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Li B, Luo C, Jin Y, Yi Y, Cheng D, Huang L, Wang G, Zhong X, Zhao H, Gao M. Evaluating magnetic resonance imaging characteristics and risk factors for hemifacial spasm. Brain Behav 2024; 14:e3438. [PMID: 38409893 PMCID: PMC10897361 DOI: 10.1002/brb3.3438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE The specific neurovascular compression (NVC) event responsible for the symptomatic manifestation of hemifacial spasm (HFS) remains difficult to assess accurately using magnetic resonance imaging (MRI). We aim to evaluate the MRI characteristics of HFS. METHOD We retrospectively included patients with HFS and divided them into a test group (n = 186) and a validation group (n = 28). The presence, severity, and offending vessel type of NVC in each portion, and the orientation of the offending vessel around the facial nerve, were recorded. Conditional logistic regression analyses were performed to evaluate correlations using test group. The validation group was used to verify whether our findings improved diagnostic performance. RESULTS Deformity in the proximal cisternal segment was significantly correlated with HFS occurrence (odds ratio [OR]: 256.58, p = .002), whereas contact was not (p = .233). Both contact and deformity in the root detachment point (OR: 19.98 and 37.22, p < .001 and p = .013, respectively) or attached segment (OR: 4.99 and 252.52, p = .001 and p < .001, respectively) were significantly correlated with HFS occurrence. Our findings improved specificity, positive predictive value, and accuracy of diagnosis than conventional diagnostic methods. The vertebral artery predominantly compress the facial nerve in the inferior-anterior position, the anterior inferior cerebellar artery predominantly in the inferior position, the posterior inferior cerebellar artery predominantly in the inferior position, vein predominantly in the posterior-superior position. CONCLUSIONS This study further demonstrates that within the susceptible portion of facial nerve, different portions of the nerve respond differently to NVC. Each offending vessel has its own preferred conflict orientation. Our study offers reference for neurosurgeons in diagnosis and treatment.
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Affiliation(s)
- Bo Li
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
- Sun Yat‐Sen UniversityGuangzhouGuangdong ProvinceChina
| | - Chun Luo
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Yabin Jin
- Institute of Translational MedicineThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Ying Yi
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Dongliang Cheng
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Linwen Huang
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Guofu Wang
- Department of Functional NeurosurgeryThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Xuguang Zhong
- Department of Functional NeurosurgeryThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Hai Zhao
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Mingyong Gao
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
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Gupta T, Munawara R, Kaur M, Ram K, Rao A, Gupta S, Gupta SK. Central myelin-peripheral myelin junction in trigeminal, facial, and vestibulocochlear nerve: A histo-morphometric study. Ann Anat 2023; 250:152128. [PMID: 37399929 DOI: 10.1016/j.aanat.2023.152128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The study aimed to locate the central myelin and peripheral myelin junction (CNS PNS Junction, CPJ) in trigeminal, facial and vestibulocochlear nerves. METHODS The cisternal segments of the nerves were cut from the brainstem to the proximal margin of trigeminal ganglia (trigeminal nerve) and internal acoustic meatus (facial and vestibulocochlear nerve) from cadavers. Horizontal sections of H&E stained slides were analysed and histo morphometry was performed. The CPJ was confirmed by immunohistochemistry using monoclonal myelin basic protein antibody. RESULTS The mean length of the trigeminal, facial and vestibulocochlear nerves were 13.6 ± 3.1 mm, 12.4 ± 1.9 mm and 11.5 ± 2.0 mm respectively; mean length of the centrally myelinated segment at the point of maximum convexity was 4.1 ± 1.5 mm, 3.7 ± 1.6 mm, 3.6 ± 1.4 mm respectively. Six different patterns were observed fortheCPJ.Utilizing the derived values, the CPJwas located at a distance of 18 - 48% and 17 - 61% of the total length of the nerve in all the cases in trigeminal and facial nerve respectively. In vestibulocochlear nerve, it was located at a distance of about 13 - 54% of the total length of the nerve. CONCLUSIONS The location of the CPJ in the vestibulocochlear nerve was midway between the brainstem and internal acoustic meatus which is a novel observation.For all the nerves, the CPJ was located either at or before the half way along the length of the nerve in huge majority (97%); never crossing the 60% of the nerve length.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Rafika Munawara
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Mandeep Kaur
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Kalu Ram
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Asha Rao
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shivani Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sunil Kumar Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Reoperation for residual or recurrent hemifacial spasm after microvascular decompression. Acta Neurochir (Wien) 2022; 164:2963-2973. [PMID: 35922722 DOI: 10.1007/s00701-022-05315-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/10/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE Microvascular decompression (MVD) surgery is the only potential curative method for hemifacial spasm (HFS). Little attention is paid to those recurrent/residual HFS cases. We want to study the potential etiology of those recurrent/residual HFS cases and evaluate the value of reoperation. METHODS We retrospectively reviewed reoperation hemifacial spasm patients in our hospital. Intraoperative videos or images were carefully reviewed, and the etiology of recurrent/residual HFS is roughly divided into three categories. Intraoperative findings, surgical outcomes, and complications were carefully studied to assess the value of reoperation for recurrent/residual HFS patients. RESULTS A total of 28 cases were included in our case series. Twenty-three of them are recurrent HFS cases, and 5 of them are residual HFS cases. The mean follow-up duration is 24.96 months. There are seventeen patients with missed culprit vessels or insufficient decompression of root exit zone (REZ), eight patients with Teflon adhesion, and three patients with improper application of decompression materials in our case series. The final reoperation outcome with 17 excellent, seven good, and four fair, respectively. Eight (28.57%) of them experienced long-term complications after reoperation. CONCLUSION Re-operation for recurrent/residual HFS is an effective therapy and can achieve a higher cure rate. However, the complication rate is higher compared to the first MVD surgery. Accurately identifying REZ and proper decompression strategies to deal with the culprit vessels are very important for surgical success. TRIAL REGISTRATION NUMBER UIN: researchregistry7603. Date of registration: Jan. 31st, 2022 "retrospectively registered".
