SRS) was performed with a tumor marginal dose of 14 Gy using two isocenters. She was followed up clinically and neuroradiologically using three-dimensional spoiled gradient-echo MR imaging. She experienced temporal neurological deterioration due to peritumoral edema in her right cerebellar peduncle and pons for a few months beginning 1.5 years after SRS, when she experienced transient right facial dysesthesia and hearing deterioration. Ten years after SRS, the patient presented with sudden onset of vertigo, gait disturbance, diplopia, dysarthria, and nausea. MR imaging demonstrated a new lesion in the right cerebellar peduncle, which was diagnosed as radiation-induced stroke. The patient was followed up conservatively and her symptoms disappeared within a few months. Multiple delayed onset radiation injuries are possible sequelae of SRS for VS. (author)

  13. Laparoscopic Non-clamping Tumor Enucleation of Renal Hilum Schwannoma in a Single Kidney: A Case Report

    Directory of Open Access Journals (Sweden)

    Fuminari Hanashima

    2015-11-01

    Full Text Available A 56-year-old woman underwent laparoscopic right nephrectomy due to pyonephrosis associated with right ureteral stones. Moreover, the patient developed a brain stem hemorrhage and became bedridden. At the time of nephrectomy, a renal tumor, with a size of 24 × 24 × 20 mm, was observed in the left renal hilum; the tumor did not show contrast enhancement on computed tomography. After 3 years, the tumor gradually grew to a size of 45 × 35 × 34 mm, and therefore, laparoscopic non-clamping tumor enucleation was performed. Pathological examination confirmed a diagnosis of renal schwannoma.

  14. Seizure, spinal schwannoma, peripheral neuropathy and pulmonary stenosis - A rare combination in a patient of Neurofibromatosis 1

    Directory of Open Access Journals (Sweden)

    Avas Chandra Ray

    2012-01-01

    Full Text Available Neurofibromatosis 1 (NF1 is the most common neurocutaneous syndrome. It is estimated to occur in approximately 1 out of every 3300 infants. The manifestations of this condition are diverse and can arise from almost any system in the body. The neurofibroma is the hallmark lesion of NF1 that develops from peripheral nerves. Here, we are reporting an 18-year-old girl with NF1. Clinical diagnosis was made according to the diagnostic criteria established by the National Institutes of Health Consensus Development Conference in 1987. She presented with quadriparesis due to dumbbell-shaped spinal schwannoma in the cervical region. She had history of recurrent seizures in the past, with poor scholastic performance. There were clinical and electrophysiological features of peripheral neuropathy and clinical and echocardiographical features of pulmonary stenosis. These are uncommon features of NF 1. The presence of all these features in a single patient makes it a unique case.

  15. Immediate and Long-term Hearing Outcomes With the Middle Cranial Fossa Approach for Vestibular Schwannoma Resection.

    Science.gov (United States)

    Ahmed, Sameer; Arts, H Alexander; El-Kashlan, Hussam; Basura, Gregory J; Thompson, B Gregory; Telian, Steven A

    2018-01-01

    To analyze the immediate postoperative and long-term hearing outcome data in patients who have undergone hearing preservation attempts with the middle cranial fossa (MCF) approach for the resection of sporadic vestibular schwannoma. Retrospective review of a surgical patient cohort. Tertiary academic referral center. Adult patients with unilateral sporadic vestibular schwannoma. Surgical treatment with a MCF approach. Comparison of pre- and postoperative audiometric data in accordance with the 1995 and 2012 American Academy of Otolaryngology/Head and Neck Surgery guidelines on reporting hearing outcomes and with a word recognition score only scale. Long-term hearing outcome data were analyzed in the following postoperative groups: 3 to 5, 6 to 8, 9 to 11, and 12+ years after surgery. From 1999 to 2016, 174 patients underwent the MCF approach and 155 of them met inclusion criteria for analysis of hearing outcome data. Class A or B hearing was preserved in 70% of the entire cohort after recovery. Seventy-one patients with measurable hearing met criteria for long-term data analysis. The rate of American Academy of Otolaryngology/Head and Neck Surgery class A or B hearing preservation was 82% at 3 to 5 years and declined thereafter. The rate of word recognition score class I or II hearing preservation was 98% at 3 to 5 years and declined less rapidly thereafter. Patients with preoperative Class A hearing had significantly higher rates of successful hearing preservation at all postoperative intervals. Delayed hearing loss occurs in a progressively increasing fashion but speech understanding remains durable for a majority of patients whose hearing is initially preserved with the MCF approach.

  16. Single Fraction Versus Fractionated Linac-Based Stereotactic Radiotherapy for Vestibular Schwannoma: A Single-Institution Experience

    Energy Technology Data Exchange (ETDEWEB)

    Collen, Christine, E-mail: ccollen@uzbrussel.be [Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels (Belgium); Ampe, Ben [Department of Neurosurgery, UZ Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels (Belgium); Gevaert, Thierry [Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels (Belgium); Moens, Maarten [Department of Neurosurgery, UZ Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels (Belgium); Linthout, Nadine; De Ridder, Mark; Verellen, Dirk [Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels (Belgium); D' Haens, Jean [Department of Neurosurgery, UZ Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels (Belgium); Storme, Guy [Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels (Belgium)

    2011-11-15

    Purpose: To evaluate and compare outcomes for patients with vestibular schwannoma (VS) treated in a single institution with linac-based stereotactic radiosurgery (SRS) or by fractionated stereotactic radiotherapy (SRT). Methods and Materials: One hundred and nineteen patients (SRS = 78, SRT = 41) were treated. For both SRS and SRT, beam shaping is performed by a mini-multileaf collimator. For SRS, a median single dose of 12.5 Gy (range, 11-14 Gy), prescribed to the 80% isodose line encompassing the target, was applied. Of the 42 SRT treatments, 32 treatments consisted of 10 fractions of 3-4 Gy, and 10 patients received 25 sessions of 2 Gy, prescribed to the 100% with the 95% isodose line encompassing the planning target volume. Mean largest tumor diameter was 16.6 mm in the SRS and 24.6 mm in the SRT group. Local tumor control, cranial nerve toxicity, and preservation of useful hearing were recorded. Any new treatment-induced cranial nerve neuropathy was scored as a complication. Results: Median follow-up was 62 months (range, 6-136 months), 5 patients progressed, resulting in an overall 5-year local tumor control of 95%. The overall 5-year facial nerve preservation probability was 88% and facial nerve neuropathy was statistically significantly higher after SRS, after prior surgery, for larger tumors, and in Koos Grade {>=}3. The overall 5-year trigeminal nerve preservation probability was 96%, not significantly influenced by any of the risk factors. The overall 4-year probability of preservation of useful hearing (Gardner-Robertson score 1 or 2) was 68%, not significantly different between SRS or SRT (59% vs. 82%, p = 0.089, log rank). Conclusion: Linac-based RT results in good local control and acceptable clinical outcome in small to medium-sized vestibular schwannomas (VSs). Radiosurgery for large VSs (Koos Grade {>=}3) remains a challenge because of increased facial nerve neuropathy.

  17. Dosimetric and Clinical Analysis of Spatial Distribution of the Radiation Dose in Gamma Knife Radiosurgery for Vestibular Schwannoma

    International Nuclear Information System (INIS)

    Massager, Nicolas; Lonneville, Sarah; Delbrouck, Carine; Benmebarek, Nadir; Desmedt, Françoise; Devriendt, Daniel

    2011-01-01

    Objectives: We investigated variations in the distribution of radiation dose inside (dose inhomogeneity) and outside (dose falloff) the target volume during Gamma Knife (GK) irradiation of vestibular schwannoma (VS). We analyzed the relationship between some parameters of dose distribution and the clinical and radiological outcome of patients. Methods and Materials: Data from dose plans of 203 patients treated for a vestibular schwannoma by GK C using same prescription dose (12 Gy at the 50% isodose) were collected. Four different dosimetric indexes were defined and calculated retrospectively in all plannings on the basis of dose–volume histograms: Paddick conformity index (PI), gradient index (GI), homogeneity index (HI), and unit isocenter (UI). The different measures related to distribution of the radiation dose were compared with hearing and tumor outcome of 203 patients with clinical and radiological follow-up of minimum 2 years. Results: Mean, median, SD, and ranges of the four indexes of dose distribution analyzed were calculated; large variations were found between dose plans. We found a high correlation between the target volume and PI, GI, and UI. No significant association was found between the indexes of dose distribution calculated in this study and tumor control, tumor volume shrinkage, hearing worsening, loss of functional hearing, or complete hearing loss at last follow-up. Conclusions: Parameters of distribution of the radiation dose during GK radiosurgery for VS can be highly variable between dose plans. The tumor and hearing outcome of patients treated is not significantly related to these global indexes of dose distribution inside and around target volume. In GK radiosurgery for VS, the outcome seems more to be influenced by local radiation dose delivered to specific structures or volumes than by global dose gradients.

  18. Contaminação tumoral em trajeto de biópsia de tumores ósseos malignos primários Tumor contamination in the biopsy path of primary malignant bone tumors

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    Marcelo Parente Oliveira

    2012-10-01

    Full Text Available OBJETIVO: Estudar os fatores possivelmente associados à contaminação tumoral do trajeto de biópsia de tumores ósseos malignos primários. MÉTODO: Foram estudados, retrospectivamente, 35 pacientes submetidos a tratamento cirúrgico com diagnóstico de osteossarcoma, tumor de Ewing e condrossarcoma. A amostra foi analisada para caracterização quanto à técnica de biópsia empregada, tipo histológico do tumor, realização de quimioterapia neoadjuvante, ocorrência de recidiva local e contaminação tumoral no trajeto da biópsia. RESULTADOS: Nos 35 pacientes avaliados ocorreram quatro contaminações (11,43%. Um caso era de osteossarcoma, dois casos de tumor de Ewing e um caso de condrossarcoma, não se observando associação entre o tipo de tumor e a presença de contaminação tumoral no trajeto da biópsia (p = 0,65. Também não se observou associação entre a presença de contaminação tumoral e a técnica de biópsia (p = 0,06. Por outro lado, observou-se associação entre a presença de contaminação tumoral e a ocorrência de recidiva local (p = 0,01 e entre a presença de contaminação e a não realização de quimioterapia neoadjuvante (p = 0,02. CONCLUSÃO: A contaminação tumoral no trajeto de biópsia de tumores ósseos malignos primários esteve associada à ocorrência de recidiva local. Por outro lado, não mostrou ser influenciada pelo tipo de biópsia realizada e pelo tipo histológico de tumor estudado. A quimioterapia neoadjuvante mostrou um efeito protetor contra esta complicação. A despeito desses achados, a contaminação tumoral é uma complicação que deve sempre ser considerada, sendo recomendada a remoção do trajeto da biópsia na cirurgia de ressecção do tumor.OBJECTIVE: To study factors possibly associated with tumor contamination in the biopsy path of primary malignant bone tumors. METHOD: Thirty-five patients who underwent surgical treatment with diagnoses of osteosarcoma, Ewing's tumor and

  19. Place of Gamma Knife Stereotactic Radiosurgery in Grade 4 Vestibular Schwannoma Based on Case Series of 86 Patients with Long-Term Follow-Up.

    Science.gov (United States)

    Lefranc, Michel; Da Roz, Leila Maria; Balossier, Anne; Thomassin, Jean Marc; Roche, Pierre Hugue; Regis, Jean

    2018-06-01

    Grade IV vestibular schwannoma (Koos classification) is generally considered to be an indication for microsurgical resection or combined radiosurgery-microsurgery. However, the place of Gamma Knife stereotactic surgery (GK-SRS), either as first-line treatment or when progression of residual tumor compresses the brainstem, has not been clearly evaluated. This article reports the results of a large case series of patients with grade 4 vestibular schwannoma treated by GK-SRS. All consecutive patients with grade IV vestibular schwannoma treated by GK-SRS in our department between 1996 and 2011 with a minimum follow-up of 3 years were included in this study. 86 patients were treated by GK-SRS with a minimum follow-up of 3 years. Mean follow-up was 6.2 years (3-16 years). The mean age of the patients at the time of GK-SRS was 54.6 years (range: 23-84) and the sex ratio was 0.6. At the time of radiosurgery, no patient presented brainstem dysfunction prior to GK-SRS. 38 patients had functional hearing before treatment. One patient presented mild trigeminal neuralgia before GK-SRS. Tumor control with no clinical deterioration was obtained in 78 patients (90.7%). No radiation-induced brainstem or cranial nerve toxicity was observed in any of these patients. Functional hearing was maintained in 25 patients. 8 (9.3%) patients presented tumor growth and required microsurgical resection in 7 cases and ventricular shunt in 1 case. On the basis of this large series, GK-SRS appears to be a safe and effective treatment option for grade IV vestibular schwannoma for patients with no signs of brainstem dysfunction. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Magnetic resonance imaging characteristics and the prediction of outcome of vestibular schwannomas following Gamma Knife radiosurgery.

    Science.gov (United States)

    Wu, Chih-Chun; Guo, Wan-Yuo; Chung, Wen-Yuh; Wu, Hisu-Mei; Lin, Chung-Jung; Lee, Cheng-Chia; Liu, Kang-Du; Yang, Huai-Che

    2017-12-01

    OBJECTIVE Gamma Knife surgery (GKS) is a promising treatment modality for patients with vestibular schwannomas (VSs), but a small percentage of patients have persistent postradiosurgical tumor growth. The aim of this study was to determine the clinical and quantitative MRI features of VS as predictors of long-term tumor control after GKS. METHODS The authors performed a retrospective study of all patients with VS treated with GKS using the Leksell Gamma Knife Unit between 2005 and 2013 at their institution. A total of 187 patients who had a minimum of 24 months of clinical and radiological assessment after radiosurgery were included in this study. Those who underwent a craniotomy with tumor removal before and after GKS were excluded. Study patients comprised 85 (45.5%) males and 102 (54.5%) females, with a median age of 52.2 years (range 20.4-82.3 years). Tumor volumes, enhancing patterns, and apparent diffusion coefficient (ADC) values were measured by region of interest (ROI) analysis of the whole tumor by serial MRI before and after GKS. RESULTS The median follow-up period was 60.8 months (range 24-128.9 months), and the median treated tumor volume was 3.54 cm 3 (0.1-16.2 cm 3 ). At last follow-up, imaging studies indicated that 150 tumors (80.2%) showed decreased tumor volume, 20 (10.7%) had stabilized, and 17 (9.1%) continued to grow following radiosurgery. The postradiosurgical outcome was not significantly correlated with pretreatment volumes or postradiosurgical enhancing patterns. Tumors that showed regression within the initial 12 months following radiosurgery were more likely to have a larger volume reduction ratio at last follow-up than those that did not (volume reduction ratio 55% vs 23.6%, respectively; p < 0.001). Compared with solid VSs, cystic VSs were more likely to regress or stabilize in the initial postradiosurgical 6-12-month period and during extended follow-up. Cystic VSs exhibited a greater volume reduction ratio at last follow-up (cystic

  1. Image-guided stereotactic radiotherapy for patients with vestibular schwannoma. A clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Badakhshi, H.; Muellner, S.; Budach, V. [Charite School of Medicine and University Hospital of Berlin, Departments for Radiation Oncology, Berlin (Germany); Wiener, E. [School of Medicine and University Hospital of Berlin, Institute for Neuroradiology, Berlin (Germany)

    2014-06-15

    Local tumor control and functional outcome after linac-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for vestibular schwannoma (VS) were assessed. In all, 250 patients with VS were treated: 190 patients with tumors < 2 cm diameter underwent SRS and 60 patients with tumors >2 to 3.5 cm underwent FSRT. Dose prescription for all cases with SRS (n = 190, 76 %) was 13.5 Gy. For FSRT, mainly two hypofractionated schedules (n = 60, 24 %) with either 7 fractions of 5 Gy (total dose: 35 Gy; n = 35) or 11 fractions of 3.8 Gy (total dose: 41.8 Gy; n = 16) were used. The primary endpoint was local tumor control. Secondary endpoints were symptomatic control and morbidity. The median follow-up was 33.8 months. The 3-year local tumor control was 88.9 %. Local control for SRS and FSRT was 88 and 92 %, respectively. For FSRT with 35 and 41.8 Gy, local control was 90 and 100 %, respectively. There were no acute reactions exceeding grade I. In 61 cases (24.4 % of the entire cohort), trigeminal neuralgia was reported prior to treatment. At last follow-up, 16.3 % (10/61) of those patients reported relief of pain. Regarding facial nerve dysfunction, 45 patients (18 %) presented with symptoms prior to RT. At the last follow-up, 13.3% (6/45) of those patients reported a relief of dysesthesia. Using SRS to treat small VS results in good local control rates. FSRT for larger lesions also seems effective. Severe treatment-related complications are not frequent. Therefore, image-guided stereotactic radiotherapy is an appropriate alternative to microsurgery for patients with VS. (orig.) [German] Wir analysierten die lokale Kontrolle und die funktionellen Verlaeufe bei Patienten mit einem Vestibularisschwannom (VS), die sich einer linacbasierten stereotaktischen Radiochirurgie (SRS) oder einer fraktionierten stereotaktischen Radiotherapie (FSRT) unterzogen. Zwischen 1998 und 2008 wurden 250 Patienten mit einem VS behandelt. In dieser Kohorte wurden 190

  2. Combination Therapy with c-Met and Src Inhibitors Induces Caspase-Dependent Apoptosis of Merlin-Deficient Schwann Cells and Suppresses Growth of Schwannoma Cells.

    Science.gov (United States)

    Fuse, Marisa A; Plati, Stephani Klingeman; Burns, Sarah S; Dinh, Christine T; Bracho, Olena; Yan, Denise; Mittal, Rahul; Shen, Rulong; Soulakova, Julia N; Copik, Alicja J; Liu, Xue Zhong; Telischi, Fred F; Chang, Long-Sheng; Franco, Maria Clara; Fernandez-Valle, Cristina

    2017-11-01

    Neurofibromatosis type 2 (NF2) is a nervous system tumor disorder caused by inactivation of the merlin tumor suppressor encoded by the NF2 gene. Bilateral vestibular schwannomas are a diagnostic hallmark of NF2. Mainstream treatment options for NF2-associated tumors have been limited to surgery and radiotherapy; however, off-label uses of targeted molecular therapies are becoming increasingly common. Here, we investigated drugs targeting two kinases activated in NF2-associated schwannomas, c-Met and Src. We demonstrated that merlin-deficient mouse Schwann cells (MD-MSC) treated with the c-Met inhibitor, cabozantinib, or the Src kinase inhibitors, dasatinib and saracatinib, underwent a G 1 cell-cycle arrest. However, when MD-MSCs were treated with a combination of cabozantinib and saracatinib, they exhibited caspase-dependent apoptosis. The combination therapy also significantly reduced growth of MD-MSCs in an orthotopic allograft mouse model by greater than 80% of vehicle. Moreover, human vestibular schwannoma cells with NF2 mutations had a 40% decrease in cell viability when treated with cabozantinib and saracatinib together compared with the vehicle control. This study demonstrates that simultaneous inhibition of c-Met and Src signaling in MD-MSCs triggers apoptosis and reveals vulnerable pathways that could be exploited to develop NF2 therapies. Mol Cancer Ther; 16(11); 2387-98. ©2017 AACR . ©2017 American Association for Cancer Research.

  3. Profile of immune cells in lymph nodes draining human malignant tumors Perfil de las células inmunes en los ganglios linfáticos que drenan tumores malignos humanos

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    Wanda Di Girolamo

    2008-12-01

    Full Text Available The purpose of this study was to characterize and quantify cells involved in immune response in metastasis-free regional lymph nodes (RLNs draining different human epithelial tumors and compare them (by immunohistochemistry with control lymph nodes from patients with non malignant diseases. We showed that T cells number was decreased in RLNs as compared to the controls with reduction in both CD4+ T cells and CD8+ T cells subsets and an inverted ratio (CD4+: CD8+. B lymphocytes and follicular dendritic cells were decreased with respect to the controls. S100+ dendritic cells (DCs and mature DCs were detected in T dependent areas. Their mean number was significantly lower as compared to control. Immature DCs were significantly diminished compared to RLN and control nodes. CD57+ cells, follicular T helper cells and/or NK cells, were localized in the clear zone of germinal centres and their mean number was significantly increased. There were no CD57+ cells in hypoplastic follicles. In this study we show that RLNs draining human cancer present reduction in almost all immune cells, except CD57+ cells. These findings may be related to the deficient anti-tumor immune response in patients with cancer and subsequent tumor progression.El objetivo del trabajo fue caracterizar y cuantificar utilizando inmuno-histoquímica, las células involucradas en la respuesta inmune en ganglios linfáticos regionales (GLRs que drenan distintos tumores epiteliales malignos humanos y compararlas con ganglios controles (GLCs provenientes de pacientes sin enfermedad neoplásica maligna. Determinamos que los GLRs presentaban una marcada depleción de linfocitos B y T, células dendríticas (CD foliculares y CD interdigitantes maduras respecto a los controles. En los linfocitos T, además de estar disminuidos, se observó una inversión de la relación T CD4+: T CD8+, a favor de los T CD8+. La depleción de CD inmaduras fue mayor respecto a las maduras. Las células CD57+, c

  4. Melanoma maligno cutâneo: sistema de pontos (scoring system para auxílio no diagnóstico histopatológico Cutaneous malignant melanoma: scoring system to assist in the histopathologic diagnosis

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    Luiz Alberto Veronese

    2006-10-01

    Full Text Available INTRODUÇÃO: O diagnóstico histopatológico de algumas lesões melanocíticas pode ser muito difícil, mesmo para especialistas, mas há casos em que a dificuldade surge pela inadequada e subjetiva aplicação dos critérios diagnósticos. OBJETIVO: O objetivo deste estudo é desenvolver um método de aplicação sistemática desses critérios, atribuindo valores para os mais importantes. MATERIAL E MÉTODOS: Selecionaram-se os critérios mais relevantes para o diagnóstico de melanoma, atribuindo valores de 1 a 5 de acordo com sua importância. Foram escolhidos 101 casos de melanomas de tipo extensivo-superficial com menos de 2mm de espessura para análise comparativa com 33 lesões melanocíticas benignas (13 nevos de Spitz, seis de Reed, seis displásicos, três congênitos, três adquiridos, um combinado e um recorrente. RESULTADOS: A soma dos valores dados aos critérios (score apresentou diferença significativa entre lesões malignas e benignas, mostrando que esse método pode ser útil ao patologista cirúrgico generalista em sua rotina diária. CONCLUSÃO: A aplicação objetiva e sistemática dos critérios histopatológicos pelo sistema de pontos (scoring system pode ajudar o diagnóstico diferencial entre maligno e benigno em muitas lesões, porém não tendo o efeito desejado nas lesões melanocíticas de comportamento biológico indeterminado.INTRODUCTION: The histopathological diagnosis of melanocytic lesions may be very difficult, even by experts within the field. The challenge can come from inaccurate and/or subjective application of the diagnosis criteria. AIM: The goal of this study was to develop a method of systematic application of histopathological criteria as a result of the most relevant microscopic characteristics. MATERIAL AND METHODS: The most important criteria to diagnosing melanoma on histopathological bases were selected and given points ranging from 1 to 5 according to their relevance to the melanoma diagnosis

