1/33. Surgical findings in idiopathic trigeminal neuropathy mimicking a trigeminal neurinoma.Idiopathic trigeminal neuropathy is a benign disorder where the main clinical feature is facial numbness limited to the territory of one or more divisions of the trigeminal nerve, persisting for a few weeks to several years and in which no underlying disease can be identified. The case of a 37-year-old man with a brief history of sensory and motor trigeminal symptoms who showed magnetic resonance imaging (MRI) findings consistent with a small trigeminal neurinoma is reported. The patient was operated on but no tumour could be found during surgery and a biopsy was taken from the portio major. Pathological diagnosis was chronic non granulomatous inflammatory reaction with areas of coagulation necrosis. Control MRI showed complete resolution of the trigeminal abnormalities. It is concluded that in patients with MRI findings suggestive of a small trigeminal schwannoma, benign idiopathic trigeminal neuropathy should also be considered in the differential diagnosis. A conservative approach with sequential MRI studies may avoid an unnecessary surgical exploration.- - - - - - - - - - ranking = 1keywords = neuropathy (Clic here for more details about this article) |
2/33. 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 = 0.16666666666667keywords = neuropathy (Clic here for more details about this article) |
3/33. The double-crush phenomenon--an unusual presentation and literature review.The double-crush syndrome was initially described by Upton and McComas in 1973. They postulated that nonsymptomatic impairment of axoplasmic flow at more than one site along a nerve might summate to cause a symptomatic neuropathy. This was suggested by their clinical observation that the majority of their patients had a median or ulnar neuropathy associated with evidence of cervicothoracic root lesions. They also hypothesized that one of the constraints on axoplasmic flow could be a metabolic neuropathy, and this is supported by the high association of diabetes and carpal tunnel syndrome. Other researchers have since reported series of patients supporting the frequent association of a proximal and distal nerve compression syndrome, including carpal tunnel syndrome associated with cervical radiculopathy, brachial plexus compression, and diabetic neuropathy. Subsequently, MacKinnon and Dellon have expanded the description of this syndrome to include a) multiple anatomic regions along a peripheral nerve, b) multiple anatomic structures across a peripheral nerve within an anatomic region, c) superimposed on a neuropathy, and d) combinations of the above. We present an unusual case of symptomatic nerve compression caused by two nonanatomic structures within an anatomic region.- - - - - - - - - - ranking = 14.243247224088keywords = tunnel, tunnel syndrome, neuropathy (Clic here for more details about this article) |
4/33. Schwannoma of the suprascapular nerve presenting with atypical neuralgia: case report and review of the literature.Compressive lesions of the suprascapular nerve produce weakness and atrophy of the supra- and infraspinatus muscles and a poorly defined aching pain along the posterior aspect of the shoulder joint and the adjacent scapula. Entrapment neuropathy of the suprascapular nerve is fairly common whereas tumorous lesions are rare; among the latter ganglion cysts are frequently seen. An isolated solitary schwannoma of the suprascapular nerve presenting with atypical neuralgic pain is exceptional. The location of a schwannoma under the firm deep cervical fascia in the posterior triangle of the neck is implicated in the genesis of neuralgic pains mimicking the suprascapular entrapment syndrome. One such case is reported with discussion of the relevant clinical features.- - - - - - - - - - ranking = 0.16666666666667keywords = neuropathy (Clic here for more details about this article) |
5/33. tarsal tunnel syndrome secondary to neurilemoma--a case report.Peripheral nerve entrapment syndromes in the foot include those symptom complexes that are primarily neurologic in origin and result from embarrassment to any of the peripheral nerve trunks or branches of the foot. tarsal tunnel syndrome usually is precipitated by compression of the tibial nerve posterior and distal to the medial malleolus. A neurilemoma is relatively uncommon in the foot. It is usually a solitary tumor that is almost exclusively benign and can be removed without jeopardizing the integrity of the nerve. diagnosis is based on a thorough history and clinical pictures. Certain diagnostic modalities, ultrasound and MRI, have been employed to aid in diagnosis. Surgical excision of the tumor remains the treatment of choice.- - - - - - - - - - ranking = 33.524784726886keywords = tunnel, tunnel syndrome (Clic here for more details about this article) |
6/33. Neurilemoma of the medial plantar nerve: a case report.The incidence of neurilemoma in the foot is uncommon. Neurilemoma of the medial plantar nerve distal to the tarsal tunnel, with symptoms isolated to the foot, is rare. A case presentation of neurilemoma arising from the distal portion of the medial plantar nerve that was identified and excised is presented with a 19-month follow-up.- - - - - - - - - - ranking = 1374.642006119keywords = tarsal tunnel, tunnel (Clic here for more details about this article) |
7/33. Reversible cochleo-vestibular deficits in two cases of jugular foramen tumor after surgery.Primary jugular foramen (JF) tumor, such as glomus jugular tumor or JF schwannoma, may manifest as a lower cranial nerve deficit; in addition, it can be accompanied by deafness or vertigo if it affects the cranial nerve (CN) VIII. Recently, we encountered JF schwannoma 1 and glomus jugulare tumor 1. Both cases invaded the adjacent cerebellopontine angle, leading to cochleo-vestibular deficits prior to the operation. After surgery, recovery of the audiovestibular function, including hearing, auditory brainstem response and caloric response, was anticipated in both patients. Therefore, cochleo-vestibular deficits in JF tumors can be attributed to compression neuropathy, rather than tumor infiltration.- - - - - - - - - - ranking = 0.16666666666667keywords = neuropathy (Clic here for more details about this article) |
8/33. Multiple schwannomas of the median nerve: a case report and literature review.We report a case of multiple schwannomas of the median nerve. Multiple schwannomas can be difficult to diagnose on clinical grounds and can be mistakenly diagnosed as carpal tunnel syndrome or ganglia as in our case. Nerve conduction studies helped locate non-visible tumours. magnetic resonance imaging (MRI) is useful in the preoperative planning of these tumours. The appearances on scanning however can be sometimes confused for ganglia as in this case. Intraneural dissection of the schwannomas was carried out and the pathology is described.- - - - - - - - - - ranking = 6.7049569453773keywords = tunnel, tunnel syndrome (Clic here for more details about this article) |
9/33. Abducens schwannoma inside the cavernous sinus proper: case report.BACKGROUND: Only 2 cases of abducens nerve schwannoma solely inside the cavernous sinus have been reported. In both cases, abducens nerve palsy remained after operation. We report the first case of abducens nerve schwannoma inside the cavernous sinus proper with postoperative recovery from abducens nerve palsy. CASE DESCRIPTION: The patient was a 47-year-old female who developed left abducens and trigeminal nerve palsies. Neuroradiological examination revealed left intra-cavernous sinus tumor. Total removal of the tumor was performed. The location of the tumor was confirmed intraoperatively inside the cavernous sinus itself, with no relation to the trigeminal nerve. Further, the relation of the tumor to one particular nerve fiber within the abducens nerve bundle was confirmed inside the cavernous sinus. After surgery, the patient had transient abducens nerve palsy. It had totally disappeared by 6 months. CONCLUSION: When the tumor origin is just within the spacious cavernous sinus rather than more posterior in the narrow dural tunnel of Dorello's canal, successful preservation of the nerve function is possible postoperatively through a thorough knowledge of the membranous anatomy and careful preoperative study of the radiographic findings.- - - - - - - - - - ranking = 3.8575137560686keywords = tunnel (Clic here for more details about this article) |
10/33. A very large Schwannoma originating from the median nerve in carpal tunnel.Schwannomas are common benign nerve tumors occurring in the peripheral nerves. A very large schwannoma of more than 5 years duration, originating from the median nerve in the carpal tunnel in a 38-year-old woman, is reported. There was a painful mass, 60 mm in length and 42 mm in diameter, on the palm without signs of sensory disturbance or atrophy on the thenar muscles. Surgical removal was performed under high-power magnification by separating the sensory and motor fascicles from the tumor. Histological examination resulted in a Schwannoma. At 4-year follow-up, the patient was asymptomatic with excellent relief of symptoms. The tumor did not recur. Although cases have been reported in the literature, this is one of the largest ever described without any neurologic deficit.- - - - - - - - - - ranking = 19.287568780343keywords = tunnel (Clic here for more details about this article) |
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