1/30. Stereotactic radiosurgery for jugular foramen schwannomas.BACKGROUND: Jugular foramen schwannomas pose difficult management problems because of the surgical risk of lower cranial neuropathy. The indications and results of stereotactic radiosurgery are not well documented. methods: We reviewed our 10-year experience in the management of 17 patients who had jugular foramen schwannomas managed with the gamma knife. Thirteen patients previously had undergone surgery (range, 1-6 resections). Four patients had multiple cranial nerve deficits before microsurgical resection; 12 developed multiple lower cranial nerve palsies after resection. Four patients underwent radiosurgery based on imaging criteria alone. Conformal dose planning (tumor margin dose of 12-18 Gy) successfully encompassed the irregular tumor volumes in all patients. RESULTS: Follow-up varied from 6 to 74 months. Tumor size decreased in eight patients, remained stable in eight, and increased in one patient during the average follow-up interval of 3.5 years. Six patients improved and 10 others retained their preradiosurgery clinical status. One patient had an increase in tumor size and clinical deterioration 6 months after radiosurgery and underwent microsurgical resection. No patient developed new cranial nerve or other neurological deficits after radiosurgery. CONCLUSIONS: We believe that gamma knife radiosurgery is an effective alternative to microsurgical resection for patients who have small tumors and intact lower cranial nerve function. It is also effective for patients who have residual or recurrent tumors after microsurgical resection.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/30. Avulsion fracture of the anterior half of the foramen magnum involving the bilateral occipital condyles and the inferior clivus--case report.A 38-year-old male presented with an avulsion fracture of the anterior half of the foramen magnum due to a traffic accident. He had palsy of the bilateral VI, left IX, and left X cranial nerves, weakness of his left upper extremity, and crossed sensory loss. He was treated conservatively and placed in a halo brace for 16 weeks. After immobilization, swallowing, hoarseness, and left upper extremity weakness improved. Hyperextension with a rotatory component probably resulted in strain in the tectorial membrane and alar ligaments, resulting in avulsion fracture at the sites of attachment, the bilateral occipital condyles and the inferior portion of the clivus. Conservative treatment is probably optimum even for this unusual and severe type of occipital condyle fracture.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
3/30. Transverse clivus fracture: case presentation and significance of clinico-anatomic correlations.BACKGROUND: Bilateral transverse basal skull fractures resulting from lateral crushing injuries involve fractures of the clivus that present clinically with multiple cranial nerve injuries and possible delayed vascular injuries due to the tight neural and vascular entry and exit routes present in this region. A case of a young patient with an extensive basal skull fracture is presented with description of the clinical signs and symptoms in relation to the neuroradiological findings. Clinico-anatomic correlations have been reiterated. CASE DESCRIPTION: A case of a young patient suffering a bilateral crush injury resulting in a basal transverse clivus and petrous bone fracture is presented. Multiple cranial nerve injuries, unilateral and bilateral, were present (CN III, VI, VII). This clinical presentation correlated well with the anatomical location and extension of the respective cranial nerves at the level of the skull base and along the fracture line extending bilaterally through the clivus and petrous bone. CONCLUSIONS: Initial neurological and neuroradiological investigations should be aimed at promptly detecting cranial nerve injuries and their correlating fracture injuries at the skull base. The possible development and progression of delayed neurological deficits should also be kept in mind and investigated.- - - - - - - - - - ranking = 1.0795727273061keywords = nerve, injury (Clic here for more details about this article) |
4/30. Bilateral hypoglossal nerve injury following the use of the laryngeal mask airway.A healthy 54-year-old man undergoing elective knee arthroscopy developed bilateral hypoglossal nerve palsy, lasting 6 weeks following the use of a laryngeal mask airway. He suffered impairment of speech and difficulty in swallowing, the latter resulting in almost 7 kg loss of weight within 2 weeks of surgery. We discuss the possible aetiology of the injury and review the literature describing injuries to the hypoglossal nerve.- - - - - - - - - - ranking = 51.246398875576keywords = nerve injury, nerve, injury (Clic here for more details about this article) |
5/30. Inferior alveolar nerve injury related to mandibular third molar surgery: an unusual case presentation.Perforation of the lower third molar roots by the inferior alveolar nerve is uncommon and can be difficult to determine by conventional radiographic methods. Presented is a case of perforation that was treated by coronectomy, and showed an unusual complication in that the retained root erupted, moving the canal with it. The radiographic assessment of root perforation and the imaging modalities used to assess such cases are discussed.- - - - - - - - - - ranking = 50.91682614827keywords = nerve injury, nerve, injury (Clic here for more details about this article) |
6/30. Skull-base trauma: neurosurgical perspective.Trauma to the cranial base can complicate craniofacial injuries and lead to significant neurological morbidity, related to brain and/or cranial nerve injury. The optimal management involves a multidisciplinary effort. This article provides the neurosurgeon's perspective in management of such trauma using a 5-year retrospective analysis of patients sustaining skull-base trauma. The salient features of anterior and middle skull-base (temporal bone) trauma are summarized, and the importance of frontal basilar trauma as well as brain injury is evident. With these injuries, all cranial nerves (except 9 to 12) are at risk; the olfactory nerve and the facial nerve are the first and second, respectively, to sustain injuries. This retrospective analysis provides a better understanding of cranial base trauma and its management. It emphasizes the multifaceted nature of such trauma and the need to recognize anterior skull-base complications, including cerebrospinal fluid leak and brain injury.- - - - - - - - - - ranking = 13.57585199168keywords = nerve injury, nerve, injury (Clic here for more details about this article) |
7/30. Tapia's syndrome following shoulder surgery.Multiple cranial palsy occurred after shoulder surgery in the sitting position. Compression by the tracheal tube, caused by displacement of the head, may have caused the injury.- - - - - - - - - - ranking = 0.079572727306124keywords = injury (Clic here for more details about this article) |
8/30. Bilateral occipital neuropathy as a rare complication of positioning for thyroid surgery in a morbidly obese patient.BACKGROUND: Peripheral neuropathies in various locations are described as complications after anesthesia and surgery. This is the first case report of temporary bilateral occipital neuropathy from positioning for thyroid surgery in a morbidly obese patient. methods: A 48-year-old women with a history of depression, fibro-myalgia, asthma, sleep apnea, diabetes mellitus and morbid obesity (127 kg, 165 cm) underwent 4 hours anesthesia with propofol/remifentanil without muscle relaxation for thyroid surgery. The neck with a very low range of motion secondary to fat tissue needed to be extended to facilitate surgery as much as possible. The head was carefully padded and there were no episodes of hypotension or hypoxemia throughout the case or in the PACU. At post op day 1 she complained of bilateral numbness in the distribution area of both greater occipital nerves. On post op day 2 tingling sensations and improvement of numbness was noticed. The patient recovered without residual symptoms after 6 weeks. CONCLUSION: pressure or shear stress to the nerve, hypoperfusion or metabolic disturbances are discussed as the leading etiology of nerve damage during surgery in the literature. pressure from fat tissue during prolonged head extension for surgery seems to be the cause in this case and should therefore be avoided whenever possible in morbidly obese patients, especially when other risk factors for neuropathy like diabetes are present.- - - - - - - - - - ranking = 0.75keywords = nerve (Clic here for more details about this article) |
9/30. Inferior alveolar nerve paresthesia relieved by microscopic endodontic treatment.We experienced two cases of inferior alveolar nerve paresthesia caused by root canal medicaments, which were successfully relieved by microscopic endodontic treatment. In the first case, the paresthesia might have been attributable to infiltration of calcium hydroxide into the mandibular canal through the root canals of the mandibular left second molar tooth. In the second case, the paresthesia might have been attributable to infiltration of paraformaldehyde through the root canals of the mandibular right second molar tooth. The paresthesia was relieved in both cases by repetitive microscopic endodontic irrigation using physiological saline solution in combination with oral vitamin B12 and adenosine triphosphate.- - - - - - - - - - ranking = 1.25keywords = nerve (Clic here for more details about this article) |
10/30. Inferior alveolar nerve injury caused by thermoplastic gutta-percha overextension.Injuries to the inferior alveolar nerve following trauma resulting in a mandibular fracture are well documented and are a well-known risk when surgical procedures are planned for the mandible in the region of the inferior alveolar canal. Such injuries are relatively rare following endodontic therapy. This article reports a case of combined thermal and pressure injury to the inferior alveolar nerve, reviews the pathogenesis of such an injury and makes suggestions for its management.- - - - - - - - - - ranking = 51.325971602882keywords = nerve injury, nerve, injury (Clic here for more details about this article) |
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