  5. Stereotactic radiotherapy of vestibular schwannoma. Hearing preservation, vestibular function, and local control following primary and salvage radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Putz, Florian; Mueller, Jan; Wimmer, Caterina; Goerig, Nicole; Knippen, Stefan; Semrau, Sabine; Fietkau, Rainer; Lettmaier, Sebastian [Friedrich-Alexander-University Erlangen-Nuremberg, Department of Radiation Oncology, Erlangen (Germany); Iro, Heinrich; Grundtner, Philipp [Friedrich-Alexander-University Erlangen-Nuremberg, Department of Otorhinolaryngology - Head and Neck Surgery, Erlangen (Germany); Eyuepoglu, Ilker; Roessler, Karl [Friedrich-Alexander-University Erlangen-Nuremberg, Department of Neurosurgery, Erlangen (Germany)

    2017-03-15

    The aim of this publication is to present long-term data on functional outcomes and tumor control in a cohort of 107 patients treated with stereotactic radiotherapy (RT) for vestibular schwannoma. Included were 107 patients with vestibular schwannoma (primary or recurrent following resection) treated with stereotactic RT (either fractioned or single-dose radiosurgery) between October 2002 and December 2013. Local control and functional outcomes were determined. Analysis of hearing preservation was limited to a subgroup of patients with complete audiometric data collected before treatment and during follow-up. Vestibular function test (FVT) results could be analyzed in a subset of patients and were compared to patient-reported dizziness. After a mean follow-up of 46.3 months, actuarial local control for the whole cohort was 100% after 2, 97.6% after 5, and 94.1% after 10 years. In patients with primary RT, serviceable hearing was preserved in 72%. Predictors for preservation of serviceable hearing in multivariate analysis were time of follow-up (odds ratio, OR = 0.93 per month; p = 0.021) and pre-RT tumor size (Koos stage I-IIa vs. IIb-IV; OR = 0.15; p = 0.031). Worsening of FVT results was recorded in 17.6% (N = 3). Profound discrepancy of patient-reported dizziness and FVT results was observed after RT. In patients with primary RT, worsening of facial nerve function occurred in 1.7% (N = 1). Stereotactic RT of vestibular schwannoma provides good functional outcomes and high control rates. Dependence of hearing preservation on time of follow-up and initial tumor stage has to be considered. (orig.) [German] Praesentation von Langzeitdaten zu funktionellen Ergebnissen und Tumorkontrolle nach stereotaktischer Radiotherapie (RT) in einer Kohorte von 107 Patienten mit Akustikusneurinom. Zwischen Oktober 2002 und Dezember 2013 wurden 107 Patienten mit Akustikusneurinom (primaer oder rezidiviert nach vorangegangener Resektion) mittels stereotaktischer RT behandelt

  6. Neurinoma del plexo braquial simulando metastasis de adenocarcinoma de mama Schwannoma of the brachial plexus resembling a breast adenocarcinoma metastasis

    Directory of Open Access Journals (Sweden)

    Gregorio Rodríguez Boto

    2011-10-01

    function. Histological findings indicated a schwannoma thus ruling out the presence of metastasis. The postoperative development was uneventful and six years after surgery, the patient is to date tumour-free. To the best of our knowledge, this is the first report of a brachial plexus schwannoma arising from the ulnar branch. Intraoperative electrophysiological monitoring is essential for a good surgical outcome.

  7. Long-term Auditory Symptoms in Patients With Sporadic Vestibular Schwannoma: An International Cross-Sectional Study.

    Science.gov (United States)

    Tveiten, Oystein Vesterli; Carlson, Matthew L; Goplen, Frederik; Vassbotn, Flemming; Link, Michael J; Lund-Johansen, Morten

    2015-08-01

    There are limited data on the long-term auditory symptoms in patients with sporadic small- and medium-sized vestibular schwannoma (VS). The initial treatment strategy for VS is controversial. To characterize auditory symptoms in a large cohort of patients with VS. Patients with ≤3 cm VS who underwent primary microsurgery, gamma knife surgery, or observation between 1998 and 2008 at 2 independent hospitals were identified. Clinical data were extracted from existing VS databases. At a mean time of 7.7 years after initial treatment, patients were surveyed via mail with the use of the Hearing Handicap Inventory for Adults (HHIA) and the Tinnitus Handicap Inventory. The response rate was 79%; a total of 539 respondents were analyzed. Overall, the hearing prognosis was poor, because more than 75% of all patients had nonserviceable hearing at the last clinical follow-up. Good baseline hearing proved to be a strong predictor for maintained serviceable hearing. Treatment modality was independently associated with both audiometric outcome and HHIA results. Active treatment with microsurgery or gamma knife surgery did not appear to be protective, because patients who were observed had the greatest probability of durable hearing. Patients in the surgical series had the greatest hearing loss. Tinnitus Handicap Inventory results were less predictable. The only predictors of tinnitus handicap were age and HHIA score. The overall prognosis for hearing in sporadic VS is poor regardless of treatment strategy. Treatment modality was an independent predictor of hearing status; observation was associated with the highest rate of hearing preservation. .

  8. Interthalamic hematoma secondary to cerebrovascular atherosclerosis in an aged grizzly bear (Ursus arctos horribilis) with primary cardiac schwannoma.

    Science.gov (United States)

    Miller, Andrew David; McDonough, Sean

    2008-12-01

    A 38-year-old intact female Grizzly bear (Ursus arctos horribilis) was evaluated for progressive seizure activity, pale mucous membranes, deficient pupillary light and menace responses, and irregular shallow respiration. Because of poor response to treatment, the animal was euthanized. Gross examination revealed abundant hemorrhage in both lateral ventricles; a large, encapsulated mass within the rostral interthalamic region; and a well-demarcated, round white mass in the apex of the right ventricle. Histologic examination of the interthalamic mass revealed a resolving hematoma composed of stratified layers of fibrin and white blood cells that was surrounded by a thick fibrous capsule. Most meningeal and intraparenchymal blood vessels had multifocal degeneration, fragmentation, and fraying of the internal elastic lamina with prominent intimal proliferations and plaques. The plaques were formed by small numbers of lipid-laden macrophages (foam cells) that were intermixed with occasional lymphocytes and plasma cells. The cardiac mass was composed of pallisading and interlacing spindle cells with parallel nuclei and abundant, pale eosinophilic cytoplasm consistent with a schwannoma.

  9. Hearing preservation in retrosigmoid approach of small vestibular schwannomas: prognostic value of the degree of internal auditory canal filling.

    Science.gov (United States)

    Tringali, Stéphane; Ferber-Viart, Chantal; Fuchsmann, Carine; Buiret, Guillaume; Zaouche, Sandra; Dubreuil, Christian

    2010-12-01

    To assess the contribution of preoperative radiologic appearance of vestibular schwannoma (VS) on the magnetic resonance imaging in constructive interference in steady-state sequences and demonstrate if the degree of the internal auditory canal (IAC) filling is correlated with hearing and facial preservation. A group of 278 patients who underwent VS surgery in a tertiary referral center. Retrosigmoid approach surgery. Patients were classified in 4 groups according to the percentage of IAC filling on the preoperative magnetic resonance imaging as Group IAC 1(IAC empty or filled filled from 25% to 50% with free fundus), Group IAC 3 (IAC filled from 50% to 75% with free fundus), and Group IAC 4 (complete filling of the IAC without fundus obliteration). A good correlation was observed between the IAC classification and the rate of hearing and facial preservation. The global rate of postoperative facial palsy was 10.4%. The global rate of hearing preservation in 213 patients with preoperative hearing class A and B was 40.8%. Regression analysis showed that the degree of lateral extension of the VS in the IAC was a strong predictor of hearing preservation ( p facial outcomes in selected patients with possible hearing preservation. In case of patient with small tumor and IAC empty or filled less than 75% and with free fundus, surgery is the treatment of choice for patients with serviceable hearing and the desire to retain it.

  10. Correlation of bacterial viability with uptake of (14C) acetate into phenolic glycolipid-1 of Mycobacterium leprae within Schwannoma cells

    International Nuclear Information System (INIS)

    Mistry, Y.; Antia, N.H.; Mukherjee, R.

    1989-01-01

    The viability of Mycobacterium leprae, maintained within 33B Schwannoma cells, was estimated in terms of incorporation of ( 14 C) acetate into its specific phenolic glycolipid-1. This measure of viability was correlated with two other assays, viz., fluorescein diacetate/ethidium bromide staining and mouse footpad growth. Observation of a 2-fold increase in the number of intracellular Mycobacterium leprae over an experimental period of 12 days also corroborated this contention. Furthermore, on addition of anti-leprosy drugs to these intracellular Mycobacterium leprae there was significant decrease in phenolic glycolipid-1 synthesis indicative of loss of viability of the organisms. This study also established the importance of the host cell for active bacillary metabolism, as Mycobacterium leprae maintained in cell-free conditions showed no incorporation into phenolic glycolipid-1. Moreover, compromising the host's protein synthesis capacity with cycloheximide, also led to reduction in bacillary metabolism. As this system measures the metabolic synthesis of a unique Mycobacterium leprae component, it would be useful for development and screening of compounds acting against specific bacillary targets. (author). 19 refs., 5 tabs

  11. Increased signal intensity of the cochlea on pre- and post-contrast enhanced 3D-FLAIR in patients with vestibular schwannoma

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Masahiro; Naganawa, Shinji; Kawai, Hisashi; Nihashi, Takashi [Nagoya University, Department of Radiology, Graduate School of Medicine, Nagoya (Japan); Fukatsu, Hiroshi [Aichi Medical University Hospital, Department of Medical Informatics, Nagakute (Japan); Nakashima, Tsutomu [Nagoya University, Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya (Japan)

    2009-12-15

    In the vestibular schwannoma patients, the pathophysiologic mechanism of inner ear involvement is still unclear. We investigated the status of the cochleae in patients with vestibular schwannoma by evaluating the signal intensity of cochlear fluid on pre- and post-contrast enhanced thin section three-dimensional fluid-attenuated inversion recovery (3D-FLAIR). Twenty-eight patients were retrospectively analyzed. Post-contrast images were obtained in 18 patients, and 20 patients had the records of their pure-tone audiometry. Regions of interest of both cochleae (C) and of the medulla oblongata (M) were determined on 3D-FLAIR images by referring to 3D heavily T2-weighted images on a workstation. The signal intensity ratio between C and M on the 3D-FLAIR images (CM ratio) was then evaluated. In addition, correlation between the CM ratio and the hearing level was also evaluated. The CM ratio of the affected side was significantly higher than that of the unaffected side (p < 0.001). In the affected side, post-contrast signal elevation was observed (p < 0.005). In 13 patients (26 cochleae) who underwent both gadolinium injection and the pure-tone audiometry, the post-contrast CM ratio correlated with hearing level (p < 0.05). The results of the present study suggest that alteration of cochlear fluid composition and increased permeability of the blood-labyrinthine barrier exist in the affected side in patients with vestibular schwannoma. Furthermore, although weak, positive correlation between post-contrast cochlear signal intensity on 3D-FLAIR and hearing level warrants further study to clarify the relationship between 3D-FLAIR findings and prognosis of hearing preservation surgery. (orig.)

  12. Increased signal intensity of the cochlea on pre- and post-contrast enhanced 3D-FLAIR in patients with vestibular schwannoma

    International Nuclear Information System (INIS)

    Yamazaki, Masahiro; Naganawa, Shinji; Kawai, Hisashi; Nihashi, Takashi; Fukatsu, Hiroshi; Nakashima, Tsutomu

    2009-01-01

    In the vestibular schwannoma patients, the pathophysiologic mechanism of inner ear involvement is still unclear. We investigated the status of the cochleae in patients with vestibular schwannoma by evaluating the signal intensity of cochlear fluid on pre- and post-contrast enhanced thin section three-dimensional fluid-attenuated inversion recovery (3D-FLAIR). Twenty-eight patients were retrospectively analyzed. Post-contrast images were obtained in 18 patients, and 20 patients had the records of their pure-tone audiometry. Regions of interest of both cochleae (C) and of the medulla oblongata (M) were determined on 3D-FLAIR images by referring to 3D heavily T2-weighted images on a workstation. The signal intensity ratio between C and M on the 3D-FLAIR images (CM ratio) was then evaluated. In addition, correlation between the CM ratio and the hearing level was also evaluated. The CM ratio of the affected side was significantly higher than that of the unaffected side (p < 0.001). In the affected side, post-contrast signal elevation was observed (p < 0.005). In 13 patients (26 cochleae) who underwent both gadolinium injection and the pure-tone audiometry, the post-contrast CM ratio correlated with hearing level (p < 0.05). The results of the present study suggest that alteration of cochlear fluid composition and increased permeability of the blood-labyrinthine barrier exist in the affected side in patients with vestibular schwannoma. Furthermore, although weak, positive correlation between post-contrast cochlear signal intensity on 3D-FLAIR and hearing level warrants further study to clarify the relationship between 3D-FLAIR findings and prognosis of hearing preservation surgery. (orig.)

  13. Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study.

    Science.gov (United States)

    Carlson, Matthew L; Tveiten, Øystein Vesterli; Driscoll, Colin L; Boes, Christopher J; Sullan, Molly J; Goplen, Frederik K; Lund-Johansen, Morten; Link, Michael J

    2015-11-01

    The primary goals of this study were: 1) to examine the influence of disease and treatment on headache in patients with sporadic vestibular schwannoma (VS); and 2) to identify clinical predictors of long-term headache disability. This was a cross-sectional observational study with international multicenter enrollment. Patients included those with primary sporadic Headache Disability Inventory (HDI), the Hospital Anxiety and Depression Scale, and a VS symptom questionnaire. The main outcome measures were univariate and multivariable associations with HDI total score. The overall survey response rate was 79%. Data from 538 patients with VS were analyzed. The mean age at time of survey was 64 years, 56% of patients were female, and the average duration between treatment and survey was 7.7 years. Twenty-seven percent of patients received microsurgery, 46% stereotactic radiosurgery, and 28% observation. Patients with VS who were managed with observation were more than twice as likely to have severe headache disability compared with 103 control subjects without VS. When accounting for baseline differences, there was no statistically significant difference in HDI outcome between treatment modalities at time of survey. Similarly, among the microsurgery cohort, the long-term risk of severe headache disability was not different between surgical approaches. Multivariable regression demonstrated that younger age, greater anxiety and depression, and a preexisting diagnosis of headache were the primary predictors of severe long-term headache disability, while tumor size and treatment modality had little influence. At a mean of almost 8 years following treatment, approximately half of patients with VS experience headaches of varying frequency and severity. Patient-driven factors including age, sex, mental health, and preexisting headache syndrome are the strongest predictors of long-term severe headache disability. Tumor size and treatment modality have less impact. These data

  14. Early Radiosurgery Improves Hearing Preservation in Vestibular Schwannoma Patients With Normal Hearing at the Time of Diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Akpinar, Berkcan [University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States); Mousavi, Seyed H., E-mail: mousavish@upmc.edu [Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); McDowell, Michael M.; Niranjan, Ajay; Faraji, Amir H. [Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Flickinger, John C. [Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Lunsford, L. Dade [Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States)

    2016-06-01

    Purpose: Vestibular schwannomas (VS) are increasingly diagnosed in patients with normal hearing because of advances in magnetic resonance imaging. We sought to evaluate whether stereotactic radiosurgery (SRS) performed earlier after diagnosis improved long-term hearing preservation in this population. Methods and Materials: We queried our quality assessment registry and found the records of 1134 acoustic neuroma patients who underwent SRS during a 15-year period (1997-2011). We identified 88 patients who had VS but normal hearing with no subjective hearing loss at the time of diagnosis. All patients were Gardner-Robertson (GR) class I at the time of SRS. Fifty-seven patients underwent early (≤2 years from diagnosis) SRS and 31 patients underwent late (>2 years after diagnosis) SRS. At a median follow-up time of 75 months, we evaluated patient outcomes. Results: Tumor control rates (decreased or stable in size) were similar in the early (95%) and late (90%) treatment groups (P=.73). Patients in the early treatment group retained serviceable (GR class I/II) hearing and normal (GR class I) hearing longer than did patients in the late treatment group (serviceable hearing, P=.006; normal hearing, P<.0001, respectively). At 5 years after SRS, an estimated 88% of the early treatment group retained serviceable hearing and 77% retained normal hearing, compared with 55% with serviceable hearing and 33% with normal hearing in the late treatment group. Conclusions: SRS within 2 years after diagnosis of VS in normal hearing patients resulted in improved retention of all hearing measures compared with later SRS.

  15. Perfusion magnetic resonance imaging provides additional information as compared to anatomical imaging for decision-making in vestibular schwannoma

    International Nuclear Information System (INIS)

    Kleijwegt, M.C.; Mey, A.G.L. van der; Wiggers-deBruine, F.T.; Malessy, M.J.A; Osch, M.J.P. van

    2016-01-01

    •DSC/ASL-MRI can be acquired in growing VS with sufficient image quality.•In most patients DSC and ASL techniques provide similar qualitative scores.•These techniques can be of importance in future decision-making. DSC/ASL-MRI can be acquired in growing VS with sufficient image quality. In most patients DSC and ASL techniques provide similar qualitative scores. These techniques can be of importance in future decision-making. The added value of perfusion MRI for decision-making in vestibular schwannoma (VS) patients is unknown. MRI offers two perfusion methods: the first employing contrast agent (dynamic susceptibility contrast (DSC)-MRI) that provides information on cerebral blood volume (CBV) and cerebral blood flow (CBF), the second by magnetic labeling of blood (arterial spin labeling (ASL)-MRI), providing CBF-images. The goal of the current study is to investigate whether DSC and ASL perfusion MRI provides complimentary information to current anatomical imaging in treatment selection process of VS. Nine patients with growing VS with extrameatal diameter >9 mm were included (>2 mm/year and 20% volume expansion/year) and one patient with 23 mm extrameatal VS without growth. DSC and ASL perfusion MRI were obtained on 3 T MRI. Perfusion in VS was scored as hyperintense, hypointense or isointense compared to the contralateral region. Seven patients showed hyperintense signal on DSC and ASL sequences. Three patients showed iso- or hypointense signal on at least one perfusion map (1 patient hypointense on both DSC-MRI and ASL; 1 patient isointense on DSC-CBF; 1 patient isointense on ASL). All patients showed enhancement on post-contrast T1 anatomical scan. Perfusion MR provides additional information compared to anatomical imaging for decision-making in VS

  16. Intraoperative cochlear nerve mapping with the mobile cochlear nerve compound action potential tracer in vestibular schwannoma surgery.

    Science.gov (United States)

    Watanabe, Nobuyuki; Ishii, Takuya; Fujitsu, Kazuhiko; Kaku, Shogo; Ichikawa, Teruo; Miyahara, Kosuke; Okada, Tomu; Tanino, Shin; Uriu, Yasuhiro; Murayama, Yuichi

    2018-05-18

    OBJECTIVE The authors describe the usefulness and limitations of the cochlear nerve compound action potential (CNAP) mobile tracer (MCT) that they developed to aid in cochlear nerve mapping during vestibular schwannoma surgery (VSS) for hearing preservation. METHODS This MCT device requires no more than 2 seconds for stable placement on the nerve to obtain the CNAP and thus is able to trace the cochlear nerve instantaneously. Simultaneous bipolar and monopolar recording is possible. The authors present the outcomes of 18 consecutive patients who underwent preoperative useful hearing (defined as class I or II of the Gardner-Robertson classification system) and underwent hearing-preservation VSS with the use of the MCT. Mapping was considered successful when it was possible to detect and trace the cochlear nerve. RESULTS Mapping of the cochlear nerve was successful in 13 of 18 patients (72.2%), and useful hearing was preserved in 11 patients (61.1%). Among 8 patients with large tumors (Koos grade 3 or 4), the rate of successful mapping was 62.5% (5 patients). The rate of hearing preservation in patients with large tumors was 50% (4 patients). CONCLUSIONS In addition to microsurgical presumption of the arrangement of each nerve, frequent probing on and around an unidentified nerve and comparison of each waveform are advisable with the use of both more sensitive monopolar and more location-specific bipolar MCT. MCT proved to be useful in cochlear nerve mapping and may consequently be helpful in hearing preservation. The authors discuss some limitations and problems with this device.

  17. Superiority of resection over enucleation for schwannomas of the cervical vagus nerve: A retrospective cohort study of 22 consecutive patients.