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Hemifacial Spasm Caused by Distal Neurovascular Compression Confirmed by Lateral Spread Response Monitoring. J Craniofac Surg 2022; 33:2555-2559. [DOI: 10.1097/scs.0000000000008820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 02/04/2023] Open
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Klenzner T, Glaas M, Volpert S, Jansen N, Kristin J, Schipper J. Cochlear Implantation in Patients With Single-sided Deafness After the Translabyrinthine Resection of the Vestibular Schwannoma-Presented at the Annual Meeting of ADANO 2016 in Berlin. Otol Neurotol 2020; 40:e461-e466. [PMID: 30870381 DOI: 10.1097/mao.0000000000002181] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate effectiveness of the cochlear implant (CI) to facilitate single-sided deafness (SSD) rehabilitation following translabyrinthine resection of the vestibular schwannoma. STUDY DESIGN Retrospective patient review. SETTING Single center, University hospital. PATIENTS Patients with SSD who underwent translabyrinthine resection of a vestibular schwannoma with anatomical preservation of the cochlear nerve and subsequent CI on the same ear. INTERVENTIONS CI at post-translabyrinthine resection of the acoustic neuroma to treat SSD, and evaluation by retrospective individual case review in a period from 2009 to 2016. MAIN OUTCOME MEASURES Individual patients' clinical outcome and speech understanding. RESULTS Thirteen patients were provided CI. In all cases, complete removal of the tumor was achieved and the cochlear nerve was preserved; in one case, the CI was implanted simultaneously. In most cases, the follow-up interval was 2 years. In 9 of 13 cases, the implanted ear achieved capability to understand and discriminate monosyllabic words at 65 dB. Level of speech understanding of over 50% at 65 dB was possible in 7 patients at 12 months after the first fitting of CI. CONCLUSIONS Under certain conditions, CI was an effective solution to restore hearing in patients with SSD following translabyrinthine access to the skull base. Study with prospective design is required to provide more significant results.
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Affiliation(s)
- Thomas Klenzner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
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Constanzo F, Teixeira BCDA, Sens P, Escuissato D, Ramina R. Cerebellopontine angle schwannomas arising from the intermediate nerve: a scoping review. Neurosurg Rev 2019; 43:1431-1441. [PMID: 31522300 DOI: 10.1007/s10143-019-01173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Abstract
Intermediate nerve schwannomas (INS) are extremely rare lesions in literature. They have been described mimicking facial nerve schwannomas, but not vestibular schwannomas (VS). We aimed to review the previously published cases, as well as the evidence to believe that they are far more common, though usually misdiagnosed as facial or VS. We performed a review of PubMed/Medline and Embase of "intermediate nerve schwannoma," "facial nerve schwannoma," "greater superficial petrosal nerve schwannoma," "geniculate ganglion schwannoma," and "chorda tympani schwannoma" to identify all cases of INS, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement. Furthermore, 2 cases operated at our center are shown to exemplify the proposed hypotheses. No article was excluded from review. Thirteen cases of INS, 11 cases of chorda tympani schwannoma, and 18 cases of greater superficial petrosal nerve schwannoma were found in literature. In facial nerve schwannomas, the predilection of schwannomas for sensory nerves, and the ability to preserve the motor facial nerve during tumor resection support the hypothesis of intermediate nerve as the nerve of origin. For VSs, the different arachnoidal arrangement of medial VS, the sharing of pia mater by the intermediate nerve and vestibular nerve, and the medial Obersteiner-Redlich zone of the intermediate nerve, support the hypothesis of intermediate nerve origin of some VS. The correct identification of the intermediate nerve as a nerve of origin of cerebellopontine angle schwannomas is of uttermost importance, especially when mistaken for VS, as this may account for the heterogeneity of facial and cochlear outcomes after surgery.
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Affiliation(s)
- Felipe Constanzo
- Neurosurgery Department, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil.
| | - