11/30. Jugular foramen tumors: diagnosis and treatment.OBJECT: Jugular foramen tumors are rare skull base lesions that present diagnostic and complex management problems. The purpose of this study was to evaluate a series of patients with jugular foramen tumors who were surgically treated in the past 16 years, and to analyze the surgical technique, complications, and outcomes. methods: The authors retrospectively studied 102 patients with jugular foramen tumors treated between January 1987 and May 2004. All patients underwent surgery with a multidisciplinary method combining neurosurgical and ear, nose, and throat techniques. Preoperative embolization was performed for paragangliomas and other highly vascularized lesions. To avoid postoperative cerebrospinal fluid (CSF) leakage and to improve cosmetic results, the surgical defect was reconstructed with specially developed vascularized flaps (temporalis fascia, cervical fascia, sternocleidomastoid muscle, and temporalis muscle). A saphenous graft bypass was used in two patients with tumor infiltrating the internal carotid artery (ICA). facial nerve reconstruction was performed with grafts of the great auricular nerve or with 12th/seventh cranial nerve anastomosis. Residual malignant and invasive tumors were irradiated after partial removal. The most common tumor was paraganglioma (58 cases), followed by schwannomas (17 cases) and meningiomas (10 cases). Complete excision was possible in 45 patients (77.5%) with paragangliomas and in all patients with schwannomas. The most frequent and also the most dangerous surgical complication was lower cranial nerve deficit. This deficit occurred in 10 patients (10%), but it was transient in four cases. Postoperative facial and cochlear nerve paralysis occurred in eight patients (8%); spontaneous recovery occurred in three of them. In the remaining five patients the facial nerve was reconstructed using great auricular nerve grafts (three cases), sural nerve graft (one case), and hypoglossal/facial nerve anastomosis (one case). Four patients (4%) experienced postoperative CSF leakage, and four (4.2%) died after surgery. Two of them died of aspiration pneumonia complicated with septicemia. Of the remaining two, one died of pulmonary embolism and the other of cerebral hypoxia caused by a large cervical hematoma that led to tracheal deviation. CONCLUSIONS: Paragangliomas are the most common tumors of the jugular foramen region. Surgical management of jugular foramen tumors is complex and difficult. Radical removal of benign jugular foramen tumors is the treatment of choice, may be curative, and is achieved with low mortality and morbidity rates. Larger lesions can be radically excised in one surgical procedure by using a multidisciplinary approach. Reconstruction of the skull base with vascularized myofascial flaps reduces postoperative CSF leaks. Postoperative lower cranial nerves deficits are the most dangerous complication.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
12/30. Avellis syndrome after minor head trauma: report of two cases.Avellis syndrome is a rare condition that usually occurs in association with infarction of the medulla oblongata or mass lesions around the jugular foramen; this syndrome has rarely been reported after trauma. Two cases of Avellis syndrome that occurred following minor head trauma are presented. The mechanism by which Avellis syndrome is produced is briefly discussed. The relative resistance to damage of the spinal accessory nerve was thought to play an important role in producing the peripheral type of Avellis syndrome. The outcome was favorable in both cases.- - - - - - - - - - ranking = 0.91120680768094keywords = accessory nerve, nerve, accessory (Clic here for more details about this article) |
13/30. Reconstruction of the spinal accessory nerve with autograft or neurotube? Two case reports.Injury to the spinal accessory nerve is most commonly iatrogenic, but can be related to cervical trauma or resection of tumor. Of the two most recent publications related to injury of the spinal accessory nerve, one describes transfer of the levator scapulae muscle to restore shoulder function, while the other reports on the results of six surgical repairs, three of which used a sural nerve graft to reconstruct a short neural defect. The present report describes the results obtained in two patients when an iatrogenic injury to the XIth nerve was reconstructed at 3 months after the loss of shoulder function. denervation of the XIth nerve was confirmed by a first EMG at 6 weeks, and a second one at 12 weeks. At surgery, each XIth nerve was found to have an in-continuity neuroma, most probably related to electrocoagulation. Intraoperative electrical stimulation did not pass the region of nerve injury. In the first patient, the XIth nerve was reconstructed with an autograft from the greater auricular nerve. In the second patient, the XIth nerve was reconstructed with a bioabsorbable conduit, the Neurotube. The patient with the Neurotube reconstruction reached M5 trapezius function by 3 months after surgery, and had no nerve graft donor-site morbidity, while the patient with the autograft reached M4 function by 6 months after reconstruction, and has persistent numbness of the ear lobe. This is the first reported case of a cranial motor nerve being reconstructed with a bioabsorbable conduit.- - - - - - - - - - ranking = 11.497581642758keywords = nerve injury, accessory nerve, nerve, injury, accessory (Clic here for more details about this article) |
14/30. Progressive cranial nerve palsy following shunt placement in an isolated fourth ventricle: case report.Cranial nerve palsy is rarely seen after shunt placement in an isolated fourth ventricle. In the few reports of this complication, neuropathies are thought to be caused by catheter injury to the brainstem nuclei either during the initial cannulations or after shrinkage of the fourth ventricle. The authors treated a child who suffered from delayed, progressive palsies of the sixth, seventh, 10th, and 12th cranial nerves several weeks after undergoing ventriculoperitoneal shunt placement in the fourth ventricle. magnetic resonance imaging revealed the catheter tip to be placed well away from the ventricular floor but the brainstem had severely shifted backward, suggesting that the pathogenesis of the neuropathies was traction on the affected cranial nerves. The authors postulated that the siphoning effect of the shunt caused rapid collapse of the fourth ventricle and while the cerebellar hemispheres were tented back by adhesions to the dura, the brainstem became the only mobile component in response to the suction forces. Neurological recovery occurred after surgical opening of the closed fourth ventricle and lysis of the basal cistern adhesions, which restored moderate ventricular volume and released the brainstem to its normal position.- - - - - - - - - - ranking = 0.73182909092245keywords = nerve, injury (Clic here for more details about this article) |
15/30. role of computerized tomography in management of impacted mandibular third molars.Nerve injury following mandibular third molar (M3) removal is a rare but serious complication. The purpose of this article is to review the role of currently available imaging technologies to facilitate clinical decision-making in the setting of M3 surgery. Given findings suggestive of high risk for inferior alveolar nerve (IAN) injury, the clinician should consider additional imaging to assess better the anatomic relationship of the IAN and M3.- - - - - - - - - - ranking = 0.1636581818449keywords = nerve, injury (Clic here for more details about this article) |
16/30. Isolated 5th to 10th cranial nerve palsy in closed head trauma.Isolated involvement of the 5th through 10th cranial nerves, in blunt head trauma, without any other neurological deficit, is extremely rare. Two such cases are reported and relevant literature reviewed. The mechanics of trauma involved and the poor recovery is outlined.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
17/30. Transient palsy of peripheral cranial nerves following open heart surgery.A 32-year-old man developed hoarseness of voice, inability to swallow and restricted movement of the tongue after open heart surgery. Peripheral injury of the cranial nerves IX, X and XII was suspected, and it was thought that the duration of the surgery together with the endotracheal tube cuff and trans-oesophageal echocardiography probe pressure, as well as the head and neck position might have been the causes of this complication.- - - - - - - - - - ranking = 0.53182909092245keywords = nerve, injury (Clic here for more details about this article) |
18/30. Mental nerve paresthesia associated with endodontic paste within the mandibular canal: report of a case.The present study describes a case of endodontic paste (Endomethasone) penetration within and along the mandibular canal from the periapical zone of a lower first premolar following endodontic treatment of the latter. The clinical manifestations comprised anesthesia of the right side of the lower lip and paresthesia of the gums in the fourth quadrant, appearing immediately after endodontic treatment. The lip anesthesia was seen to decrease, with persistence of the gingival paresthesia, after 7 months.- - - - - - - - - - ranking = 0.4keywords = nerve (Clic here for more details about this article) |
19/30. Inferior alveolar nerve injury related to surgery for an erupted third molar.Removal of third molars is one of the most common operations performed in oral surgery. A well recognized serious complication of mandibular third molar extraction is injury to the inferior alveolar nerve (IAN). We describe a case of an unusual nerve passage discovered after the extraction of a completely erupted third molar. The likelihood of direct damage to the IAN can be predicted with more specific information obtained by the use of a preoperative computerized tomography scan when conventional radiography does not clearly show the nerve canal.- - - - - - - - - - ranking = 20.59855955023keywords = nerve injury, nerve, injury (Clic here for more details about this article) |
20/30. Lower cranial nerve palsies. Potentially lethal in association with upper cervical fracture-dislocations.Palsies of the lower cranial nerves occurred in association with traumatic atlantoaxial dissociations in two patients. The fracture-dislocations sustained were rare injuries and the neurologic complications contributed greatly to their morbidity and mortality.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
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