    Science.gov (United States)

    Illuminati, Giulio; Pizzardi, Giulia; Minni, Antonio; Masci, Federica; Ciamberlano, Bernardo; Pasqua, Rocco; Calio, Francesco G; Vietri, Francesco

    2016-05-01

    Schwannoma of the cervical vagus nerve is rare. Treatment options include intracapsular enucleation and en bloc resection. The purpose of this study was to compare the outcomes of enucleation and resection in terms of postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence, quality-adjusted life-year (QALY) and vocal handicap index (VHI). Twentytwo consecutive patients were divided into two groups. Patients in group A (n = 9) underwent intracapsular enucleation, whereas patients in Group B (n = 13) underwent en bloc resection. Main endpoints of the study were postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence and quality of life. The quality of life after surgery was assessed according to the quality-adjusted life-year (QALY) EQ-5D-5L methodology, and calculation of the voice handicap index (VHI). Postoperative mortality was nil. Morbidity included 1 wound dehiscence in group A and 2 transitory dysphagias in group B. Freedom from vocal cord palsy was 22% in group A and zero in group B (p = 0.15). Operation-specific local recurrence rate was 33% (3/9 patients) in group A and nil in group B (0/23 patients) (p = 0.05). QALYs was 0.55 in group A and 0.54 in group B (p = 1.0). VHI was 23.77 in group A and 26.15 in group B (p = 1.00). Resection is superior to enucleation in terms of freedom from local recurrence. Functional results are comparable for both techniques. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Quality of life after gamma knife radiosurgery treatment in patients with a vestibular schwannoma: the patient’s perspective

    Science.gov (United States)

    van Haren, Anniek E. P.; Mulder, Jef J. S.; Hanssens, Patrick E. J.; van Overbeeke, Jacobus J.; Cremers, Cor W. R. J.; Graamans, Kees

    2009-01-01

    This study evaluates the impact of gamma knife radiosurgery (GKRS) on the quality of life (QOL) of patients with a sporadic vestibular schwannoma (VS). This study pertains to 108 VS patients who had GKRS in the years 2003 through 2007. Two different QOL questionnaires were used: medical outcome study short form 36 (SF36) and Glasgow benefit inventory (GBI). Radiosurgery was performed using a Leksell 4C gamma knife. The results of the QOL questionnaires in relation to prospectively and retrospectively gathered data of the VS patients treated by GKRS. Eventually, 97 patients could be included in the study. Their mean tumor size was 17 mm (range 6–39 mm); the mean maximum dose on the tumor was 19.9 Gy (range 16–25.5 Gy) and the mean marginal dose on the tumor was 11.1 (range 9.3–12.5 Gy). SF36 scores showed results comparable to those for a normal Dutch population. GBI showed a marginal decline in QOL. No correlation was found between QOL and gender, age, tumor size, or radiation dose. Increased audiovestibular symptoms after GKRS were correlated with a decreased GBI score, and decreased symptoms were correlated with a higher QOL post-GKRS. In this study shows that GKRS for VS has little impact on the general QOL of the VS patient. However, there is a wide range in individual QOL results. Individual QOL was influenced by the audiovestibular symptoms. No predictive patient, tumor, or treatment factors for QOL outcome after GKRS could be determined. Comparison with microsurgery is difficult because of intra group variability. PMID:19894058

  19. Fractionated stereotactic radiotherapy for vestibular schwannoma (VS): Comparison between cystic-type and solid-type VS

    International Nuclear Information System (INIS)

    Shirato, Hiroki; Sakamoto, Touru; Takeichi, Norihito; Aoyama, Hidefumi; Suzuki, Keishiro; Kagei, Kenji; Nishioka, Takashi; Fukuda, Satoshi; Sawamura, Yutaka; Miyasaka, Kazuo

    2000-01-01

    Purpose: To compare the effectiveness and complications of fractionated stereotactic radiotherapy (SRT) for cystic-type vestibular schwannoma (VS) with those of solid-type VS. Methods and Materials: In 65 patients treated with fractionated SRT between 1991 and 1999, 20 were diagnosed with cystic VS, in which at least one-third of the tumor volume was a cystic component on magnetic resonance imaging (MRI), and 45 were diagnosed with solid VS. Thirty-six Gy to 50 Gy in 20-25 fractions was administered to the isocenter and approximately 80% of the periphery of the tumor. All cystic and solid components were included in the gross tumor volume. The mean follow-up period was 37 months, ranging from 6 to 97 months. Results: The actuarial 3-year rate of no episode of enlargement greater than 2.0 mm was 55% for cystic-type and 75% for solid-type VS; the difference was statistically significant (p 0.023). The actuarial 3-year tumor-reduction (reduction in tumor size greater than 2.0 mm) rates were 93% and 31%, respectively (p = 0.0006). The overall actuarial tumor control rate (no tumor growth greater than 2.0 mm after 2 years or no requirement of salvage surgery) was 92% at 5 years in 44 patients with a follow-up period of 2 or more years. There was no difference in the class hearing preservation rate between cystic VS and solid VS. No permanent trigeminal or facial nerve palsy was observed in either group. Conclusion: Transient tumor enlargement occurs in cystic VS more frequently than in solid-type VS, but the subsequent tumor-reduction rate in cystic VS is better.

  20. Phase II study of everolimus in children and adults with neurofibromatosis type 2 and progressive vestibular schwannomas

    Science.gov (United States)

    Karajannis, Matthias A.; Legault, Geneviève; Hagiwara, Mari; Giancotti, Filippo G.; Filatov, Alexander; Derman, Anna; Hochman, Tsivia; Goldberg, Judith D.; Vega, Emilio; Wisoff, Jeffrey H.; Golfinos, John G.; Merkelson, Amanda; Roland, J. Thomas; Allen, Jeffrey C.

    2014-01-01

    Background Activation of the mammalian target of rapamycin (mTOR) signaling pathway is thought to be a key driver of tumor growth in Merlin (NF2)-deficient tumors. Everolimus is an oral inhibitor of mTOR complex 1 (mTORC1) with antitumor activity in a variety of cancers. Methods We conducted a single-institution, prospective, 2-stage, open-label phase II study to estimate the response rate to everolimus in neurofibromatosis type 2 (NF2) patients with progressive vestibular schwannoma (VS). Ten eligible patients were enrolled, including 2 pediatric patients. Everolimus was administered at a daily dose of 10 mg (adults) or 5 mg/m2/day (children <18 y) orally in continuous 28-day courses, for up to 12 courses. Response was assessed every 3 months with MRI, using 3-dimensional volumetric tumor analysis, and audiograms. Nine patients were evaluable for the primary response, defined as ≥15% decrease in VS volume. Hearing response was evaluable as a secondary endpoint in 8 patients. Results None of the 9 patients with evaluable disease experienced a clinical or MRI response. No objective imaging or hearing responses were observed in stage 1 of the trial, and the study was closed according to predefined stopping rules. Conclusion Everolimus is ineffective for the treatment of progressive VS in NF2 patients. We are currently conducting a pharmacokinetic/pharmacodynamic (“phase 0”) study of everolimus in presurgical VS patients to elucidate the biological basis for apparent treatment resistance to mTORC1 inhibition in these tumors. PMID:24311643

  1. 3D quantitative assessment of response to fractionated stereotactic radiotherapy and single-session stereotactic radiosurgery of vestibular schwannoma

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, T. [The Johns Hopkins Hospital School of Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, Baltimore, MD (United States); University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg (Germany); Chapiro, J. [The Johns Hopkins Hospital School of Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Interventional Radiology, Baltimore, MD (United States); Lin, M. [Philips Research North America, Ultrasound Imaging and Interventions (UII), Briarcliff Manor, NY (United States); Geschwind, J.F. [The Johns Hopkins Hospital School of Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Interventional Radiology, Baltimore, MD (United States); Yale University School of Medicine, Department of Radiology and Imaging Science, New Haven, CT (United States); Kleinberg, L. [The Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (United States); Rigamonti, D.; Jusue-Torres, I.; Marciscano, A.E. [The Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD (United States); Yousem, D.M. [The Johns Hopkins Hospital School of Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, Baltimore, MD (United States)

    2016-03-15

    To determine clinical outcome of patients with vestibular schwannoma (VS) after treatment with fractionated stereotactic radiotherapy (FSRT) and single-session stereotactic radiosurgery (SRS) by using 3D quantitative response assessment on MRI. This retrospective analysis included 162 patients who underwent radiation therapy for sporadic VS. Measurements on T1-weighted contrast-enhanced MRI (in 2-year post-therapy intervals: 0-2, 2-4, 4-6, 6-8, 8-10, 10-12 years) were taken for total tumour volume (TTV) and enhancing tumour volume (ETV) based on a semi-automated technique. Patients were considered non-responders (NRs) if they required subsequent microsurgical resection or developed radiological progression and tumour-related symptoms. Median follow-up was 4.1 years (range: 0.4-12.0). TTV and ETV decreased for both the FSRT and SRS groups. However, only the FSRT group achieved significant tumour shrinkage (p < 0.015 for TTV, p < 0.005 for ETV over time). The 11 NRs showed proportionally greater TTV (median TTV pre-treatment: 0.61 cm{sup 3}, 8-10 years after: 1.77 cm{sup 3}) and ETV despite radiation therapy compared to responders (median TTV pre-treatment: 1.06 cm{sup 3}; 10-12 years after: 0.81 cm{sup 3}; p = 0.001). 3D quantification of VS showed a significant decrease in TTV and ETV on FSRT-treated patients only. NR had significantly greater TTV and ETV over time. (orig.)

  2. Long-term Hearing Preservation After Resection of Vestibular Schwannoma: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Ahsan, Syed F; Huq, Farhan; Seidman, Michael; Taylor, Andrew

    2017-12-01

    The objective is to perform a systematic review and meta-analysis of the literature on the long-term results of hearing preservation after vestibular schwannoma resection. Ovid/Medline, PubMed, Embase, and the Cochrane library from January 1980 to January 2015. Inclusion criteria: age ≥18 years, minimum 10 patients in the treatment group, hearing preserving microsurgery, no previous radiation treatment, serviceable hearing at immediate postop follow-up, hearing outcomes reported using Gardner Robinson or the American Academy of Otolaryngology-Head and Neck Surgeons hearing grading scales, and average follow-up of 5 years. Preoperative, immediate postoperative, and last follow-up audiograms were required. Exclusion criteria included neurofibromatosis type 2 patients and surgery for salvage therapy or decompression. Quality evaluated using Methodological Index for Non-Randomized Studies. Meta-analysis was performed using R v3.2.2, Metafor package v 1.9-7. Cohen's D was used to determine effect size. Ten reports had at least 5-year follow-up and used standardized hearing grading scales. The systematic review found that if hearing was preserved at Class A or B at early postop visit, the chance of preserving hearing at 5 years was excellent. Those who maintained speech discrimination score ≥ 89% at the early postoperative follow-up had better long-term hearing preservation. The meta-analysis reveals that only preoperative and postoperative pure-tone average was associated with long-term hearing preservation. Long-term (>5 yr) hearing durability rates are generally very good. Most studies do not report patient and tumor characteristics, therefore precluding combining studies for meta-analysis. Only preoperative and postoperative postoperative pure-tone average was associated with long-term hearing durability.

  3. Early Radiosurgery Improves Hearing Preservation in Vestibular Schwannoma Patients With Normal Hearing at the Time of Diagnosis

    International Nuclear Information System (INIS)

    Akpinar, Berkcan; Mousavi, Seyed H.; McDowell, Michael M.; Niranjan, Ajay; Faraji, Amir H.; Flickinger, John C.; Lunsford, L. Dade

    2016-01-01

    Purpose: Vestibular schwannomas (VS) are increasingly diagnosed in patients with normal hearing because of advances in magnetic resonance imaging. We sought to evaluate whether stereotactic radiosurgery (SRS) performed earlier after diagnosis improved long-term hearing preservation in this population. Methods and Materials: We queried our quality assessment registry and found the records of 1134 acoustic neuroma patients who underwent SRS during a 15-year period (1997-2011). We identified 88 patients who had VS but normal hearing with no subjective hearing loss at the time of diagnosis. All patients were Gardner-Robertson (GR) class I at the time of SRS. Fifty-seven patients underwent early (≤2 years from diagnosis) SRS and 31 patients underwent late (>2 years after diagnosis) SRS. At a median follow-up time of 75 months, we evaluated patient outcomes. Results: Tumor control rates (decreased or stable in size) were similar in the early (95%) and late (90%) treatment groups (P=.73). Patients in the early treatment group retained serviceable (GR class I/II) hearing and normal (GR class I) hearing longer than did patients in the late treatment group (serviceable hearing, P=.006; normal hearing, P<.0001, respectively). At 5 years after SRS, an estimated 88% of the early treatment group retained serviceable hearing and 77% retained normal hearing, compared with 55% with serviceable hearing and 33% with normal hearing in the late treatment group. Conclusions: SRS within 2 years after diagnosis of VS in normal hearing patients resulted in improved retention of all hearing measures compared with later SRS.

  4. PREHAB vs. REHAB - presurgical treatment in vestibular schwannoma surgery enhances recovery of postural control better than postoperative rehabilitation: Retrospective case series.

    Science.gov (United States)

    Tjernström, Fredrik; Fransson, Per-Anders; Kahlon, Babar; Karlberg, Mikael; Lindberg, Sven; Siesjö, Peter; Magnusson, Måns

    2018-01-01

    To evaluate post-surgical postural stability when treating patients with remaining vestibular function with intratympanic gentamicin (PREHAB) prior to schwannoma surgery. 44 consecutive patients with some form remaining vestibular function scheduled for vestibular schwannoma surgery. 20 were medically deafferented with intratympanic gentamicin before surgery and 24 were not. Both groups were of the same age, had the same tumor size, same type of surgery, and same perioperative sensory rehabilitation (training exercises), and no surgical complications. Postural stability measured as energy expenditure while standing on a force platform during vibratory stimulation of the calf muscles, performed prior to surgery (or gentamicin treatment) and 6 months after surgery. Patients pretreated with gentamicin had significantly better postural stability at the time for follow-up (p postural challenge (p control their stability (p postural control system benefited from a better short-term (adaptation) and long-term (habituation) recovery, when experiencing a postural challenge or resolving a sensory conflict. The benefits could be attributed to; active and continuous motor learning as the vestibular function slowly attenuates; no concomitant central nervous dysfunction due to effects from neurosurgery, thus allowing time for a separate unimpeded recovery process with more limited challenges and objectives; and the initiation and certain progression of sensory reweighting processes allowed prior to surgery. In contrast, worse compensation could be due to; immobilization from nausea after surgery, harmful amount of stress and cognitive dysfunction from the combination of surgical and sensory trauma and an abrupt vestibular deafferentation and its consequences on sensory reweighting.

  5. Comparison of contrast-enhanced T1-weighted and 3D constructive interference in steady state images for predicting outcome after hearing-preservation surgery for vestibular schwannoma

    Energy Technology Data Exchange (ETDEWEB)

    Kocaoglu, M.; Bulakbasi, N.; Ucoz, T.; Ustunsoz, B.; Tayfun, C.; Somuncu, I. [GATA Department of Radiology, 06018, Etlik, Ankara (Turkey); Pabuscu, Y. [Department of Radiology, Celal Bayar University, Manisa (Turkey)

    2003-07-01

    We compared contrast-enhanced T1-weighted and 3D constructive interference in steady state (CISS) sequences for demonstrating possible prognostic factors in hearing-preservation surgery for vestibular schwannoma. We studied 22 patients with vestibular schwannomas having hearing-preservation surgery. Postoperatively six (27%) had a facial palsy and eight (36%) had hearing loss. There was a significant correlation between the size of the tumour and facial palsy (r=-0.72). Both techniques adequately demonstrated all tumours. Involvement of the fundus of the internal auditory canal (IAC) and a small distance between the lateral border of the tumour and the fundus were correlated significantly with hearing loss (r=-0.81 and -0.75, respectively). The 3D-CISS sequence, by virtue of its high contrast resolution was superior to T1-weighted images (P<0.05) for detection of the fundal involvement. The direction of displacement of the facial nerve did not correlate with facial palsy or hearing loss. We think that 3D-CISS images better show the features influencing surgical outcome, but that contrast-enhanced T1-weighted images are required for diagnosis. (orig.)

  6. Comparison of contrast-enhanced T1-weighted and 3D constructive interference in steady state images for predicting outcome after hearing-preservation surgery for vestibular schwannoma

    International Nuclear Information System (INIS)

    Kocaoglu, M.; Bulakbasi, N.; Ucoz, T.; Ustunsoz, B.; Tayfun, C.; Somuncu, I.; Pabuscu, Y.

    2003-01-01

    We compared contrast-enhanced T1-weighted and 3D constructive interference in steady state (CISS) sequences for demonstrating possible prognostic factors in hearing-preservation surgery for vestibular schwannoma. We studied 22 patients with vestibular schwannomas having hearing-preservation surgery. Postoperatively six (27%) had a facial palsy and eight (36%) had hearing loss. There was a significant correlation between the size of the tumour and facial palsy (r=-0.72). Both techniques adequately demonstrated all tumours. Involvement of the fundus of the internal auditory canal (IAC) and a small distance between the lateral border of the tumour and the fundus were correlated significantly with hearing loss (r=-0.81 and -0.75, respectively). The 3D-CISS sequence, by virtue of its high contrast resolution was superior to T1-weighted images (P<0.05) for detection of the fundal involvement. The direction of displacement of the facial nerve did not correlate with facial palsy or hearing loss. We think that 3D-CISS images better show the features influencing surgical outcome, but that contrast-enhanced T1-weighted images are required for diagnosis. (orig.)

  7. Timomas malignos: A experiência do IPO do Porto e revisão da literatura Malignant thymomas: The experience of the Portuguese Oncological Institute, Porto, and literature review

    Directory of Open Access Journals (Sweden)

    Berta Sousa

    2007-07-01

    Full Text Available Introdução: Os tumores epiteliais tímicos (TET, a maioria timomas, são neoplasias desenvolvidas a partir das células epiteliais do timo e constituem cerca de 30% das massas do mediastino anterior em adultos. Os timomas são constituídos por células sem características citológicas de malignidade, sendo o comportamento maligno determinado pela invasão da cápsula e estruturas adjacentes. Estes tumores apresentam um amplo espectro de características clínicas e morfológicas, e as pequenas séries de doentes conhecidas tornam difícil o estabelecimento de um tratamento standard. Material e métodos: Efectuou-se um estudo retrospectivo dos doentes admitidos com diagnóstico de timoma no Instituto Português de Oncologia - Centro do Porto (IPO-Porto, de 1983 a 2004. Foram analisadas as suas características clínicas, classificação histológica segundo a OMS, o estadiamento de Masaoka, e a sua relação com as modalidades de tratamento. Procedeu-se à revisão dos registos clínicos destes doentes e revisão do material histológico para a classificação segundo critérios da OMS de 1999. Resultados: No IPO-Porto, entre 1983 e 2004, foram tratados 28 doentes com TET. Destes, 21 eram timomas invasivos, sendo estes o objecto deste estudo. Dos dados demográficos salienta-se que eram 11 homens, 10 mulheres, com uma idade mediana de 55 anos (24-79 anos. A classificação histológica da OMS foi a seguinte: 2 doentes (9,5% Tipo A, 6 (28,6% tipo AB, 4 (19% tipo B1, 2 (9,5% tipo B2, 7 (33,4% tipo B3. O estadiamento segundo Masaoka foi 9 doentes (42,8% com estádio II, 6 (28,6% com estádio III e 6 (28,6% com estádio IVa. A maioria dos doentes apresentava sintomas locais à apresentação, com apenas 1 doente com diagnóstico de aplasia eritrocitária e 5 com Mastenia gravis (MG. Os 6 doentes submetidos apenas a ressecção cirúrgica completa não tiveram evidência de recorrência da doença (2 tipo A-II, 2 tipo AB-II, 1 tipo B1-II, 1 tipo B

  8. Epithelioid schwannoma of the skin displaying unique histopathological features: a teaching case giving rise to diagnostic difficulties on a morphological examination of a resected specimen, with a brief literature review.

    Science.gov (United States)

    Yamada, Sohsuke; Kirishima, Mari; Hiraki, Tsubasa; Higashi, Michiyo; Hatanaka, Kazuhito; Tanimoto, Akihide

    2017-01-19

    Epithelioid schwannoma as a rare variant poses a challenge to all pathologists, as this uncommon entity is extremely difficult to conclusively diagnose by morphological analyses on a resected sample alone owing to its unique histopathological features. However, few papers have described the detailed clinicopathological characteristics of epithelioid schwannoma. A 65-year-old female presented with a history of a flat and slightly elevated firm and tan plaque accompanied by occasional tenderness, measuring 10 × 8 mm, in the right joint of her hand 1 year before resection. A gross examination of a locally resected specimen revealed an encapsulated nodular lesion, yellow-whitish in color, partly filled with blood. A microscopic examination showed that the tumor predominantly consisted of a solid proliferation of epithelioid cells having mildly enlarged and round to partially spindled nuclei and abundant vacuolated or clear cytoplasm with very few mitotic figures and modest nuclear size variation, associated with focal hyalinized, cystic and hemorrhagic degeneration. This well-demarcated tumor was surrounded by dense, hyalinized and layered fibrocollagenous stroma. Immunohistochemically, these tumor cells were diffusely positive for S-100 protein and had a very low MIB-1 labeling index, and type IV collagen was strongly reactive with reduplicated basal lamina of them. We ultimately made a diagnosis of cutaneous epithelioid schwannoma. We should be aware that, since pathologists might misinterpret epithelioid schwannoma as other soft tissue tumors, including its malignant counterpart, a wide panel of immunohistochemical antibodies can be powerful supplementary tools for identifying a very rare entity of conventional schwannoma.

  9. WE-F-304-04: Radiosurgery for Vestibular Schwannomas: Tumor Control Probability Analyses and Recommended Reporting Standards

    Energy Technology Data Exchange (ETDEWEB)

    Soltys, S. [Stanford Univ. (United States)

    2015-06-15

    in explaining the results of hypofractionated RT Describe the dose/volume metrics that are considered safe in SBRT treatment of tumors near the optic structures. Discuss the efficacy of hypofractionation and dosing schedules used in treating vestibular schwannomas Identify some difficulties in modeling TCP and NTCP for cranial tumors treated with hypofractionation. One moderator, Dr. Grimm, designed and holds intellectual property rights to the DVH Evaluator software tool which is an FDA-cleared product in commercial use, and can analyze some of this data. No others have relevant conflicts of interest.

  10. The Risk Factors of Symptomatic Communicating Hydrocephalus After Stereotactic Radiosurgery for Unilateral Vestibular Schwannoma: The Implication of Brain Atrophy

    Energy Technology Data Exchange (ETDEWEB)

    Han, Jung Ho [Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Dong Gyu, E-mail: gknife@plaza.snu.ac.kr [Department of Neurosurgery, Seoul National University Hospital, Seoul (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Chung, Hyun-Tai; Paek, Sun Ha; Park, Chul-Kee [Department of Neurosurgery, Seoul National University Hospital, Seoul (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Chae-Yong [Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Hwang, Seung-Sik [Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon (Korea, Republic of); Park, Jeong-Hoon [Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do (Korea, Republic of); Kim, Young-Hoon [Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Jin Wook; Kim, Yong Hwy; Song, Sang Woo; Kim, In Kyung; Jung, Hee-Won [Department of Neurosurgery, Seoul National University Hospital, Seoul (Korea, Republic of); Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2012-11-15

    Purpose: To identify the effect of brain atrophy on the development of symptomatic communicating hydrocephalus (SCHCP) after stereotactic radiosurgery (SRS) for sporadic unilateral vestibular schwannomas (VS). Methods and Materials: A total of 444 patients with VS were treated with SRS as a primary treatment. One hundred eighty-one patients (40.8%) were male, and the mean age of the patients was 53 {+-} 13 years (range, 11-81 years). The mean follow-up duration was 56.8 {+-} 35.8 months (range, 12-160 months). The mean tumor volume was 2.78 {+-} 3.33 cm{sup 3} (range, 0.03-23.30 cm{sup 3}). The cross-sectional area of the lateral ventricles (CALV), defined as the combined area of the lateral ventricles at the level of the mammillary body, was measured on coronal T1-weighted magnetic resonance images as an indicator of brain atrophy. Results: At distant follow-up, a total of 25 (5.6%) patients had SCHCP. The median time to symptom development was 7 months (range, 1-48 months). The mean CALV was 334.0 {+-} 194.0 mm{sup 2} (range, 44.70-1170 mm{sup 2}). The intraclass correlation coefficient was 0.988 (95% confidence interval [CI], 0.976-0.994; p < 0.001). In multivariate analysis, the CALV had a significant relationship with the development of SCHCP (p < 0.001; odds ration [OR] = 1.005; 95% CI, 1.002-1.007). Tumor volume and female sex also had a significant association (p < 0.001; OR = 1.246; 95% CI, 1.103-1.409; p < 0.009; OR = 7.256; 95% CI, 1.656-31.797, respectively). However, age failed to show any relationship with the development of SCHCP (p = 0.364). Conclusion: Brain atrophy may be related to de novo SCHCP after SRS, especially in female patients with a large VS. Follow-up surveillance should be individualized, considering the risk factors involved for each patient, for prompt diagnosis of SCHCP.

  11. WE-F-304-04: Radiosurgery for Vestibular Schwannomas: Tumor Control Probability Analyses and Recommended Reporting Standards

    International Nuclear Information System (INIS)

    Soltys, S.

    2015-01-01

    in explaining the results of hypofractionated RT Describe the dose/volume metrics that are considered safe in SBRT treatment of tumors near the optic structures. Discuss the efficacy of hypofractionation and dosing schedules used in treating vestibular schwannomas Identify some difficulties in modeling TCP and NTCP for cranial tumors treated with hypofractionation. One moderator, Dr. Grimm, designed and holds intellectual property rights to the DVH Evaluator software tool which is an FDA-cleared product in commercial use, and can analyze some of this data. No others have relevant conflicts of interest

  12. The Risk Factors of Symptomatic Communicating Hydrocephalus After Stereotactic Radiosurgery for Unilateral Vestibular Schwannoma: The Implication of Brain Atrophy

    International Nuclear Information System (INIS)

    Han, Jung Ho; Kim, Dong Gyu; Chung, Hyun-Tai; Paek, Sun Ha; Park, Chul-Kee; Kim, Chae-Yong; Hwang, Seung-Sik; Park, Jeong-Hoon; Kim, Young-Hoon; Kim, Jin Wook; Kim, Yong Hwy; Song, Sang Woo; Kim, In Kyung; Jung, Hee-Won

    2012-01-01

    Purpose: To identify the effect of brain atrophy on the development of symptomatic communicating hydrocephalus (SCHCP) after stereotactic radiosurgery (SRS) for sporadic unilateral vestibular schwannomas (VS). Methods and Materials: A total of 444 patients with VS were treated with SRS as a primary treatment. One hundred eighty-one patients (40.8%) were male, and the mean age of the patients was 53 ± 13 years (range, 11–81 years). The mean follow-up duration was 56.8 ± 35.8 months (range, 12–160 months). The mean tumor volume was 2.78 ± 3.33 cm 3 (range, 0.03–23.30 cm 3 ). The cross-sectional area of the lateral ventricles (CALV), defined as the combined area of the lateral ventricles at the level of the mammillary body, was measured on coronal T1-weighted magnetic resonance images as an indicator of brain atrophy. Results: At distant follow-up, a total of 25 (5.6%) patients had SCHCP. The median time to symptom development was 7 months (range, 1–48 months). The mean CALV was 334.0 ± 194.0 mm 2 (range, 44.70–1170 mm 2 ). The intraclass correlation coefficient was 0.988 (95% confidence interval [CI], 0.976–0.994; p < 0.001). In multivariate analysis, the CALV had a significant relationship with the development of SCHCP (p < 0.001; odds ration [OR] = 1.005; 95% CI, 1.002–1.007). Tumor volume and female sex also had a significant association (p < 0.001; OR = 1.246; 95% CI, 1.103–1.409; p < 0.009; OR = 7.256; 95% CI, 1.656–31.797, respectively). However, age failed to show any relationship with the development of SCHCP (p = 0.364). Conclusion: Brain atrophy may be related to de novo SCHCP after SRS, especially in female patients with a large VS. Follow-up surveillance should be individualized, considering the risk factors involved for each patient, for prompt diagnosis of SCHCP.

  13. Long-term Treatment Response and Patient Outcomes for Vestibular Schwannoma Patients Treated with Hypofractionated Stereotactic Radiotherapy

    Directory of Open Access Journals (Sweden)

    Mira A. Patel

    2017-09-01

    Full Text Available PurposeThe aim of this study is to evaluate long-term treatment outcome and toxicities among vestibular schwannoma (VS patients treated with hypofractionated stereotactic radiotherapy (HSRT.Methods383 patients with unilateral VS treated with HSRT (25 Gy, five fractions between 1995 and 2007 were retrospectively reviewed. Treatment failure was defined as requiring salvage microsurgery. Posttreatment new/progressive clinical symptoms or increases in baseline tumor volume (BTV due to treatment effect or progression were noted. Symptom outcomes were reported as baseline and posttreatment ± improvement, respectively. Symptoms were grouped by cranial nerve (CN VII or CNVIII. Audiometry was assessed baseline and posttreatment hearing. Patients were grouped as having greater than serviceable hearing [Gardner Robertson (GR score 1–2] or less than non-serviceable hearing (GR score 3–5 by audiometry.ResultsMedian follow-up was 72.0 months. Nine (2.3% experienced treatment failure. At last follow-up, 74 (19.3% had new/progressive symptoms and were categorized as radiologic non-responders, whereas 300 (78.3% had no tumor progression and were grouped as radiologic responders. Average pretreatment BTV for treatment failures, radiologic non-responders, and radiologic responders was 2.11, 0.44, and 1.87 cm3, respectively. Pretreatment CNVII and CNVIII symptoms were present in 9.4 and 93.4% of patients, respectively. Eight (24% with pre-HSRT CNVII and 37 (10% with pre-HSRT CNVIII symptoms recovered CN function post-HSRT. Thirty-five (9% and 36 (9.4% experienced new CNVII and CNVIII deficit, respectively, after HSRT. Of these, 20 (57% and 18 (50% recovered CNVII and CNVIII function, respectively, after HSRT. Evaluable audiograms were available in 199 patients. At baseline and at last follow-up, 65.8 and 36.2% had serviceable hearing, respectively. Fifty-one percent had preservation of serviceable hearing at last follow-up.ConclusionTreatment of VS

  14. Revisión sistemática del schwannoma localizado en el suelo oral. A propósito de un caso

    Directory of Open Access Journals (Sweden)

    Carlos A. Espinosa-Fariñas

    2016-04-01

    Conclusiones: Los schwannomas localizados en el suelo de la boca son infrecuentes. Se presentan en torno a los 40 años, con leve predominancia por el sexo masculino y del lado izquierdo del suelo oral. El tiempo de evolución se encuentra próximo a los 9 meses. Usualmente asintomático. Los nervios hipogloso y lingual se afectan por igual. En proporción similar, el nervio de origen no puede ser identificado. La punción aspiración con aguja fina no es efectiva. El tratamiento de elección consiste en la enucleación del tumor una vez diagnosticado. No se documentaron recidivas.

  15. Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution

    International Nuclear Information System (INIS)

    Andrews, David W.; Suarez, Oscar; Goldman, H. Warren; Downes, M. Beverly; Bednarz, Greg; Corn, Benjamin W.; Werner-Wasik, Maria; Rosenstock, Jeffrey; Curran, Walter J.

    2001-01-01

    Background: Stereotactic radiosurgery (SRS) and, more recently, fractionated stereotactic radiotherapy (SRT) have been recognized as noninvasive alternatives to surgery for the treatment of acoustic schwannomas. We review our experience of acoustic tumor treatments at one institution using a gamma knife for SRS and the first commercial world installation of a dedicated linac for SRT. Methods: Patients were treated with SRS on the gamma knife or SRT on the linac from October 1994 through August 2000. Gamma knife technique involved a fixed-frame multiple shot/high conformality single treatment, whereas linac technique involved daily conventional fraction treatments involving a relocatable frame, fewer isocenters, and high conformality established by noncoplanar arc beam shaping and differential beam weighting. Results: Sixty-nine patients were treated on the gamma knife, and 56 patients were treated on the linac, with 1 NF-2 patient common to both units. Three patients were lost to follow-up, and in the remaining 122 patients, mean follow-up was 119±67 weeks for SRS patients and 115±96 weeks for SRT patients. Tumor control rates were high (≥97%) for sporadic tumors in both groups but lower for NF-2 tumors in the SRT group. Cranial nerve morbidities were comparably low in both groups, with the exception of functional hearing preservation, which was 2.5-fold higher in patients who received conventional fraction SRT. Conclusion: SRS and SRT represent comparable noninvasive treatments for acoustic schwannomas in both sporadic and NF-2 patient groups. At 1-year follow-up, a significantly higher rate of serviceable hearing preservation was achieved in SRT sporadic tumor patients and may therefore be preferable to alternatives including surgery, SRS, or possibly observation in patients with serviceable hearing

  16. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Adults With Vestibular Schwannomas: Executive Summary.

    Science.gov (United States)

    Olson, Jeffrey J; Kalkanis, Steven N; Ryken, Timothy C

    2018-02-01

    Vestibular schwannomas (VS) are uncommon lesions that are a substantial challenge to the neurosurgeons, otologists, and radiation oncologists who undertake their clinical management. A starting point to improving the current knowledge is to define the benchmarks of the current research studying VS management using evidence-based techniques in order to allow meaningful points of departure for future scientific and clinical research. To establish the best evidence-based management of VS, including initial otologic evaluation, imaging diagnosis, use of surgical techniques, assessment of tumor pathology, and the administration of radiation therapy. Multidisciplinary writing groups were identified to design questions, literature searches, and collection and classification of relevant findings. This information was then translated to recommendations based on the strength of the available literature. This guideline series yielded some level 2 recommendations and a greater number of level 3 recommendations directed at the management of VS. Importantly, in some cases, a number of well-designed questions and subsequent searches did not yield information that allowed creation of a meaningful and justifiable recommendation. This series of guidelines was constructed to assess the most current and clinically relevant evidence for the management of VS. They set a benchmark regarding the current evidence base for this type of tumor while also highlighting important key areas for future basic and clinical research, particularly on those topics for which no recommendations could be formulated.  The full guidelines can be found at: https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma. Copyright © 2017 by the Congress of Neurological Surgeons

  17. Canine malignant peripheral nerve sheath tumor involving nerve roots of the third lumbar spinal cord segmentTumor maligno da bainha de nervo periférico envolvendo raízes nervosas do terceiro segmento medular lombar em um cão

    Directory of Open Access Journals (Sweden)

    Elisângela Olegário da Silva

    2012-12-01

    Full Text Available Malignant peripheral nerve sheath tumors (MPNST involving spinal nerve roots are uncommon in dogs. A nine-year old, intact, mixed-breed dog, demonstrated clinical signs of incoordination in the pelvic limbs and micturition for approximately one week. Clinical examination revealed proprioceptive deficits and bilateral patellar hyperreflexia. During exploratory celiotomy a mass was observed adhered to the lumbar vertebral segments. Medical therapy was initiated, but neurological signs were progressive, and the owner opted for euthanasia. Gross examination showed that the mass in the abdominal cavity was attached to the lumbar segments L3 and L4, causing bone lysis in L3, but showed no tumor invasion into the spinal canal. Microscopic features were characterized by prominent proliferation of ovoid and fusiform cells with poorly defined cytoplasm arranged in interlacing bundles and concentric whorls. The cells were embedded in a delicate to moderate collagenous stroma and moderate anisokariose and high mitotic activity were noted. The immunohistochemical assay showed positive staining for GFAP, S-100 protein and vimentin, and negative staining for factor VIII, ?-actin and citokeratine. The definitive diagnosis of malignant peripheral nerve sheath tumor was made on the basis of the histological and immunohistochemical findings. Tumores malignos da bainha de nervo periférico (TMBNP em raízes nervosas espinhais são incomuns em cães. Relata-se o caso de um cão, sem raça definida, nove anos de idade, não castrado, com histórico de incoordenação em membros pélvicos e retenção urinária há aproximadamente uma semana. Ao exame clínico constatou-se déficit proprioceptivo e hiperreflexia patelar bilaterais. Durante a celiotomia exploratória constatou-se uma massa intensamente vascularizada e aderida aos segmentos vertebrais lombares. Estabeleceu-se plano terapêutico e o animal foi tratado com fluidoterapia, anti-inflamatório e analg

  18. Malign retroperitoneal schwannoma

    International Nuclear Information System (INIS)

    Pinilla Gonzalez, Rafael; Hadi Al-Bahlooli, Saeed; Lopez Lazo, Sarah; Quintana Diaz, Juan Carlos; Gonzales Rivera, Armando

    2009-01-01

    The retroperitoneal tumors are infrequent and are classified according to the original tissue. This is a case presentation of a patient presenting with pain in right hypochondrium and a tumor in this zone, weight loss and painful discomfort in the anterolateral face of right thigh. In physical examination we found cutaneousmucous paleness and painless tumor in hypochondrium and right flank. Abdominal ultrasound (US) showed a homogenous mass of 14,11 cm and abdominal computed tomography allows to see a right retroperitoneal tumor rejecting the kidney. Excretory urogram showed a anteromedial rejection of right kidney. An encapsulated tumor with a few peritumoral adherences was removed. By histological study it was possible to confirm a fusiform cells tumor with hyperchromatism and nuclear pleomorphism, numerous mitosis and areas of necrosis and in the diagnosis of malign tumor of the sheath of a peripheral nerve.(author)

  19. how acoustic schwannomas?

    African Journals Online (AJOL)

    chemistry In the diagnosis of brain tumours and, furthermore, shows that ... Psammoma. Factor. Ulex*. (J). Tumour. Case. Sex (yrs). Site. Subtype bodies. CAM 5.2 HMFG. » ..... Zulch KJ. Brain Tumor,: Their Biology and Pathology. 2nd ed.

  20. Should vestibular schwannoma in patients with useful hearing be treated with radiation? A comparison of patients treated with stereotactic radiotherapy (SRT) and those not treated with SRT

    International Nuclear Information System (INIS)

    Shirato, H.; Sakamoto, T.; Kagei, K.; Satoh, N.; Hashimotok, S.; Aoyama, H.; Kitahara, H.; Inuyama, Y.; Miyasaka, K.

    1997-01-01

    Purpose/Objective: Prognostic factors for hearing preservation after SRT in patients with vestibular schwannoma are investigated, and hearing change is compared to that of the matched control group of patients whose hearing was observed historically. Material and Methods: Of 41 patients with vestibular schwannoma treated from 1991 through 1997 by SRT, 24 with measurable hearing, given 36 Gy in 20 fractions to 48 Gy in 23 fractions were investigated. Tumor sizes ranged from 5 mm to 30 mm with a median of 15 mm. Nine patients had episodes of sudden hearing loss and 12 suffered from progressive hearing loss. Follow-up time after SRT ranged from 4 to 70 months, resulting in a median follow-up time of 21 months. Twelve patients with vestibular schwannoma who were followed without any treatment were selected as a matched control. Results: Eighty-three percent showed a less than 20dB change in pure tone average (PTA), and 43.5% showed a less than 10dB change after SRT. Tumor size was not related to the change in PTA. A higher preservation rate was suggested in subjects younger than 50 years of age. Good pre-treatment PTA (less than 42dB) was related in hearing preservation after RT (p< 0.05). A change in PTA of less than 10 dB was observed in 67.5% of those patients who experienced a sudden onset of hearing loss and in 25.0% of those patients with progressive hearing loss (p< 0.05). Worsening in PTA more than 10dB was observed in no patients with normal type of audiogram before SRT, 33.3% of valley type impairment (drop in 1-2kHz), 63.6% of a high-tone impariment type and 66.7% of horizontal impairment type. No change in PTA between 14 and 32 months after the treatment was observed in 3 patients who were given 36 Gy in 20 fractions. Tumor size did not increase in 97.6% of patients by SRT and in 66.7% by follow-up policy. In patients who received SRT, PTA hearing loss recorded from their first visit was a little worse at 1 year, but at 2 and 3 years became the same as

  1. SU-F-T-611: Critical Analysis and Efficacy of Linac Based (Beam Modulator) and Cyberknife Treatment Plans for Acoustic Neuroma/schwannoma

    International Nuclear Information System (INIS)

    KP, Karrthick; Kataria, T; Thiyagarajan, R; Selvan, T; Abhishek, A

    2016-01-01

    Purpose: To study the critical analysis and efficacy of Linac and Cyberknife (CK) treatment plans for acoustic neuroma/schwannoma. Methods: Twelve of acoustic neuroma/schwannoma patients were taken for these study that. Treatment plans were generated in Multiplan treatment planning system (TPS) for CK using 5,7.5 and 10mm diameter collimators. Target volumes were in the range of 0.280 cc to 9.256 cc. Prescription dose (Rx) ranges from 1150cGy to 1950cGy delivered over 1 to 3 Fractions. For same patients stereotactic Volumetric modulated arc plans were generated using Elekta Linac with MLC thickness of 4mm in Monaco TPS. Appropriate calculation algorithms and grid size were used with same Rx and organ at risk (OAR) constrains for both Linac and CK plans. Treatment plans were developed to achieve at least 95% of the target volume to receive the Rx. The dosimetric indices such as conformity index (CI), coverage, OAR dose and volume receiving 50% of Rx (V50%) were used to evaluate the plans. Results: Target volumes ranges from 0.280 cc to 3.5cc shows the CI of 1.16±0.109 and 1.53±0.360 for cyberknife and Linac plans respectively. For small volume targets, the OARs were well spared in CK plans. There are no significant differences in CI and OAR doses were observed between CK and Linac plans that have the target volume >3.5 cc. Perhaps the V50% were lesser in CK plans, and found to be 12.8± 8.4 and 22.8 ± 15.0 for CK and Linac respectively. Conclusion: The analysis shows the importance of collimator size for small volume targets. The target volumes >3.5 cc can be treated in Linac as comparable with CK. For targets <3.5cc CK plans showed superior plan quality with better CI and OAR sparing than the Linac based plans. Further studies may require evaluating the clinical advantage of CK robotic system.

  2. Baseline and follow-up MRI of the internal auditory canal after suboccipital resection of acoustic schwannoma: appearances and clinical correlations

    International Nuclear Information System (INIS)

    Smith, M.; Castillo, M.; Campbell, J.; Pillsbury, H.; Walters, T.

    1995-01-01

    Prospective baseline MRI was obtained on 31 patients who had ''total'' removal of acoustic schwannoma 6 months to 9 years previously. Follow-up MRI was performed after 1-2 years on patients with questionable abnormalities. We found four patterns (1) internal auditory canals (IAC) with nonenhancing soft-tissue strands, possibly scars or distorted residual nerves (8); (2) IAC with marginal enhancement-reactive dura mater (16); (3) IAC with contrast-enhancing globular tissues suggesting residual or recurrent tumour (5); (4) high-signal intensity in the IAC before contrast medium administration, probably related to graft with fat/fascia/muscle (2). Prospective 1- to 2-year follow-up studies were available in 8, 5, and 1 patients in groups 2, 3, and 4 respectively. In group 2, dural enhancement remained unchanged in 5 patients and decreased in 3. In group 3 follow-up showed 1 tumor recurrence (surgically confirmed) and 4 stable abnormalities. In group 4, follow-up in 1 of the 2 patients was stable. In groups 1 and 2, the MRI features correlate well with complete tumor removal. Whether follow-up in these groups is indicated needs to be determined. In group 3 residual or recurrent tumor cannot be excluded. In group 4, grafts may prevent adequate visualization of the IAC. (orig.)

  3. Radiological indeterminate vestibular schwannoma and meningioma in cerebellopontine angle area: differentiating using whole-tumor histogram analysis of apparent diffusion coefficient.

    Science.gov (United States)

    Xu, Xiao-Quan; Li, Yan; Hong, Xun-Ning; Wu, Fei-Yun; Shi, Hai-Bin

    2017-02-01

    To assess the role of whole-tumor histogram analysis of apparent diffusion coefficient (ADC) maps in differentiating radiological indeterminate vestibular schwannoma (VS) from meningioma in cerebellopontine angle (CPA). Diffusion-weighted (DW) images (b = 0 and 1000 s/mm 2 ) of pathologically confirmed and radiological indeterminate CPA meningioma (CPAM) (n = 27) and VS (n = 12) were retrospectively collected and processed with mono-exponential model. Whole-tumor regions of interest were drawn on all slices of the ADC maps to obtain histogram parameters, including the mean ADC (ADC mean ), median ADC (ADC median ), 10th/25th/75th/90th percentile ADC (ADC 10 , ADC 25 , ADC 75 and ADC 90 ), skewness and kurtosis. The differences of ADC histogram parameters between CPAM and VS were compared using unpaired t-test. Multiple receiver operating characteristic (ROC) curves analysis was used to determine and compare the diagnostic value of each significant parameter. Significant differences were found on the ADC mean , ADC median , ADC 10 , ADC 25 , ADC 75 and ADC 90 between CPAM and VS (all p values Histogram analysis of ADC maps based on whole tumor can be a useful tool for differentiating radiological indeterminate CPAM from VS. The ADC 90 value was the most promising parameter for differentiating these two entities.

  4. Failure of gamma-aminobutyrate acid-beta agonist baclofen to improve balance, gait, and postural control after vestibular schwannoma resection.

    Science.gov (United States)

    De Valck, Claudia F J; Vereeck, Luc; Wuyts, Floris L; Van de Heyning, Paul H

    2009-04-01

    Incomplete postural control often occurs after vestibular schwannoma (VS) surgery. Customized vestibular rehabilitation in man improves and speeds up this process. Animal experiments have shown an improved and faster vestibular compensation after administration of the gamma-aminobutyrate acid (GABA)-beta agonist baclofen. To examine whether medical treatment with baclofen provides an improvement of the compensation process after VS surgery. A time-series study with historical control. Tertiary referral center. Thirteen patients who underwent VS resection were included and compared with a matched group of patients. In addition to an individualized vestibular rehabilitation protocol, the study group received medical treatment with 30 mg baclofen (a GABA-beta agonist) daily during the first 6 weeks after surgery. Clinical gait and balance tests (Romberg maneuver, standing on foam, tandem Romberg, single-leg stance, Timed Up & Go test, tandem gait, Dynamic Gait Index) and Dizziness Handicap Inventory. Follow-up until 24 weeks after surgery. When examining the postoperative test results, the group treated with baclofen did not perform better when compared with the matched (historical control) group. Repeated-measures analysis of variance revealed no significant group effect, but a significant time effect for almost all balance tests during the acute recovery period was found. An interaction effect between time and intervention was seen concerning single-leg stance and Dizziness Handicap Inventory scores for the acute recovery period. Medical therapy with baclofen did not seem to be beneficial in the process of central vestibular compensation.

  5. Stereotactic Fractionated Radiotherapy and LINAC Radiosurgery in the Treatment of Vestibular Schwannoma-Report About Both Stereotactic Methods From a Single Institution

    International Nuclear Information System (INIS)

    Kopp, Christine; Fauser, Claudius; Mueller, Axel; Astner, Sabrina T.; Jacob, Vesna; Lumenta, Christianto; Meyer, Bernhard; Tonn, Joerg-Christian; Molls, Michael; Grosu, Anca-Ligia

    2011-01-01

    Purpose: To evaluate tumor control and side effects associated with radiosurgery (RS) and stereotactic fractionated radiotherapy (SFR) for vestibular schwannomas (VSs) in a group of patients treated at the same institution. Methods and Materials: Between May 1997 and June 2007, 115 consecutive cases of VS were treated in our department. The SFR group (47 patients), including larger tumors (maximum diameter >1.5 cm), received a total dose of 54 Gy at 1.8 Gy per fraction. The RS group (68 patients, maximum diameter <1.5 cm) received a total dose of 12 Gy at the 100% isodose. Evaluation included serial imaging tests (magnetic resonance imaging) and neurologic and functional hearing examinations. Results: The tumor control rate was 97.9% in the SFR group for a mean follow-up time of 32.1 months and 98.5% in the RS group for a mean follow-up time of 30.1 months. Hearing function was preserved after RS in 85% of the patients and after SFR in 79%. Facial and trigeminal nerve function remained mostly unaffected after SFR. After RS, new trigeminal neuropathy occurred in 9 of 68 patients (13%). Conclusions: A high tumor control rate and low number of side effects are registered after SFR and RS of VS. These results confirm that considering tumor diameter, both RS and SFR are good treatment modalities for VS.

  6. Gamma knife radiosurgery for acoustic schwannomas. An analysis of the method of low dose and conformal multiple shots with smaller collimator

    International Nuclear Information System (INIS)

    Fukuoka, Seiji; Takanashi, Masami; Hojo, Atsufumi; Konishi, Masanori; Nakamura, Hirohiko

    2003-01-01

    The purpose of this study was to analyze tumor control and possible complications of gamma knife radiosurgery (GKRS) in patients with acoustic schwannomas treated using low marginal dose and conformal multiple shots with smaller collimators to fit irregular tumor shapes. The authors evaluated 183 patients with follow-up periods ranging from 3 to 11 years. Marginal doses were 9 to 15 Gy (median 12 Gy), with corresponding treatment volumes being between 0.1 and 18.7 ml (median 1.8 ml). The number of isocenter varied from 2 to 24 shots (median 9 shots). The actuarial tumor control rate (resection-free survival) was 96.5%. Useful hearing, trigeminal and facial functions were preserved at 75%, 97.4%, and 100%, respectively. Hydrocephalus was recognized in 5.7% of all patients, and seems to occur in cases with medium sized tumors where mild ventricular enlargement is evident prior to treatment. GKRS proves to be a safe and effective therapy for small to medium sized tumors. However, the indication for larger sized tumors (diameter 3+ cm) should be carefully considered, larger tumors being less easy to control and liable to cause ataxia due to transient expansion. (author)

  7. A Rare Case of Radiologically Not Distinguishable Coexistent Meningioma and Vestibular Schwannoma in the Cerebellopontine Angle – Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Juergen Grauvogel

    2010-08-01

    Full Text Available Background: The simultaneous occurrence of cerebellopontine angle (CPA meningioma and vestibular schwannoma (VS in the absence of neurofibromatosis type 2 or history of irradiation is very rare. We report a case with coexistent CPA meningioma and VS, which were radiologically not distinguishable in preoperative imaging. Case Description: A 46-year-old female presented with acute hearing loss, tinnitus and gait ataxia. Otorhinolaryngological diagnostic workup and imaging studies showed an intra- and extrameatal homogenous contrast enhancing lesion. The neuroradiological diagnosis was VS. The patient was operated via the retrosigmoid approach. Intraoperatively two distinct tumors were found: a small, mainly intrameatally located VS and a larger meningioma originating from the dura of the petrous bone. Both tumors were completely microsurgically removed. The patient experienced no new neurological deficit after surgery; particularly facial nerve function was completely preserved. Histopathological examination revealed a fibromatous meningioma and a VS, respectively. Conclusions: The coincidental occurrence of CPA meningioma and VS is very rare. Careful interpretation of imaging studies before surgery is crucial. Even such rare cases should be kept in mind when discussing the therapeutic options with the patient. More studies are needed for a better understanding of mechanisms leading to multiple tumor growth.

  8. Mesotelioma maligno: descripción clínica y radiológica de 45 casos con y sin exposición a asbestos Malignant mesothelioma: clinical and radiological picture of 45 cases with or without exposure to asbestos

    Directory of Open Access Journals (Sweden)

    Ma. del Pilar García-López

    2000-11-01

    Full Text Available OBJETIVO: Identificar y caracterizar los principales síntomas, la presentación clínica y las alteraciones radiológicas de pacientes con mesotelioma maligno (MM, admitidos en una institución gubernamental especializada en enfermedades del tórax. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo en el cual se revisaron los registros médicos y radiológicos de pacientes diagnosticados con MM, admitidos en el Instituto Nacional de Enfermedades Respiratorias (INER, en la ciudad de México, de 1991 a 1998. Se incluyeron los siguientes datos: edad, ocupación, exposición a asbestos, latencia, historia familiar en relación con otras neoplasias, sintomatología clínica y alteraciones radiológicas. Se calcularon porcentajes por sexo y grupo de edad. RESULTADOS: Se encontraron 45 casos con MM, y en 80% de ellos no se pudo documentar historia exposicional a asbestos. El grupo de edad con mayor frecuencia se encontró entre los 51-60 años. Disnea y dolor torácico fueron los principales síntomas. Las anormalidades radiológicas estuvieron constituidas por derrame y engrosamiento pleural en 75% de los pacientes. CONCLUSIONES: La presentación clínica y las anormalidades radiológicas en pacientes con MM sin historia de exposición a asbestos fueron similares a las de los pacientes con antecedentes de exposición a asbestos.OBJECTIVE: Our aim was to identify and describe the main symptoms, clinical presentation, and radiographic changes in malignant mesothelioma (MM patients. MATERIAL AND METHODS: We reviewed the medical and X-ray records of all patients diagnosed with MM, admitted between 1991 and 1998 to the National Institute of Respiratory Diseases (INER, which is a governmental institution specialized in chest disease in Mexico City. The following data were collected: Age, occupation, asbestos exposure, latency, family history of cancer, clinical symptoms, and X-ray changes. Data are presented as percentages by sex and age group

  9. Prevalência e achados epidemiológicos, anatomopatológicos e imuno-histoquímicos dos tumores hepáticos malignos primários de cães da Região Central do Rio Grande do Sul (1965-2012

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    Mariana M. Flores

    2013-04-01

    Full Text Available A prevalência e os aspectos epidemiológicos, anatomopatológicos e imuno-histoquímicos dos tumores hepáticos malignos primários (THMP em cães foram estudados. De 7.373 cães necropsiados em 48 anos (1965-2012, 64 morreram de THMP, o que corresponde a 0,9% do total de cães que morreram por qualquer causa, 7,8% do total de cães que morreram por tumores em geral e 33,5% do total de cães que morreram por tumores hepáticos. Desses 64 casos de THMP, 51 foram revistos histologicamente, avaliados imuno-histoquimicamente e reclassificados como carcinomas (colangiocarcinomas [n=36], carcinomas hepatocelulares [n=9] e hepatocolangiocarcinoma [n=1] e sarcomas (hemangiossarcomas [n=5]. Dos cães com colangiocarcinomas e carcinomas hepatocelulares em que a idade estava disponível nos protocolos, 64,7% e 77,8% eram idosos, respectivamente. Na necropsia, colangiocarcinomas caracterizaram-se principalmente por ocorrerem em um padrão multinodular (83,3%, enquanto carcinomas hepatocelulares ocorreram tanto de forma massiva (44,4% quanto nodular (44,4%. Metástases extra-hepáticas foram vistas em 77,8% e 33,3% dos casos de colangiocarcinomas e carcinomas hepatocelulares, respectivamente, e em relação aos colangiocarcinomas afetaram principalmente pulmões (52,8%, linfonodos (50% e peritônio (19,4%. Ascite (22,2% e icterícia (22,2% foram achados associados ocasionalmente com ambos os tumores. Na histologia, a maior parte dos colangiocarcinomas (86,1% e dos carcinomas hepatocelulares (55,6% tinha padrão tubular e trabecular, respectivamente. Na imuno-histoquímica, a maioria (63,9% dos colangiocarcinomas demonstrou imunomarcação para CK7 e nenhum imunomarcou para Hep Par 1. A maioria (55,6% dos carcinomas hepatocelulares demonstrou imunomarcação para Hep Par 1 e nenhum imunomarcou para CK7. Os resultados aqui apresentados demonstram uma altíssima prevalência de THMP, principalmente colangiocarcinomas, e servem para auxiliar, através dos

  10. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients With Vestibular Schwannomas.

    Science.gov (United States)

    Hadjipanayis, Constantinos G; Carlson, Matthew L; Link, Michael J; Rayan, Tarek A; Parish, John; Atkins, Tyler; Asher, Anthony L; Dunn, Ian F; Corrales, C Eduardo; Van Gompel, Jamie J; Sughrue, Michael; Olson, Jeffrey J

    2018-02-01

    What surgical approaches for vestibular schwannomas (VS) are best for complete resection and facial nerve (FN) preservation when serviceable hearing is present? There is insufficient evidence to support the superiority of either the middle fossa (MF) or the retrosigmoid (RS) approach for complete VS resection and FN preservation when serviceable hearing is present. Which surgical approach (RS or translabyrinthine [TL]) for VS is best for complete resection and FN preservation when serviceable hearing is not present? There is insufficient evidence to support the superiority of either the RS or the TL approach for complete VS resection and FN preservation when serviceable hearing is not present. Does VS size matter for facial and vestibulocochlear nerve preservation with surgical resection? Level 3: Patients with larger VS tumor size should be counseled about the greater than average risk of loss of serviceable hearing. Should small intracanalicular tumors (<1.5 cm) be surgically resected? There are insufficient data to support a firm recommendation that surgery be the primary treatment for this subclass of VSs. Is hearing preservation routinely possible with VS surgical resection when serviceable hearing is present? Level 3: Hearing preservation surgery via the MF or the RS approach may be attempted in patients with small tumor size (<1.5 cm) and good preoperative hearing. When should surgical resection be the initial treatment in patients with neurofibromatosis type 2 (NF2)? There is insufficient evidence that surgical resection should be the initial treatment in patients with NF2. Does a multidisciplinary team, consisting of neurosurgery and neurotology, provides the best outcomes of complete resection and facial/vestibulocochlear nerve preservation for patients undergoing resection of VSs? There is insufficient evidence to support stating that a multidisciplinary team, usually consisting of a neurosurgeon and a neurotologist, provides superior outcomes compared

  11. Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery.

    Science.gov (United States)

    Hasegawa, Toshinori; Kida, Yoshihisa; Kato, Takenori; Iizuka, Hiroshi; Kuramitsu, Shunichiro; Yamamoto, Takashi

    2013-03-01

    Object Little is known about long-term outcomes, including tumor control and adverse radiation effects, in patients harboring vestibular schwannomas (VSs) treated with stereotactic radiosurgery > 10 years previously. The aim of this study was to confirm whether Gamma Knife surgery (GKS) for VSs continues to be safe and effective > 10 years after treatment. Methods A total of 440 patients with VS (including neurofibromatosis Type 2) treated with GKS between May 1991 and December 2000 were evaluable. Of these, 347 patients (79%) underwent GKS as an initial treatment and 93 (21%) had undergone prior resection. Three hundred fifty-eight patients (81%) had a solid tumor and 82 (19%) had a cystic tumor. The median tumor volume was 2.8 cm(3) and the median marginal dose was 12.8 Gy. Results The median follow-up period was 12.5 years. The actuarial 5- and ≥ 10-year progression-free survival was 93% and 92%, respectively. No patient developed treatment failure > 10 years after treatment. According to multivariate analysis, significant factors related to worse progression-free survival included brainstem compression with a deviation of the fourth ventricle (p 13 Gy) and 100% in the low marginal dose group (≤ 13 Gy). Ten patients (2.3%) developed delayed cyst formation. One patient alone developed malignant transformation, indicating an incidence of 0.3%. Conclusions In this study GKS was a safe and effective treatment for the majority of patients followed > 10 years after treatment. Special attention should be paid to cyst formation and malignant transformation as late adverse radiation effects, although they appeared to be rare. However, it is necessary to collect further long-term follow-up data before making conclusions about the long-term safety and efficacy of GKS, especially for young patients with VSs.

  12. Changes in Listing plane thickness caused by vestibular schwannoma: a parameter for evaluating the accuracy of the gravity-oriented internal model.

    Science.gov (United States)

    Tsutsumi, Takeshi; Ikeda, Takuo; Watanabe, Kensuke; Kikuchi, Shigeru

    2011-12-01

    Three-dimensional analysis of video-oculograms can be used to calculate Listing plane for patients and experimental subjects. Listing plane reflects the head's orientation with respect to gravity, which suggests that the plane is derived from otolithic vestibular input, itself, or from a gravity-oriented internal model constructed through integration of visual, vestibular, and proprioceptive sensory inputs. The goal of this study was to determine whether the Listing plane can serve as a parameter for evaluating static (peripheral or central) vestibular function. Prospective study. Tertiary referral center. Healthy subjects and patients with unilateral vestibular schwannoma without any previous treatment. Diagnostic. Video-oculograms were recorded from healthy subjects (aged 36.8 ± 6.3 yr) and from patients (aged 60.3 ± 7.5 yr) during voluntary gaze with the head in an upright or each-side-down orientation, and the thicknesses of the calculated Listing planes were then compared. Results revealed thickening of the Listing plane in patients only when the head was in an impaired-side-down orientation (1.250 ± 0.795 and 1.074 ± 0.759 degrees in the right- and left-side-down head orientations in healthy subjects versus 2.222 ± 1.237 degrees in the impaired-side-down orientation in patients), and this thickening correlated with caloric weakness. By contrast, neither the sensation of postural instability nor postural disturbance in force platform recordings contributed to the thickness of Listing plane. The thickness of the Listing plane could be a novel parameter for quantitatively evaluating static vestibular (otolithic) function, although central compensation might exist.

  13. Symptomatic Outcomes in Relation to Tumor Expansion After Fractionated Stereotactic Radiation Therapy for Vestibular Schwannomas: Single-Institutional Long-Term Experience

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    Aoyama, Hidefumi, E-mail: h-aoyama@med.niigata-u.ac.jp [Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo (Japan); Department of Radiology, Division of Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata (Japan); Onodera, Shunsuke [Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo (Japan); Takeichi, Norihito [Department of Otolaryngology, Hokkaido University Graduate School of Medicine, Sapporo (Japan); Onimaru, Rikiya [Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo (Japan); Terasaka, Shunsuke; Sawamura, Yutaka [Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo (Japan); Shirato, Hiroki [Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo (Japan)

    2013-02-01

    Purpose: The effect of transient tumor expansion after conventionally fractionated stereotactic radiation therapy (SRT) on the symptomatic outcomes is not well-known. Methods and Materials: This study enrolled 201 consecutive patients who received SRT for vestibular schwannoma. A conventional fractionation schedule was applied in 194 patients (97%), and 142 (71%) received a total dose of 50 Gy. The median follow-up time was 72 months. Results: The maximum diameter was 9 mm or less in 13 patients, 10-19 mm in 79 patients, 20-29 mm in 87 patients, and 30 mm or greater in 22 patients. At presentation, tumor size of 20 mm or greater was significantly associated with loss of serviceable hearing and trigeminal neuropathy. After SRT, tumor expansion was observed in 42 patients (21%). By tumor size, tumor expansion was observed in 0%, 11.4%, 25.6%, and 50% of patients with tumors of 9 mm or less, 10-19 mm, 20-29 mm, and 30 mm or greater, respectively, in diameter. The tumor expansion was significantly associated with an increased risk of hydrocephalus requiring shunt placement (P=.004), loss of serviceable hearing (P=.0064), and worsening of facial (P<.0001) and trigeminal nerve (P<.0001) functions. Spontaneous tumor shrinkage was observed in 29 of those 42 patients, mostly within 2 years after the expansion, and the majority of the worsened symptoms except for hearing resolved once the tumor had shrunk. As a result, salvage surgical resection for symptomatic relief was required in only 5% of patients. Conclusions: Fractionated SRT could be safely applied even for medium- to large-sized ({>=}20 mm) tumors. However, greater knowledge of the risks and consequences, including transient symptomatic worsening, and the time span of expansion will be required for the follow-up of patients after SRT to avoid unnecessary surgical intervention.

  14. Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma. Hearing preservation and patients' self-reported outcome based on an established questionnaire

    International Nuclear Information System (INIS)

    Kessel, Kerstin A.; Fischer, Hanna; Vogel, Marco M.E.; Combs, Stephanie E.; Oechsner, Markus; Bier, Henning; Meyer, Bernhard

    2017-01-01

    Stereotactic radiotherapy (RT) has been established as a valid treatment alternative in patients with vestibular schwannoma (VS). There is ongoing controversy regarding the optimal fractionation. Hearing preservation may be the primary goal for patients with VS, followed by maintenance of quality of life (QoL). From 2002 to 2015, 184 patients with VS were treated with radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT). A survey on current symptoms and QoL was conducted between February and June 2016. Median follow-up after RT was 7.5 years (range 0-14.4 years). Mean overall survival (OS) after RT was 31.1 years, with 94 and 87% survival at 5 and 10 years, respectively. Mean progression-free survival (PFS) was 13.3 years, with 5- and 10-year PFS of 92%. Hearing could be preserved in RS patients for a median of 36.3 months (range 2.3-13.7 years). Hearing worsened in 17 (30%) cases. Median hearing preservation for FSRT was 48.7 months (range 0.0-13.8 years); 29 (23%) showed hearing deterioration. The difference in hearing preservation was not significant between RS and FSRT (p = 0.3). A total of 123/162 patients participated in the patient survey (return rate 76%). The results correlate well with the information documented in the patient files for tinnitus and facial and trigeminal nerve toxicity. Significant differences appeared regarding hearing impairment, gait uncertainty, and imbalance. These data confirm that RS and FSRT are comparable in terms of local control for VS. RS should be reserved for smaller lesions, while FSRT can be offered independently of tumor size. Patient self-reported outcome during follow-up is of high value. The established questionnaire could be validated in the independent cohort. (orig.) [de

  15. Differences in Clinical Results After LINAC-Based Single-Dose Radiosurgery Versus Fractionated Stereotactic Radiotherapy for Patients With Vestibular Schwannomas

    International Nuclear Information System (INIS)

    Combs, Stephanie E.; Welzel, Thomas; Schulz-Ertner, Daniela; Huber, Peter E.; Debus, Juergen

    2010-01-01

    Purpose: To evaluate the outcomes of patients with vestibular schwannoma (VS) treated with fractionated stereotactic radiotherapy (FSRT) vs. those treated with stereotactic radiosurgery (SRS). Methods and Materials: This study is based on an analysis of 200 patients with 202 VSs treated with FSRT (n = 172) or SRS (n = 30). Patients with tumor progression and/or progression of clinical symptoms were selected for treatment. In 165 out of 202 VSs (82%), RT was performed as the primary treatment for VS, and for 37 VSs (18%), RT was conducted for tumor progression after neurosurgical intervention. For patients receiving FSRT, a median total dose of 57.6 Gy was prescribed, with a median fractionation of 5 x 1.8 Gy per week. For patients who underwent SRS, a median single dose of 13 Gy was prescribed to the 80% isodose. Results: FSRT and SRS were well tolerated. Median follow-up time was 75 months. Local control was not statistically different for both groups. The probability of maintaining the pretreatment hearing level after SRS with doses of ≤13 Gy was comparable to that of FSRT. The radiation dose for the SRS group (≤13 Gy vs. >13 Gy) significantly influenced hearing preservation rates (p = 0.03). In the group of patients treated with SRS doses of ≤13 Gy, cranial nerve toxicity was comparable to that of the FSRT group. Conclusions: FSRT and SRS are both safe and effective alternatives for the treatment of VS. Local control rates are comparable in both groups. SRS with doses of ≤13 Gy is a safe alternative to FSRT. While FSRT can be applied safely for the treatment of VSs of all sizes, SRS should be reserved for smaller lesions.

  16. Prognostic Factors of Balance Quality After Transpetrosal Vestibular Schwannoma Microsurgery: An Instrumentally and DHI-based Prospective Cohort Study of 48 Patients.

    Science.gov (United States)

    Thomeer, Hans; Bonnard, Damien; Franco-Vidal, Valérie; Porez, Florence; Darrouzet, Patricia; Liguoro, Dominique; Darrouzet, Vincent

    2015-06-01

    To evaluate short- and mid-term level of imbalance after vestibular schwannoma (VS) microsurgery by the transpetrosal approach, to search for factors predictive of vestibular compensation, and to determine which patient categories need a postoperative vestibular rehabilitation program. Prospective cohort study at a tertiary referral center. Between 2010 and 2011, patients aged 18 to 75 operated on for VS by transpetrosal approaches were included. VS was characterized by its size (Koos classification) and the presence or not of a cystic component. Hearing was classified according to the Gardner Robertson grading. The preoperative workup included an audiogram, computerized video nystagmography (VNG) with caloric testing, gaze study, rotatory tests, click-evoked cervical vestibular evoked myogenic potential measurements (cVEMPs), and subjective visual vertical test. Patients were asked to complete a Dizziness Handicap Inventory (DHI). Postoperatively, patients were reevaluated on D7 (clinical status), D90 (VNG and DHI), and D180 (DHI). Timing and duration of vestibular rehabilitation were also recorded. Forty-eight patients were included. Preoperatively, 77% experienced mild instability problems with a mean DHI score of 14.1 (range 4-32). Postoperatively, 71% reported stable or even improved perceived stability. Mean DHI scores were 28.1 on D90 and 19.8 on D180. Serviceable hearing, cystic transformation, normal cVEMPs, diplopia, and vestibular syndrome on D7 were found to be predictive of worse equilibrium outcome than when absent. A preoperative caloric deficit greater than 75% seemed to be a good prognostic factor. Vestibular rehabilitation was conducted in 56% of patients. Starting it early (<1 mo) seemed to be beneficial for final equilibrium outcome. VS microsurgery provides good stability results. Some preoperative parameters may be predictive of worse or improved balance recovery, as is clinical status on D7.

  17. Radioiodinated (I{sup 131} and I{sup 125}) Fibrinogen for the Detection of Malignant Tumours in Man; Emploi de Fibrinogene Marque avec {sup 131}I ou {sup 125}I pour la Detection de Tumeurs Malignes chez l'Homme; Primenenie mechennogo radioaktivnym Jodom-131 i Jodom-125 fibrinogena dlya obnaruzheniya zlokachestvennykh opukholej u cheloveka; Empleo el Fibrinogeno Radioyodado ({sup 131}I y {sup 125}I) para la Deteccion de Tumores Malignos en el Hombre

    Energy Technology Data Exchange (ETDEWEB)

    Monasterio, G.; Becchini, M. F.; Riccioni, N. [Centre of Nuclear Medicine, Medical Clinic, University of Pisa (Italy)

    1964-10-15

    fibrinogene marque avec {sup 1}'3{sup 1}I a donne des resultats corrects dans 79% des cas examines; aucun resultat faussement positif n'a ete enregistre sur toute la serie. Le memoire expose succinctement le procede et les resultats. D'apres les donnees obtenues, il semble que le fibrinogene marque avec {sup 131}l puisse etre utilise avec succes pour la detection precoce de tumeurs malignes chez l'homme; en ameliorant la technique de detection, il sera peut-etre possible d'augmenter sensiblement la valeur du diagnostic etabli par ce procede. (author) [Spanish] Se ha demostrado que en muchos tumores malignos, tanto en los inducidos en animales de laboratorio como en los formados espontaneamente en el hombre, hay un elevado contenido de fibrina-, se ha establecido una relacion entre este hecho y la gran cantidad de tromboplastina presente en el tumor, que seria lo que provoca la formacion de fibrina por polimerizacion del fibrinogeno. Teniendo esto en cuenta, los autores emplearon fibrinogeno humano marcado con {sup 131}I y {sup 125}l para detectar tumores malignos en el hombre. Estudiaron la absorcion del fibrinogeno radioyodado en tumores malignos y benignos y en lesiones no neoplasticas extensas. Han examinado hasta ahora 73 casos, constituidos 53 de ellos por tumores malignos localizados en el esqueleto, los pulmones, el cerebro, el tubo digestivo, etc. El ensayo de absorcion del fibrinogeno-{sup 131}I dio resultados correctos en el 79% de los casos; en toda la serie no se dio ningun resultado erroneamente positivo. Los autores discuten brevemente la tecnica y los resultados obtenidos. Los datos que ha sido posible reunir parecen indicar que el fibrinogeno-{sup 131}I puede utilizarse con exito para la deteccion temprana de formaciones malignas en el hombre; es probable que perfeccionando la tecnica de deteccion se logre aumentar notablemente el valor diagnostico del metodo. (author) [Russian] V bol'shom kolichestve zlokachestvennyh opuholej kak jeksperimental'nym putem, tak

  18. Absceso de pared abdominal por tumor maligno de colon transverso.

    OpenAIRE

    Morales Polanco, Sergio; Díaz Rosales, Juan de Dios; Arenas Valles, Jorge

    2017-01-01

    Introduction: Colon cancer is one of the most frequent and mortal digestive tumors. Complications of this disease could be several and in a few cases, could be rare and infrequent. This article present a case of patient with an abdominal wall abscess due to a malignant transverse colonic tumor. Clinic presentation: Male 56 years-old patient with sepsis and a mass in left superior quadrant on abdomen. The patient was underwent to exploratory laparotomy and findings were a large tumor in transv...

  19. Melanoma maligno em búfalos (Bubalus bubalis albinos

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    Maria Cecília Florisbal Damé

    2015-10-01

    Full Text Available Descrevem-se melanomas múltiplos em dois búfalos albinos da raça Murrah no Sul do Brasil. Macroscopicamente havia múltiplos tumores enegrecidos no músculo esquelético, pulmões, linfonodos, saco pericárdio, cápsula renal, mediastino e pleura. Microscopicamente foram observadas células epitelióides poliédricas dispostas em ninhos sólidos ou fascículos entrelaçados sustentadas por um estroma colagenoso fino e esparso. O citoplasma era eosinofílico e por vezes continham quantidades variáveis de pigmento de melanina. A taxa de mitose foi baixa. Na imuno-histoquímica houve imunomarcação positiva utilizando anticorpo anti-tirosinase, anti-Melan-A, anti-vimentina, anti-proteína S-100 e antineurofilamento. É possível que o polimorfismo relacionado com o gene da pigmentação em búfalos albinos tenha contribuído para o maior risco de desenvolvimento de melanomas, como foi sugerido em humanos.

  20. Astrocinoma pilocytic maligno. A purpose of two cases

    International Nuclear Information System (INIS)

    Castillo, C.; Mañana, G.; Castillo, L.; Delgado, L.

    2010-01-01

    Malignant transformation of pilocytic astrocytoma (PA) is an event extremely uncommon (<3%), with only a few cases of malignant AP cerebellar published in the literature. Malignancy can occur de novo or after radiation treatment, the latter being the most frequent cases. the mitoses could be considered as a marker of anaplastic progression for some authors, but not have not been defined clearly where the morphological criteria for identification and distinction of the forms AP streams. In the present study, we describe two cases of patients with cerebellar AP a adult 27 years and a preschool 2 years, which were listed as AP de novo malignancies. Besides AP pilocíticas characteristics figures, the study atypical characters showed pathological increase in cell density and mitosis, cellular pleomorphic and foci of necrosis behavior aggressive clinical histology was consistent with both. The first case presented an early recurrence and rapid clinical progression despite treatment instituted, and died 8 months after diagnosis The second case presented two early tumor recurrence, performing surgery, radiant and systemic, and being now free from progression at 16 months of diagnosis

  1. Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central Pleurodesis for malignant pleural effusions: a survey of physicians in South and Central America

    Directory of Open Access Journals (Sweden)

    Evaldo Marchi

    2010-12-01

    Full Text Available OBJETIVO: A pleurodese é uma alternativa eficaz no controle dos derrames pleurais malignos, mas existem controvérsias a respeito de sua indicação e técnica. O objetivo deste estudo foi avaliar como é realizada a pleurodese em países da América do Sul e Central. MÉTODOS: Profissionais que realizam pleurodese responderam um questionário sobre critérios de indicação para pleurodese, técnicas utilizadas e desfechos. RESULTADOS: Nossa amostra envolveu 147 profissionais no Brasil, 49 em outros países da América do Sul e 36 em países da América Central. Mais de 50% dos participantes realizavam pleurodese somente se confirmada a malignidade no derrame pleural. Entretanto, escalas de dispneia e de status de performance eram raramente utilizadas para indicar o procedimento. Aproximadamente 75% dos participantes no Brasil e na América Central preferiam realizar a pleurodese somente no caso de recidiva do derrame, e a expansão pulmonar deveria variar de 90% a 100%. O talco slurry foi o agente mais utilizado, instilado via drenos de calibre intermediário. A toracoscopia foi realizada em menos de 25% dos casos. Febre e dor torácica foram os efeitos adversos mais comuns, e empiema ocorreu em OBJECTIVE: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. METHODS: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. RESULTS: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50% of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and

  2. Biomicroscopia ultra-sônica (UBM no planejamento cirúrgico e acompanhamento pós-operatório de melanomas malignos de íris e corpo ciliar Ultrasound biomicroscopy (UBM in the surgical planning and postoperative follow-up of iris and ciliary body melanomas

    Directory of Open Access Journals (Sweden)

    Zélia Maria da Silva Corrêa

    2003-08-01

    Full Text Available OBJETIVO: Estudar os achados da biomicroscopia ultra-sônica (UBM em melanomas malignos primários da íris e corpo ciliar antes e depois da resecção cirúrgica e correlacionar a extensão do tumor (revelado pela biomicroscopia ultra-sônica aos achados histopatológicos. MÉTODOS: Estudo prospectivo de 5 pacientes com diagnóstico clínico de tumor de íris e/ou corpo ciliar. Estes pacientes foram avaliados pela biomicroscopia ultra-sônica antes e após iridociclectomia ou iridectomia. Os espécimens foram enviados para estudo histopatológico. Os pacientes foram acompanhados por período mínimo de 6 meses quando foi realizada nova biomicroscopia ultra-sônica. RESULTADOS: Neste grupo de 5 pacientes, 3 eram do sexo feminino e 2, do masculino, variação de idade de 32 e 64 anos. Todos os casos eram unilaterais. Quatro pacientes apresentaram massa iridociliar e um apresentou lesão limitada à íris. Em todos os casos a biomicroscopia ultra-sônica auxiliou o planejamento cirúrgico para a ressecção tumoral com margens livres. A biomicroscopia ultra-sônica no pós-operatório revelou ausência de crescimento tumoral em todos os casos, sendo que 2 pacientes apresentaram vítreo na incisão cirúrgica, 1 deles com tração vítrea leve, mas sem sinais de descolamento de retina. CONCLUSÃO: A biomicroscopia ultra-sônica pareceu ser método auxiliar confiável para diagnosticar tumores de íris e corpo ciliar, planejar o tratamento cirúrgico e o acompanhamento pós-operatório.PURPOSE: To study pre-operatively and post-operatively ultrasound biomicroscopy (UBM findings of iris and ciliary body melanomas and correlate tumor extension (revealed by ultrasound biomicroscopy with histopathology findings. METHODS: Prospective study of 5 patients with a clinical diagnosis of iris and ciliary body tumors. These patients were evaluated by ultrasound biomicroscopy before and after treatment with iridectomy or iridociclectomy. All specimens were sent

  3. The Short-Term and Intermediate-Term Risk of Second Neoplasms After Diagnosis and Treatment of Unilateral Vestibular Schwannoma: Analysis of 9460 Cases

    International Nuclear Information System (INIS)

    Carlson, Matthew L.; Glasgow, Amy E.; Jacob, Jeffrey T.; Habermann, Elizabeth B.; Link, Michael J.

    2016-01-01

    Purpose: To determine the incidence of second intracranial neoplasms after the diagnosis and treatment of sporadic vestibular schwannoma (VS). Methods and Materials: Analysis of the Surveillance, Epidemiology, and End Results (SEER) database including all patients identified with a diagnosis of VS and a second intracranial tumor. The Kaplan-Meier method was used to determine the incidence of second tumors while allowing for censoring at loss to follow-up or death. Multivariable associations between treatment modality and second tumor formation were explored using Cox proportional hazards regression analysis. Two illustrative cases are also presented. Results: In all, 9460 patients with unilateral VS were identified between 2004 and 2012. Overall, 66 (0.7%) patients experienced a separate intracranial tumor, benign or malignant, after treatment of VS. Kaplan-Meier estimates for time to second neoplasm at 1, 3, and 5 years were 0.3%, 0.7%, and 0.8%, respectively. Multivariable comparison between VS treatment modalities revealed that the risk of second tumor formation was similar between radiation and surgery (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.36-1.51; P=.93) but greater for tumors managed with observation alone compared with radiation (HR 2.48; 95% CI 1.31-4.71; P<.01). A total of 6 (0.06%) intracranial malignancies were diagnosed after VS treatment. Kaplan-Meier estimates for time to malignancy at 1, 3, and 5 years were 0%, 0.1%, and 0.1%, respectively. After adjustment for age at diagnosis, sex, and treatment modality, the probability of malignancy after radiation was not greater than after observation alone or microsurgery (HR 4.88; 95% CI 0.85-28.14; P=.08) during the study period. Conclusions: The risk for the development of a second intracranial neoplasm, benign or malignant, at 5 years after treatment of unilateral VS is approximately 0.8%, whereas the risk of acquiring a separate malignancy is 0.1%, or approximately 1 per 1000 cases

  4. The Short-Term and Intermediate-Term Risk of Second Neoplasms After Diagnosis and Treatment of Unilateral Vestibular Schwannoma: Analysis of 9460 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Carlson, Matthew L., E-mail: carlson.matthew@mayo.edu [Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota (United States); Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota (United States); Glasgow, Amy E. [Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota (United States); Jacob, Jeffrey T. [Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota (United States); Habermann, Elizabeth B. [Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota (United States); Link, Michael J. [Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota (United States); Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota (United States)

    2016-07-15

    Purpose: To determine the incidence of second intracranial neoplasms after the diagnosis and treatment of sporadic vestibular schwannoma (VS). Methods and Materials: Analysis of the Surveillance, Epidemiology, and End Results (SEER) database including all patients identified with a diagnosis of VS and a second intracranial tumor. The Kaplan-Meier method was used to determine the incidence of second tumors while allowing for censoring at loss to follow-up or death. Multivariable associations between treatment modality and second tumor formation were explored using Cox proportional hazards regression analysis. Two illustrative cases are also presented. Results: In all, 9460 patients with unilateral VS were identified between 2004 and 2012. Overall, 66 (0.7%) patients experienced a separate intracranial tumor, benign or malignant, after treatment of VS. Kaplan-Meier estimates for time to second neoplasm at 1, 3, and 5 years were 0.3%, 0.7%, and 0.8%, respectively. Multivariable comparison between VS treatment modalities revealed that the risk of second tumor formation was similar between radiation and surgery (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.36-1.51; P=.93) but greater for tumors managed with observation alone compared with radiation (HR 2.48; 95% CI 1.31-4.71; P<.01). A total of 6 (0.06%) intracranial malignancies were diagnosed after VS treatment. Kaplan-Meier estimates for time to malignancy at 1, 3, and 5 years were 0%, 0.1%, and 0.1%, respectively. After adjustment for age at diagnosis, sex, and treatment modality, the probability of malignancy after radiation was not greater than after observation alone or microsurgery (HR 4.88; 95% CI 0.85-28.14; P=.08) during the study period. Conclusions: The risk for the development of a second intracranial neoplasm, benign or malignant, at 5 years after treatment of unilateral VS is approximately 0.8%, whereas the risk of acquiring a separate malignancy is 0.1%, or approximately 1 per 1000 cases

  5. The impact of MRI steady-state sequences as an additional assessment modality in vestibular schwannoma patients after LINAC stereotactic radiotherapy or radiosurgery.

    Science.gov (United States)

    Sauer, Julian P; Kinfe, Thomas M; Pintea, Bogdan; Schäfer, Andreas; Boström, Jan P

    2018-05-23

    Data concerning the clinical usefulness of steady-state sequences (SSS) for vestibular schwannomas (VS) after linear accelerator (LINAC) stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are scarce. The aim of the study was to investigate whether SSS provide an additional useful follow-up (FU) tool to the established thin-layered T1 sequences with contrast enhancement. Pre- and post-treatment SSS were identified in 45 consecutive VS patients (2012-2016) with a standardized FU protocol including SSS at 2-3 months and 6 months/yearly in our prospective database and were retrospectively re-evaluated. The SSS were used throughout for the segmentation of the cochlea and partly of the trigeminal nerve in the treatment planning. Data analysis included signal conversion in SSS and possible correlation with neuro-otological outcome and volumetric assessment after a certain time interval. The series included 42 SRS and 3 SRT patients (31 female/14 male; mean age 59.3 years, range: 25-81 years). An SSS signal conversion was observed in 20 tumors (44.4%) within a mean time of 11 months (range: 7-15 months). Mean FU time was 26 months (median of 4 FU visits) and demonstrated tumor volume shrinkage in 29 cases (64.4%) correlating with FU time (p = 0.07). The incidence rate of combined shrinkage and signal conversion (48.3%) compared to those without signal conversion (51.7%) did not differ significantly (p = 0.49). In case of an early signal conversion at the first FU, a weak statistical significance (p = 0.05) for a higher shrinkage rate of VS with signal conversion was found. Side effects in cases with signal conversion (9/20, 45%) were more frequently than without signal conversion (6/25, 24%) without reaching statistical significance (p = 0.13). Our data confirmed the usefulness of SSS for anatomical segmentation of VS in LINAC-SRS/SRT treatment planning and add data supporting their potential as an adjunctive FU option in

  6. Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma. Hearing preservation and patients' self-reported outcome based on an established questionnaire

    Energy Technology Data Exchange (ETDEWEB)

    Kessel, Kerstin A.; Fischer, Hanna; Vogel, Marco M.E.; Combs, Stephanie E. [Technical University of Munich (TUM), Department of Radiation Oncology, Munich (Germany); Helmholtz Zentrum Muenchen, Institute of Innovative Radiotherapy (iRT), Neuherberg (Germany); Oechsner, Markus [Technical University of Munich (TUM), Department of Radiation Oncology, Munich (Germany); Bier, Henning [Technical University of Munich (TUM), Department of Otorhinolaryngology, Munich (Germany); Meyer, Bernhard [Technical University of Munich (TUM), Department of Neurosurgery, Munich (Germany)

    2017-03-15

    Stereotactic radiotherapy (RT) has been established as a valid treatment alternative in patients with vestibular schwannoma (VS). There is ongoing controversy regarding the optimal fractionation. Hearing preservation may be the primary goal for patients with VS, followed by maintenance of quality of life (QoL). From 2002 to 2015, 184 patients with VS were treated with radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT). A survey on current symptoms and QoL was conducted between February and June 2016. Median follow-up after RT was 7.5 years (range 0-14.4 years). Mean overall survival (OS) after RT was 31.1 years, with 94 and 87% survival at 5 and 10 years, respectively. Mean progression-free survival (PFS) was 13.3 years, with 5- and 10-year PFS of 92%. Hearing could be preserved in RS patients for a median of 36.3 months (range 2.3-13.7 years). Hearing worsened in 17 (30%) cases. Median hearing preservation for FSRT was 48.7 months (range 0.0-13.8 years); 29 (23%) showed hearing deterioration. The difference in hearing preservation was not significant between RS and FSRT (p = 0.3). A total of 123/162 patients participated in the patient survey (return rate 76%). The results correlate well with the information documented in the patient files for tinnitus and facial and trigeminal nerve toxicity. Significant differences appeared regarding hearing impairment, gait uncertainty, and imbalance. These data confirm that RS and FSRT are comparable in terms of local control for VS. RS should be reserved for smaller lesions, while FSRT can be offered independently of tumor size. Patient self-reported outcome during follow-up is of high value. The established questionnaire could be validated in the independent cohort. (orig.) [German] Die stereotaktische Radiotherapie (RT) wurde als gueltige Behandlungsalternative bei Patienten mit Vestibularisschwannom (VS) etabliert. Diskussionen ueber die optimale Fraktionierung laufen jedoch. Der Erhalt von Hoervermoegen

  7. Malignant schwannoma of the abdomen

    International Nuclear Information System (INIS)

    Kraemer, S.C.; Kolokythas, O.; Aschoff, A.J.; Merkle, E.

    1996-01-01

    A 63 year-old female patient presented herself because of abdominal distension, without being able to report specific complaints. Clinical examination found a well palpable, elastic and engorged abdominal tumour approximately of the size of a football. Conventional imaging of the small intestine according to Sellink with subsequent delayed film revealed in the first instance a displacement of intestinal loops and of the colon frame, with no signs of an onstruction. A similar diagnosis resulted from intraarterial angiography of the abdominal vessels, showing a displacement of the truncus coeliacus, and the A. mesenterica superior. There were no signs of vascular occlusions or pathologic tumour vessels. Surgery revealed a tumour of about 10 kg, with pathologic vascular connection and a broad area of contact to neighbouring intestinal loops. Control CT performed one year after surgery revealed newly developed, multiple, nodular formations, their structure and contrast signs being similar to those of the primary tumour. (orig./VHE) [de

  8. 经中颅底硬膜间入路切除中后颅窝哑铃型三叉神经鞘瘤%Middle cranial fossa interdural approach for dumbbell-shaped trigeminal schwannomas

    Institute of Scientific and Technical Information of China (English)

    何升学; 刘宏毅; 邹元杰; 马骏; 张岩松; 黄庆玖; 陈永严; 章文斌; 刘永

    2016-01-01

    目的 探讨经中颅底硬膜间入路切除中后颅窝哑铃型三叉神经鞘瘤的手术适应症及治疗效果.方法 回顾性分析2009年10月至2014年11月间南京医科大学附属脑科医院神经外科采用经中颅底硬膜间入路切除中后颅窝哑铃型三叉神经鞘瘤7例患者的临床及影像资料、手术疗效和术后并发症情况. 结果 7例患者中Mp型5例、MP型2例. 7例患者术后第1 d复查MRI显示肿瘤均全切,无手术死亡者;术后脑神经功能障碍较术前改善4例,无明显变化3例,无加重和出现新的脑神经麻痹;1例患者出现皮下积液和颅内感染,经腰穿置管脑脊液引流和抗生素治疗痊愈;1例出现颞肌萎缩. 术后7例患者均长期随访,随访时间12~60个月,无1例患者复发. 结论 中颅底硬膜间入路手术是切除Mp型和部分MP型三叉神经鞘瘤的一种有效治疗方法,主要在硬膜间进行手术操作,有利于脑组织、脑神经及血管的保护,手术损伤小、反应小、并发症少.%Objective To investigate the effect and indication of the middle cranial fossa interdural approach for dumbbell-shaped trigeminal schwannomas .Methods The clinical data of 7 patients with dumbbell-shaped trigeminal schwannomas underwent through middle cranial fossa interdural approach from October , 2009 to November , 2014 were analyzed retrospectively .Tumors were classified into three types based on their distribution over the petrous ridge ( Mp type,MP type and mP type ) .The middle cranial fossa interdural approach was selected for type Mp and MP .The extent of tumor resection , cranial nerve outcome , approach-related morbidities , and recurrence of the tumors were documented .Results Of 7 patients,5 were Mp and 2 MP.MRI of postoperative one day showed that total resection was achieved in all patients .There was no operative mortality or new permanent neurological deficits .Improvement of the preoperative cranial nerve dysfunction was observed

  9. Preoperative diffusion tensor imaging-fiber tracking for facial nerve identification in vestibular schwannoma: a systematic review on its evolution and current status with a pooled data analysis of surgical concordance rates.

    Science.gov (United States)

    Savardekar, Amey R; Patra, Devi P; Thakur, Jai D; Narayan, Vinayak; Mohammed, Nasser; Bollam, Papireddy; Nanda, Anil

    2018-03-01

    OBJECTIVE Total tumor excision with the preservation of neurological function and quality of life is the goal of modern-day vestibular schwannoma (VS) surgery. Postoperative facial nerve (FN) paralysis is a devastating complication of VS surgery. Determining the course of the FN in relation to a VS preoperatively is invaluable to the neurosurgeon and is likely to enhance surgical safety with respect to FN function. Diffusion tensor imaging-fiber tracking (DTI-FT) technology is slowly gaining traction as a viable tool for preoperative FN visualization in patients with VS. METHODS A systematic review of the literature in the PubMed, Cochrane Library, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and those studies that preoperatively localized the FN in relation to a VS using the DTI-FT technique and verified those preoperative FN tracking results by using microscopic observation and electrophysiological monitoring during microsurgery were included. A pooled analysis of studies was performed to calculate the surgical concordance rate (accuracy) of DTI-FT technology for FN localization. RESULTS Fourteen studies included 234 VS patients (male/female ratio 1:1.4, age range 17-75 years) who had undergone preoperative DTI-FT for FN identification. The mean tumor size among the studies ranged from 29 to 41.3 mm. Preoperative DTI-FT could not visualize the FN tract in 8 patients (3.4%) and its findings could not be verified in 3 patients (1.2%), were verified but discordant in 18 patients (7.6%), and were verified and concordant in 205 patients (87.1%). CONCLUSIONS Preoperative DTI-FT for FN identification is a useful adjunct in the surgical planning for large VSs (> 2.5 cm). A pooled analysis showed that DTI-FT successfully identifies the complete FN course in 96.6% of VSs (226 of 234 cases) and that FN identification by DTI-FT is accurate in 90.6% of cases (205 of 226

  10. PET and PET/CT in malignant melanoma; PET y PET/CT en melanoma maligno

    Energy Technology Data Exchange (ETDEWEB)

    Garcia O, J R [Nuclear Medicine and Molecular Imaging PET/CT, Centro Medico ABC, Mexico D.F. (Mexico)

    2007-07-01

    The advantages that it has the PET/CT are: 1. It diminishes mainly positive false lesions. It identifies physiologic accumulate places. 2. It diminishes in smaller grade false negative. Small injuries. Injuries with low grade concentration. Injure on intense activity areas. 3. Precise anatomical localization of accumulate places. 4. Reduction of the acquisition time. (Author)

  11. El genio maligno de Suárez: Suárez y Descartes

    OpenAIRE

    Baciero Ruiz, Francisco Tadeo

    2007-01-01

    [ES] Tradicionalmente se ha considerado la filosofía cartesiana como un comienzo casi absoluto en la historia de la Filosofía. Sin embargo, las conocidas hipótesis del “genio maligno” y del “Dios engañador”, parte fundamental del artificio de la “duda metódica” en las Meditaciones metafísicas, se encuentran en la Disputación metafísica 9 de Suárez (la única mención de Suárez en todo Descartes, precisamente en las “Respuestas” a las Meditaciones). Parece claro, a partir de la correspondencia d...

  12. Mal tiempo, tiempo maligno, tiempo de subversión ritual. La temposensitividad agrofestiva invernal

    Directory of Open Access Journals (Sweden)

    Del Campo Tejedor, Alberto

    2006-06-01

    Full Text Available In the light of a number of festive, ritual, poetico-musical and literary expresions, from Andalusia and elsewhere, the author discusses time as lived by agrarian cultures: a syncretic time, resulting from the superposition of civico-political, religious and peasant calendars; a cyclic time, given the effects of astronomico-meteorological time on nature and the subsequent cultural response on both the instrumental dimension (the work in the fields and the expresive dimension (the rituals and the festivals; and, finally, an ages-old bipolar time, experienced as the succession of two alternating seasons —wintertime and summertime—which also underlies a dichotomous agrofestive time-sensitiveness analyzed here under the following hypothesis: during the months of «good weather,» especially May and June, the rituals have a propitiatory and positively extolling sense; they mimetically dramatize the union between earth, vegetation, animals and humans by means of prototypes and archetypes that symbolically recreate the natural order of things. By contrast, the wintertime rituals and festivals—from 1st November till Carnival, and particularly around Christmas—all have in common a grotesque character and a sense of inverted order, symbolically signifying, with a logic at once serio-comic and ambiguous, the dark side of existence, while ritually conjuring up the fears of bad weather, of fateful and pernicious time, the time of cold nights, hunger and death.

    A la luz de algunas expresiones festivas, rituales, poético-musicales y literarias, de Andalucía y otros contextos, el artículo aborda el tiempo vivido por las culturas agroganaderas: un tiempo sincrético, como consecuencia de la superposición de los calendarios civil-político, religioso y campesino; un tiempo cíclico, fruto de la incidencia del tiempo astronómico-meteorológico en la naturaleza y la consiguiente respuesta cultural en el plano instrumental (los trabajos agrícolas y expresivo (rituales y fiestas; y, finalmente, un tiempo bipolar, que se experimenta desde antiguo en dos estaciones —invierno y verano—, base de una temposensitividad agrofestiva igualmente dicotómica, que es analizada a raíz de la siguiente hipótesis: durante los meses de buen tiempo, especialmente mayo y junio, los rituales de nuestro entorno funcionan con un sentido propiciatorio y de exaltación positiva, escenificando miméticamente la unión entre tierra, vegetación, animal y hombre a través de prototipos o arquetipos que recrean simbólicamente el orden natural de las cosas. Por el contrario, las fiestas y rituales invernales —desde Todos los Santos hasta el Carnaval, y muy especialmente los días en torno a la Navidad— tienen en común su carácter grotesco y de inversión del orden, que expresa en clave simbólica, con una lógica jocoseria y ambigua, el lado oscuro de la existencia, conjurando ritualmente los miedos al mal tiempo, al tiempo aciago y nefasto, al tiempo del frío, la noche, el hambre y la muerte.

  13. Asociación de linfomas malignos con herpes virus I y II

    Directory of Open Access Journals (Sweden)

    Ashley Efraín Alarcon-Rozas

    2002-04-01

    Full Text Available Objetivos: Conocer la prevalencia de la seropositividad para herpes virus I y II en pacientes con linfomas non Hodgkin y su asociación con el linaje celular (B ó T. Pacientes y métodos: Se tomó una muestra de 60 pacientes en el Hospital Almenara de agosto de 1999 a diciembre del 2000 todos ellos pacientes con diagnostico establecido de linfoma non Hodgkin nuevos o en primera recaída, el análisis se realizó mediante bioestadística descriptiva. Resultados: La mediana de la edad fue de 59 años, 2/3 fueron varones, 65% pacientes nuevos y el linfoma primario fue extraganglionar en un 58% de los casos. El 80% de los linfomas fueron a células B y mas del 90% en estadios avanzados (III y IV, ningún caso fue positivo para IgM herpes I o II y 25% tuvieron serología positiva IgG para herpes I o II (2/3 positivos para IgG I de los cuales el 93% fueron a células B. Conclusiones: La prevalencia de seropositividad para herpes virus I y II en pacientes con linfoma non Hodgkin es del 25%, mayormente asociado a células B, además de tener un porcentaje considerable de linfomas a células T (25% y linfomas extranodales (58%; para evaluar la posibilidad de asociación entre este virus y los linfomas requerimos de un estudio caso-control.

  14. Termoterapia transpupilar em melanoma maligno da coróide Transpupillary thermotherapy for malignant choroidal melanoma

    Directory of Open Access Journals (Sweden)

    Martha M. Motomo Chojniak

    2001-04-01

    Full Text Available Objetivo: Vários métodos vem sendo utilizados para o tratamento dos melanomas da coróide. A proposta deste trabalho preliminar é avaliar a eficácia da termoterapia transpupilar (TTT como tratamento primário de melanomas da coróide pequenos. Métodos: Foi realizado um trabalho prospectivo e não-randomizado para avaliar os aspectos clínicos, resposta do tumor, complicações e resultados visuais de pacientes portadores de melanomas da coróide pequenos (até 4,0 mm de espessura e 12 mm de diâmetro basal tratados por termoterapia transpupilar utilizando-se sucessivas aplicações de laser diodo contínuo de 810 nm. Resultados: Foram tratados 11 pacientes portadores de melanomas da coróide pequenos. O tumor era único e pigmentado em 100% dos casos. Crescimento documentado esteve presente em 5 pacientes (45,45% previamente ao tratamento e fatores de risco para crescimento ou metástase estavam presentes em todos os pacientes. O tempo de seguimento destes pacientes a partir do tratamento foi em média de 5,72 meses (3 - 8 meses. Foram utilizadas 3 sessões de laser em 5 pacientes (45,45% e 4 sessões em 6 pacientes (64,64%. As lesões apresentavam, por ocasião do diagnóstico, uma espessura média de 2,65 mm (1,85-3,86 mm, com maior diâmetro basal médio de 7,98 mm (4,2-11,33 mm. Após o tratamento, a espessura média foi de 1,83 mm (0,98-2,93 mm e o maior diâmetro basal médio foi de 6,59 mm (3,81 mm -10,67 mm. Das lesões tratadas, 100% apresentaram diminuição da altura e do máximo diâmetro basal, tendo sido a diminuição média da espessura de 0,89 mm e do máximo diâmetro basal de 1,39 mm. A acuidade visual manteve-se inalterada em 5 casos (45,45% e piorou após o tratamento em 6 casos (54,54%. Ocorreram complicações em 9 casos, tendo sido considerada complicação grave 1 caso de descolamento parcial da retina (9,09%; as outras complicações foram consideradas leves: pequenas hemorragias intra-retinianas em 7 pacientes (63,63%, vitreite associada a tênues membranas vítreas em 1 paciente (9,09% e quemose associada a edema palpebral em 1 paciente (9,09%. Controle tumoral local com conservação do globo ocular foi observado durante este pequeno tempo de seguimento em 100% dos pacientes tratados. Por ocasião da "última revisão", 100% dos pacientes estavam vivos e sem doença metastática. Conclusão: Este estudo preliminar sugere que a termoterapia transpupilar apresenta-se como um método efetivo e seguro para o tratamento de selecionados melanomas pequenos da coróide. Para melhor avaliação é necessário tempo de seguimento prolongado.Purpose: Several methods have been used for treatment of choroidal melanoma. The purpose of this preliminary paper is to evaluate the effectiveness of transpupillary thermo- therapy (TTT as a primary treatment of small choroidal melanomas. Methods: This is a prospective nonrandomized study evaluating clinical aspects, tumor response, complications and visual outcome in patients presenting small choroidal melanomas (up to 4.0 mm thick and 12 mm base diameter treated with TTT over 810 nm laser diode applications. Results: There were 11 patients treated with trans-pupillary thermotherapy, all of them presenting pig-mented small choroidal melanomas. Growth previous to treatment was documented in 5 patients and risk factors for growth or metastatic disease was present in all the patients. After treatment the patients were followed for 3 to 8 months (mean 5.7 months. Three laser sessions were used in 5 pa-tients and 4 sessions in 6 patients. The lesions presented at the beginning of the treatment a mean thickness of 2.7 mm, with a mean larger base diameter of 7.8 mm. All the lesions responded to treatment and presented decrease of thickness and base diameters. After transpupillary thermotherapy, the lesions' mean thickness was 1.8 mm and the mean larger base diameter was 6.7 mm. The mean reduction in thickness was 0.9 mm and the mean decrease in larger base diameter was 1.4 mm. The visual acuity remained unaffected in 5 cases and worsened after treatment in 6 cases. Nine patients presented compli- cations. A major complication occurred in a single patient who presented retinal detachment. Minor compli-cations were observed as follows: small retinal hemorrhages (7 patients, vitreous inflammation associated with tenuous vitreous membranes (1 patient and conjunctiva and eyelid edema (1 patient. Local tumor control and conservation of the eyeball was accomplished in all the patients; they are all alive without evidence of metastatic disease in this initial follow-up period. Conclusion: This preliminary study suggests that the transpupillary thermotherapy is a promi-sing, effective and safe method for treatment of selected small choroidal melanomas. Further studies with longer follow-up period are necessary to better evaluate this treatment.

  15. Tumores malignos del mediastino en niños: un problema clínico urgente

    Directory of Open Access Journals (Sweden)

    Iliana De los Reyes

    2010-05-01

    Full Text Available Los tumores de mediastino conforman un grupo heterogéneo de enfermedades. La localización de la masa se relaciona con las características clínicas y la aparición de complicaciones. Las masas malignas del mediastino anterior más frecuentes en niños son las neoplasias de precursores linfoides tipo leucemia/linfoma linfoblástico T, el linfoma de Hodgkin y los tumores germinales. El manejo de la urgencia oncológica producida por el efecto compresivo de la masa requiere una evaluación exhaustiva y una rápida intervención, que permita salvaguardar la vida del paciente sin sacrificar el tratamiento óptimo posterior. El síndrome de la vena cava superior, el taponamiento cardiaco y otros hacen parte de las urgencias mecánicas más frecuentes.Se presenta el caso de un niño de ocho años de edad con síntomas respiratorios y presencia de masa en el mediastino anterior, confirmada por citometría de flujo como linfoma linfoblástico, que requirió manejo con esteroides y quimioterapia para citorreducción y mejoría de las complicaciones.

  16. Protagonismo del sistema inmune en el microambiente de los tumores malignos de la mama

    OpenAIRE

    Arango Prado, María del Carmen; Rodríguez-Padilla, Cristina

    2016-01-01

    Los avances recientes en la comprensión de los mecanismos génicos y moleculares del cáncer de mama han revelado que el sistema inmune protagoniza los eventos responsables del desarrollo y la progresión del tumor. Las células de la respuesta inmune innata y adaptativa, así como diversos mediadores solubles liberados por ellas, pueden establecer una respuesta antitumoral protectora o, por el contrario, inducir eventos de inflamación crónica que favorezcan la promoción y progresión de esta enfer...

  17. Distribución geográfica de algunos tumores malignos en Cuba

    OpenAIRE

    Ramos González, Mylene María

    2009-01-01

    El cáncer es uno de los fenómenos más complejos de la naturaleza y resulta desde el punto de vista médico una enfermedad muy difícil de abordar por la amplia multicausalidad que incide en su origen, la complejidad de sus mecanismos patogénicos y la variedad de formas y tipos de cáncer que pueden originarse en el ser humano. Esta enfermedad constituye un problema de salud a nivel mundial. Ha sido ampliamente reconocida la importancia del conocimiento de la distribución geográfica de esta enfer...

  18. Crioterapia en pequeños tumores malignos palpebrales Cryotherapy in small malignant eyelids tumors

    Directory of Open Access Journals (Sweden)

    Clara Gómez Cabrera

    2003-06-01

    Full Text Available Para determinar la efectividad de la crioterapia como tratamiento del cáncer de los párpados, se realizó un análisis descriptivo de tipo retrospectivo de 10 pacientes con diagnóstico clínico de carcinoma palpebral cuyo máximo tamaño de la lesión fue de 5 mm y que no fuese pigmentado. El 60 % de los pacientes se encontraba entre los 31 y los 60 años de edad y el 80 % pertenece al sexo femenino. El párpado superior estuvo afectado en un 80 % y el 90 % de las lesiones fueron por clínica diagnosticadas como carcinoma basocelular.y respondieron al tratamiento. La crioterapia es un tratamiento efectivo y curativo en pequeños tumores palpebrales.To determine the effectiveness of cryotherapy to treat eyelids cancer, a descriptive retrospective analysis was made in 10 patients with clinical diagnosis of non-pigmented eyelids carcinoma with a maximun size of 5 mm. 60 % of the patients were between 31 and 60 years old, whereas 80 % were females. The upper eyelid was affected in 80 % and 90 % of the lesions were clinically diagnosed as basal cell carcinoma and responded to treatment. Cryotherapy is an effective and curative treatment in small eyelids tumors.

  19. Tumores hepáticos incomuns: ensaio iconográfico - Parte 1

    Directory of Open Access Journals (Sweden)

    Bruno Cheregati Pedrassa

    2014-10-01

    Full Text Available A maioria dos tumores hepáticos primários malignos é representada pelo carcinoma hepatocelular e pelo colangiocarcinoma, entretanto, uma variedade de outras lesões hepáticas incomuns pode ser encontrada. Lesões comuns como o hemangioma, a hiperplasia nodular focal e as metástases são bem conhecidas e já foram extensamente documentadas na literatura. O diagnóstico das lesões hepáticas típicas pode ser feito com alguma segurança utilizando-se os diversos métodos de imagem; por outro lado, as lesões incomuns são geralmente um desafio diagnóstico para o radiologista. Nesta primeira parte do estudo abordaremos cinco tumores hepáticos incomuns - o angiossarcoma, o angiomiolipoma, o cistoadenoma/carcinoma biliar, o hemangioendotelioma epitelioide e o carcinoma hepatocelular fibrolamelar -, suas principais características e achados de imagem, com foco na tomografia computadorizada e na ressonância magnética.

  20. Reconstrucción palpebral inferior después de la escisión de tumores malignos

    OpenAIRE

    Arias Soto, Julio Cesar; Abreu Perdomo, Franklin A.; Ortiz Silveira, Marlenys; Despaigne Delisle, Justo; Matienzo Vergara, Sulli de la Caridad

    2013-01-01

    Se presentan 4 casos clínicos de pacientes de 46-76 años con carcinomas basocelular y escamoso de párpado inferior, diagnosticados en la consulta oftalmológica del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso". A los afectados se le realizó tarsectomía parcial o total con reconstrucción palpebral mediante colgajos miocutáneos en islas de área cigomática y músculo nasal. Los resultados tanto funcionales como estéticos fueron óptimos y se corroboró la efectividad de los colgajos antes...

  1. 81. Tumor maligno en cav idad ca rdíaca simulando trombosis quística

    Directory of Open Access Journals (Sweden)

    M.aT. Conejero Jurado

    2010-01-01

    Conclusiones: Los sarcomas cardíacos, por su clínica inespecífica y baja incidencia, son difíciles de diagnosticar. La supervivencia a corto plazo es baja. La imagen ecográfica, «simulando» una trombosis quística, es extremadamente rara. La intervención probablemente no se habría indicado en caso de sospecha preoperatorio de sarcoma.

  2. Intraparotid facial nerve schwannoma: Report of two cases

    Directory of Open Access Journals (Sweden)

    Seyyed Basir Hashemi

    2008-07-01

    Full Text Available Introduction: Intra parotid facial nerve schowannoma is a rare tumor. Case report: In this article we presented two cases of intra parotid facial nerve schowannoma. In two cases tumor presented with asymptomatic parotid mass that mimic pleomorphic adenoma. No preoperative facial nerve dysfunction in cases is detected. Diagnostic result and surgical management are discussed in this paper.  

  3. Socio-demographic distribution of vestibular schwannomas in Denmark

    DEFF Research Database (Denmark)

    Stepanidis, Karen; Kessel, Marie; Caye-Thomasen, Per

    2014-01-01

    , for example, the size of the tumor and the age and address of the patient has been registered. Up to 2012, 2739 patients were diagnosed with a VS. Patient distribution according to area of habitat was determined by subgrouping into urban, suburban, rural, and remote municipalities, using the definitions...

  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

    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.......23-0.50) compared with married men with a higher education. Lower incidence rates were also observed among unemployed or early-retirement pensioners, whereas there were no differences in incidence rates across the broad groups of occupations and across the types of districts. Sociodemographic indicators were...

  5. Prepontine Schwannoma Presenting With Atypical Facial Symptoms - A Case Report

    Directory of Open Access Journals (Sweden)

    Rishi Kumar Bali

    2005-01-01

    Full Text Available Face is an important landmark and any pathological condition affecting it has tremendous bearing on psychological make up of the patient. This report describes a rare case of a young female who presented with Hemifacial dysaesthesia complicated by ipsilateral masticatory complex dyskinesia.

  6. 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...

  7. 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...

  8. Clasificación pronóstica de los tumores malignos de glándula parótida

    Directory of Open Access Journals (Sweden)

    Juan M. Maza-Solano

    2016-01-01

    Conclusiones: El índice de Vander Poorten es aplicable en áreas hospitalarias con escaso número de carcinomas de parótida. Permite establecer un pronóstico de supervivencia más certero sobre pacientes individuales.

  9. Tumor maligno indiferenciado disseminado. Diagnóstico ao exame oftalmológico: relato de um caso Metastatic undifferentiated malignant tumor: report of a case

    Directory of Open Access Journals (Sweden)

    Henrique Shiguekiyo Kikuta

    2001-08-01

    Full Text Available Objetivo: Demonstrar a importância da anamnese e do exame físico geral nas afecções orbitárias, como orientadores do diagnóstico e do tratamento adequados. Métodos: Anamnese, exame físico geral e oftalmológico e exames complementares: radiografia de tórax, ultra-sonografia abdominal e pélvica, tomografia computadorizada de órbita; e procedimentos de biópsia punção aspirativa de massa orbitária, biópsia excisional de nódulo esternal e respectivos exames de citologia, histologia e imuno-histoquímico. Resultados: A ultra-sonografia pélvica demonstrou a presença de grande massa em anexo, provavelmente o foco primário. A radiografia de tórax revelou massas provavelmente metastáticas. O resultado do exame histopatológico das biópsias de massa retrobulbar e nódulo esternal foi compatível com neoplasia maligna indiferenciada. Conclusões: Este relato ressalta a importância da anamnese e do exame físico geral nas afecções orbitarias, orientando o diagnóstico e o tratamento adequado, pois embora a paciente apresentasse múltiplas metástases, foram os sinais oftalmológicos que a conduziram ao médico.Purpose: To demonstrate the importance of clinical history and general physical examination in orbital affections as guides for correction of and early diagnosis allowing adequate treatment. Methods: Clinical history, ophthalmologic and general physical examination and complementary examinations: Chest X-ray, pelvic and abdominal ultrasonography, orbital computerized tomography; fine needle aspiration biopsy of tumor, orbitary procedures, excisional biopsy of sternal nodule and retrospective cytologic, histologic and imunohistochenical examinations. Results: Pelvic ultrasonography demonstrated the presence of a large tumor in anexus, probably the primary focus. In the chest X-ray there is evidence of metastatic mass. The histopathological findings of both retrobulbar mass and sternal nodule were compatible with undifferentiated malignant neoplasm. Conclusions: This paper reports the importance of clinical history and general physical examination in the orbital affections guiding the physician to correct diagnosis and apply adequate treatment in a case in which the patient presenting multiple metastases, the ophthalmologic signs were the ones that led him to medical visit.

  10. Integrin inhibitor (Cilengitide) as radiosensitization strategy for malignant tumors; Inibidor de integrina (Cilengitida) como estratégia de radiossensibilização de tumores malignos

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Felipe Henrique de Souza

    2017-07-01

    Radiotherapy is effective in tumor control, but several tumors have molecular characteristics that lead to radioresistance and possible posttreatment recurrence. Many tumors have overexpression of integrin receptors. Integrins play a central role in growth, motility, regulation of adhesion and survival, leading to increased proliferation, invasion and metastasis of tumors, making these receptors excellent targets for the development of new therapies. Studies have shown that inhibiting the interaction of matrix proteins with integrin receptors may increase the cytotoxic effect of ionizing radiation by demonstrating the radiosensitizing potential of combination therapy in tumoral lines. Cilengitide an inhibitor of integrins receptors α Vβ3 and αVβ5 stands out for its great antitumor potential against gliomas. Thus, the combination of ionizing radiation with cilengitide is an alternative therapeutic strategy. However, the effect of this combination is little studied in Glioblastomas (U87 and T98) and not studied in melanoma (UACC). The objective of this study was to evaluate the radiosensitising potential of the RGD molecule cilengitida by means of the combined treatment with gamma radiation in different tumor lines, as well as to compare the effect of this combination therapy with cisplatin, a molecule already used in clinical practice. Our panel of tumor cell lines was composed of U87 (wild-type p53 malignant glioblastoma) T98 (malignant glioblastoma mutant p53), MCF7 (mammary carcinoma) and UACC (melanoma). The radiosensitizer effect of cilengitide was evaluated by the quantification of metabolic cell viability through the MTT assay. Inhibition of colony formation was investigated in clonogenicity assays. The flow cytometer was used to investigate cell cycle distribution and the type of cell death induced. We observed that in all cell lines examined, cilengitida promoted detachment, metabolic alterations and reduction of proliferation, as well as alteration of cell cycle distribution, induction of apoptotic and autophagic death. The combined treatment of ionizing radiation with cilengitida resulted in a synergistic effect pattern, potentiating the therapy with ionizing radiation in the decrease of metabolism and cellular proliferation, as well as increasing the induction of apoptotic and autophagic cell death. Combination therapy with cilengitida was more potent when compared to the effect of combination therapy with cisplatin, showing that anti-integrin therapies are excellent therapeutic strategies for tumor radiosensitization. These results indicate the potential radiosensitizer of cilengitida, proving to be a promising treatment against malignant tumors. (author)

  11. Resultados del tratamiento quirúrgico de los tumores malignos del párpado inferior Results of the surgical treatment of malignant tumors of the lower eyelid

    Directory of Open Access Journals (Sweden)

    Roberto Frías Banqueris

    2008-06-01

    Full Text Available INTRODUCCIÓN. Es objetivo de este trabajo describir el tratamiento quirúrgico de las lesiones malignas localizadas en el párpado inferior, de extensión mayor del 25 % y propagación a los cantos mediales y externo. MÉTODOS. Un equipo multidisciplinario del Hospital «Celia Sánchez Manduley» (Manzanillo realizó un estudio descriptivo y prospectivo entre enero de 2001 y diciembre de 2006. Se seleccionaron para el estudio 19 pacientes que cumplieron con los criterios de inclusión, que fueron valorados previamente por el equipo multidisciplinario, y que dieron su consentimiento informado de participar en la investigación. Se describieron variables como edad, sexo, técnica quirúrgica empleada, localización, resultado anatomopatológico, complicaciones y resultado final. A los pacientes se les daría seguimiento durante un mínimo de 5 años. RESULTADOS. Se encontró un ligero predominio del sexo masculino y de edades por encima de los 50 años. La resección del tumor en cuña, seguida de la reconstrucción por técnica de colgajo de mejilla de Mustardé, fue la técnica de elección. El 79 % de los tumores resultó ser del tipo carcinoma basocelular. La necrosis parcial del colgajo y el hematoma fueron las complicaciones más frecuentes. Los pacientes se han mantenido en consulta de seguimiento, sin recidiva ni persistencia tumoral. CONCLUSIONES. El tratamiento quirúrgico por técnica de Mustardé combinada con otras técnicas y realizado por un equipo multidisciplinario es ideal para la cirugía del cáncer del párpado inferior.INTRODUCTION. The objective of this paper is to describe the surgical treatment of the malignant lesions localized in the lower eyelid with an extension over 25 % and propagation to the medial and external edges. METHODS. A multidisciplinary team of «Celia Sánchez Manduley» Hospital (Manzanillo conducted a descriptive and prospective study from January 2001 to December 2006. 19 patients that fulfilled the inclusion criterion were selected for the study. They were previously assessed and they gave their informed consent to take part in the study. Variables such as age, sex, surgical technique used, localization, anatomopathological result, complications and final result were described. Patients will be followed up for at least 5 years. RESULTS. A mild predominance of males and of ages over 50 was found. The wedge resection of the tumor followed by Mustardé's cheek flap reconstruction technique was the elective technique. 79 % of the tumors proved to be basocellular carcinoma. Partial necropsy of the flap and hematoma were the most frequent complications. The patients have been followed up without relapse or tumoral resistance. CONCLUSIONS. The surgical treatment by Mustardé's technique combined with other techniques carried out by a multidisciplinary team is ideal for the surgery of lower eyelid cancer.

  12. Residential traffic noise exposure and vestibular schwannoma - a Danish case-control study

    DEFF Research Database (Denmark)

    Roswall, Nina; Stangerup, Sven-Eric; Cayé-Thomasen, Per

    2017-01-01

    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...

  13. Contribution of p75NTR to Schwannoma Growth and Therapeutic Responses

    Science.gov (United States)

    2015-05-01

    in 0.125% typ- sin with EDTA (Life Technology) and 0.2% collagenase (Sigma) in Hank’s balanced salt solution without calcium and magnesium (Life...cells following deafness correlate with cell proliferation. Molecular and cellular neurosciences 47:306-315. Rong R, Surace EI , Haipek CA, Gutmann DH

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

    African Journals Online (AJOL)

    We report the case of a 23yearold woman with a mass extending from the ... in our case laparoscopy was not considered owing to the size and anatomical location of the tumour. ... bladder, uterus, distal inferior vena cava .... cyst in pregnancy.

  15. Need for facial reanimation after operations for vestibular schwannoma: patients perspective

    DEFF Research Database (Denmark)

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

    2003-01-01

    (15%) of 779 patients considered their facial palsy to be a big problem and 125 patients (16%) were interested in surgical treatment for the sequelae of facial palsy. Seventy-eight (10%) had already had some kind of operation, usually the VII-XII coaptation. Thirty-three of 61 patients who had already...

  16. Fractionated Stereotactic Radiotherapy in the Treatment of Vestibular Schwannoma (Acoustic Neuroma): Predicting the Risk of Hydrocephalus

    International Nuclear Information System (INIS)

    Powell, Ceri; Micallef, Caroline; Gonsalves, Adam; Wharram, Bev; Ashley, Sue; Brada, Michael

    2011-01-01

    Purpose: To determine the incidence and predictive factors for the development of hydrocephalus in patients with acoustic neuromas (AN) treated with fractionated stereotactic radiotherapy. Patients and Methods: Seventy-two patients with AN were treated with fractionated stereotactic radiotherapy between 1998 and 2007 (45-50 Gy in 25-30 fractions over 5 to 6 weeks). The pretreatment MRI scan was assessed for tumor characteristics and anatomic distortion independently of subsequent outcome and correlated with the risk of hydrocephalus. Results: At a median follow-up of 49 months (range, 1-120 months), 5-year event-free survival was 95%. Eight patients (11%) developed hydrocephalus within 19 months of radiotherapy, which was successfully treated. On univariate analysis, pretreatment factors predictive of hydrocephalus were maximum diameter (p = 0.005), proximity to midline (p = 0.009), displacement of the fourth ventricle (p = 0.02), partial effacement of the fourth ventricle (p < 0.001), contact with the medulla (p = 0.005), and more brainstem structures (p = 0.004). On multivariate analysis, after adjusting for fourth ventricular effacement, no other variables remained independently associated with hydrocephalus formation. Conclusions: Fractionated stereotactic radiotherapy results in excellent tumor control of AN, albeit with a risk of developing hydrocephalus. Patients at high risk, identified as those with larger tumors with partial effacement of the fourth ventricle before treatment, should be monitored more closely during follow-up. It would also be preferable to offer treatment to patients with progressive AN while the risk of hydrocephalus is low, before the development of marked distortion of fourth ventricle before tumor diameter significantly exceeds 2 cm.

  17. Facial nerve function after vestibular schwannoma surgery following failed conservative management

    DEFF Research Database (Denmark)

    Kaltoft, Mikkel; Stangerup, Sven-Eric; Cayé-Thomasen, Per

    2012-01-01

    the risk of impaired facial nerve function post-surgery. OBJECTIVE:: To compare facial nerve function in patients operated soon after diagnosis with patients allocated to conservative management, and the subgroup of these who later had surgery due to tumor growth. METHODS:: 1378 consecutive patients...... patients had normal facial nerve function at the end of observation. Good facial nerve outcome was found in 87 % of patients operated at diagnosis, and in 84 % of patients operated after established tumor growth. For the subgroup of small extrameatal tumors this difference was significant. Pooling all...... to preservation of the facial nerve function. Tumor growth during observation is found in only a minor proportion of the patients, and in these cases surgery or irradiation should be performed immediately....

  18. Epithelioid variant of malignant peripheral nerve sheath tumor (malignant schwannoma) of the urinary bladder.

    Science.gov (United States)

    Eltoum, I A; Moore, R J; Cook, W; Crowe, D R; Rodgers, W H; Siegal, G P

    1999-10-01

    Sarcoma represents less than 2% of all neoplasms diagnosed or recognized in effusions. Epithelioid peripheral nerve sheath tumor is a rare tumor that is difficult to differentiate from other epithelioid tumors without the use of ancillary studies. A 39-year-old paraplegic man presented with hematuria and a bladder mass that extended to involve the pelvic peritoneum. Light microscopy using hematoxylin-eosin, Papanicolaou, and immunohistochemical stains as well as transmission electron microscopy showed features of epithelioid malignant peripheral nerve sheath tumor with rhabdoid features and an accompanying eosinophilic infiltrate. Cytologic smears confirmed the similarities between the primary tumor in the bladder and the cells in the pelvic fluid and excluded the possibility of reactive changes related to postsurgical radiation. Ancillary studies were critical in narrowing the differential diagnoses and reaching the final conclusion.

  19. Precisión diagnóstica de la FDG-PET para diferenciar derrames pleurales malignos de benignos: revisión sistemática y meta-análisis

    OpenAIRE

    Hernández Ferrer, Paula Judit

    2016-01-01

    Background: The aim of this study was to summarize the evidence for the use of the FDG-PET in ruling in or out the malignant origin of a pleural effusion PE. Methods: A meta­ analysis was conducted of diagnostic accuracy studies published in the database from inception to June 2013, without language restrictions. Two investigators selected studies that had evaluated the performance of FDG-PET imaging in patients with PE, using pleural histopathology as the reference standard for malignanc...

  20. Quais as características propostas pelo BIRADS-US que melhor diferenciam nódulos malignos dos benignos? What characteristics proposed by BIRADS ultrasound better distinguish between benign and malignant nodes?

    Directory of Open Access Journals (Sweden)

    Eduardo Carvalho Pessoa

    2007-12-01

    Full Text Available OBJETIVO: analisar qual das características propostas pelo BIRADS-US tem maior impacto na diferenciação das lesões benignas das malignas. MÉTODOS: estudamos as características ultra-sonográficas do BIRADS em 384 nódulos submetidos à biópsia percutânea no período de fevereiro de 2003 a dezembro de 2006. Utilizou-se, para o exame, o aparelho Logic 5, com transdutor linear multifreqüencial de 7,5-12 MHz. A análise ultra-sonográfica do nódulo foi baseada no BIRADS-US levando em conta: forma, orientação, margem, limites da lesão, ecogenicidade, características acústicas posteriores, o tecido circunjacente e a presença de calcificações. Estes dados foram submetidos à análise estatística com modelo de regressão logística. Para o estudo de associação entre estas variáveis utilizamos o teste do c² e também calculamos a sensibilidade e a especificidade das variáveis "tecido ao redor", "calcificações", "efeito posterior", "limite da lesão" e "orientação". RESULTADOS: as lesões benignas representaram 42,4% e as malignas, 57,6%. A análise por regressão logística encontrou odds ratio (OR aumentado para câncer de 7,7 vezes quando o tecido ao redor esteve alterado, de 6,2 vezes quando houve presença das microcalcificações no interior das lesões, de 1,9 quando o efeito acústico foi sombra, de 25,0 vezes quando houve o halo ecogênico e de 7,1 vezes quando a orientação foi não paralela. CONCLUSÕES: dentre as características estudadas, o limite da lesão, representado pela presença ou não do halo ecogênico, é o mais importante diferenciador das massas benignas das malignas.PURPOSE: to analyze which characteristics proposed by the BIRADS lexicon for ultrasound have the greatest impact on distinguishing between benign and malignant lesions. METHODS: ultrasonography features from the third edition of the BIRADS were studied in 384 nodes submitted to percutaneous biopsy from February 2003 to December 2006, at the Medical School of Botucatu. For the ultrasonography, the equipment Logic 5 with a 7.5-12 MHz multifrequential linear transducer was used. The ultrasonography analysis of the node considered the features proposed by the BIRADS lexicon for ultrasound. The data were submitted to statistical analysis by the logistic regression model. RESULTS: the benign lesions represented 42.4% and the malignant, 57.6%. The logistic regression analysis found an odds ratio (OR for cancer of 7.69 times when the surrounding tissue was altered, of 6.25 times when there were microcalcifications in the lesions interior, of 1.95 when the acoustic effect is shadowing, of 25.0 times when there was the echogenic halo, and of 7.14 times when the orientation was non-parallel. CONCLUSIONS: among the features studied, the lesion limit, represented by the presence or not of the halogenic halo, is the most important differentiator of the benign from the malignant masses.

  1. Caracterización de los egresos hospitalarios con tumores malignos, según la información de los Grupos Relacionados con el Diagnóstico

    Directory of Open Access Journals (Sweden)

    Lina María López-Cano

    2017-09-01

    Full Text Available Objetivo: caracterizar los egresos hospitalarios del año 2014 con diagnóstico de cáncer, de acuerdo a la información de los Grupos Relacionados con el Diagnóstico (GRD. Metodología: estudio analítico con análisis descriptivo e inferencial, compuesto por información secundaria. La descripción estadística se hizo según la naturaleza y nivel de medición de las variables, y se realizó un análisis bivariado para estimar la diferencia de medias utilizando la t-Student (t y la anova paramétrica (F de Snedecor. Resultados: se atendieron 3.030 egresos, con un peso medio relativo de 1,62, una estancia media inliers de 10,69 días y un iema de 0,97. El 56,01% de los egresos presentó un nivel de severidad mayor, con un peso relativo de 2,09 y una estancia media de 13,53 días. De los pacientes que presentaron una probabilidad mayor de morir, el 32,64% egresaron vivos y el 19,62% fallecieron. Se encontraron diferencias estadísticamente significativas en la estancia media con el estado al alta, el nivel de severidad y el nivel de mortalidad. Conclusiones: los resultados de este estudio indican el manejo eficaz que la institución le da a la estancia hospitalaria, evidenciado en la atención de 76 pacientes más por el ahorro de los días de estancia y en los indicadores funcionales, los cuales fueron acordes con la complejidad de los pacientes.

  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

    by the wait-and-re-scan policy (272 patients) during the period 1976-2000 were studied retrospectively. The consequences of operation/diagnosis (and observation) on vocational status, ability to handle daily chores and some psycho-social aspects were studied by means of a prospective postal questionnaire......, no difference existed between the observed group and operated patients with a tumour below 20 mm in size. A change in vocational status was most frequent for assisting spouses, unskilled manual workers and the self-employed. The majority of both observed and operated patients experienced no change...... in their ability to handle daily chores. The changed ability of operated patients was worse than that of observed patients. Among various changes in their psycho-social well-being, decrease in social ability was the most frequent complaint in both groups, followed by increased fatigue, decreased concentration...

  3. The effect of bevacizumab on vestibular schwannoma tumour size and hearing in patients with neurofibromatosis type 2

    DEFF Research Database (Denmark)

    Alanin, Mikkel Christian; Klausen, Camilla; Caye-Thomasen, Per

    2015-01-01

    -34). We observed a radiological response (≥20 % tumour shrinkage) in seven out of 18 tumours (39 %) in six out of 12 patients (50 %). Sustained radiological responses were maintained in six tumours (33 %) for more than 2 months. Three patients had objectively improved hearing and five patients reported...... been shown to induce tumour shrinkage and improve hearing. We retrospectively reviewed the effect of bevacizumab on hearing and VS tumour size in 12 consecutive NF2 patients. Bevacizumab 10 mg/kg was administered intravenously every second week for 6 months; hereafter, bevacizumab 15 mg...

  4. Thallium chloride 201Tl combined with single photon emission computed tomography (SPECT) in the evaluation of vestibular schwannoma growth

    DEFF Research Database (Denmark)

    Charabi, Samih Ahmed; Lassen, N A; Thomsen, J

    1997-01-01

    . The relative tracer concentration and uptake were correlated to tumor volume determined by gadolinium DTPA enhanced MR, to prediagnostic duration of symptoms, to tumor vascularity expressed by the average number of intratumoral vessels using the endothelial marker CD31, and to the proliferative activity...... as a diagnostic modality of small intracanalicular tumors, when compared with gadolinium DTPA enhanced MR. Relating U and C in all tumors (n = 29) and the prospectively registered data on the prediagnostic duration of symptoms, a statistical significance was found (p = 0.012 and p = 0.015). No statistically...

  5. Swelling of the Upper Lip...Not always a Mucous Retention Cyst!!

    OpenAIRE

    Savitri M. Nerune; R. M. Potekar; Lynda D. Rodrigues; Namrata Balchandra Mestri

    2017-01-01

    Schwannoma, also known as neurilemmoma, is a solitary benign tumour arising from the Schwann cells. Oral schwannomas are rare and upper lip is an uncommon site. The diagnosis of schwannoma is typically made on histopathology and surgical resection is the treatment of choice. We report a case of swelling of the upper lip in a 26 year old male which was clinically diagnosed as mucous retention cyst and on histopathological examination, a diagnosis of schwannoma was of...

  6. Swelling of the Upper Lip...Not always a Mucous Retention Cyst!!

    Directory of Open Access Journals (Sweden)

    Savitri M. Nerune

    2017-04-01

    Full Text Available Schwannoma, also known as neurilemmoma, is a solitary benign tumour arising from the Schwann cells. Oral schwannomas are rare and upper lip is an uncommon site. The diagnosis of schwannoma is typically made on histopathology and surgical resection is the treatment of choice. We report a case of swelling of the upper lip in a 26 year old male which was clinically diagnosed as mucous retention cyst and on histopathological examination, a diagnosis of schwannoma was offered.

  7. Critérios histopatológicos para diagnóstico de melanoma maligno cutâneo: análise comparativa de sua freqüência em lesões benignas e melanomas de pequena espessura (< 2 mm Histopathological criteria for cutaneous malignant melanoma: comparative analysis between benign and thin malignant lesions (< 2 mm

    Directory of Open Access Journals (Sweden)

    Luiz Alberto Veronese

    2007-10-01

    Full Text Available INTRODUÇÃO: A histopatologia convencional continua sendo o padrão-ouro no diagnóstico dos melanomas cutâneos, apesar do progresso da imuno-histoquímica e da biologia molecular. Os critérios microscópicos existentes para esse diagnóstico são numerosos, porém nenhum deles é específico para se afirmar que uma determinada lesão é maligna quando ele está presente, ou é benigna na sua ausência. Alguns critérios têm uma relevância maior para o diagnóstico em relação a outros. OBJETIVO: Este estudo propõe uma análise daqueles critérios considerados mais importantes, comparando sua presença em lesões melanocíticas benignas e melanomas. MATERIAL E MÉTODOS: Foram estudadas 33 lesões melanocíticas benignas (nevo de Spitz: 13; nevo de Reed: 6; nevo displásico: 6; nevo congênito: 3; nevo adquirido: 3; nevo combinado: 1; nevo recorrente: 1, bem como 101 casos de melanomas extensivo/superficiais: 25 intra-epidérmicos e 76 invasivos de pequena espessura (INTRODUCTION: Conventional histopathology has been considered as the gold standard in the diagnosis of cutaneous malignant melanoma, despite the progress of molecular biology and immunohistochemistry. There are many microscopic criteria for diagnosis of melanoma, however there is not a single one that can be useful to define malignancy. AIM: Our purpose is to analyse the criteria considered more important to the diagnosis of melanoma, comparing their presence in benign melanocytic lesions and melanomas. MATERIAL AND METHODS: We studied 33 benign melanocytic lesions (Spitz nevi, 13; Reed nevi, 6; dysplastic nevi, 6; congenital nevi, 3; acquired nevi, 3; combined nevus, 1; recurrent nevus, 1 and 101 extensive/superficial melanomas (25 in situ and 76 invasive up to 2 mm thickness. RESULTS: Some criteria showed high frequency in benign lesions, showing low-specificity, while others had low-positivity in the benign and high-frequency in malignant lesions, consequently high-specificity and greater importance in the melanoma diagnosis. CONCLUSION: The five criteria that presented statistically significant difference after comparison with benign lesions were: 1. linear proliferation of a single layer cells in basal layer; 2. single cells at periphery; 3. cells in the granular layer; 4. extensive pagetoid array; and 5. large, irregular and/or multiple nucleoli . Thin melanomas usually do not show many of important criteria, like lack of cell maturation, necrosis and deep mitoses.

  8. Brazilian experience using high-dose sequential therapy (HDS followed by autologous hematopoietic stem cell transplantation (ASCT for malignant lymphomas Experiência brasileira utilizando terapia sequencial de alta dose seguido de transplante autólogo de célula-tronco hematopoética para linfomas malignos

    Directory of Open Access Journals (Sweden)

    Cármino A. de Souza

    2009-08-01

    Full Text Available Using the overall survival (OS, disease free survival (DFS and progression free survival (PFS, as well as associated toxicity, the purpose of this work was to evaluate the effectiveness of HDS followed by ASCT as salvage therapy. A retrospective analysis was performed of 106 patients with high grade non-Hodgkin lymphoma receiving HDS followed by ASCT, between 1998 and 2006. Median age was 45 years (Range: 8-65, with 66 (62% men. Histopathological classification was: 78% DLBCL patients, 12% T and anaplastic and 9% Mantle cell lymphomas; 87% had B cell and 12% T cell lymphomas; 83% were stage III-IV (Ann Arbor Staging, 63% had B symptoms, 32% had bone marrow involvement, 62% bulky disease and 42% high-intermediate or high risk IPI. After HDCY, 9 patients died, 7 from toxicity and 2 from sepsis. Eighty patients underwent ASCT, 47% were in complete remission (CR and 15% died, all from toxicity. Their OS was 45% over 8 years. During the follow-up, another 35 patients died [4 CR, 1 partial response (PR, 2 relapsed disease (RD and 28 disease progression (DP], 11 (31% had not performed ASCT. OS was 37%; DFS was 49% and PFS 28%. OS by diagnosis was 42% for DLBCL, 40% for T-cell (8 y and 20% for Mantle Cell (6 y (P=NS. OS by B symptom patients was 22% vs. 58% (P=0.002 and PFS was 23% vs. 37% (P=0.03. Patients who achieved CR after HDCY (38 had significantly better OS and PFS (38% and 17% than patients who remained in DP (PA proposta deste trabalho foi avaliar a eficácia da HDS seguida do transplante autólogo como terapia de salvamento através da sobrevida global, livre de doença e livre de progressão bem como sua toxicidade. Realizou-se estudo retrospectivo com 106 pacientes com LNH de alto grau de malignidade entre 1998 e 2006. A mediana de idade foi 45 anos (8-65; 62% homens; DLBCL, 78%; 12%, T e anaplásico e 9%, linfoma da zona do manto; 87%, células B; 83% estádios III-IV; 63% com sintomas B; 32% com infiltração da medula óssea ao diagnóstico; 62% com grande massa e 42% com IPI de alto risco ou intermediário. Após alta dose de ciclofosfamida (HDCY, nove pacientes faleceram. Oitenta pacientes realizaram o transplante, sendo que 47% estavam em RC e 15% faleceram devido à toxicidade. A sobrevida global foi de 45% em oito anos para estes pacientes. Trinta e cinco pacientes não realizaram o transplante por causas diversas. Sobre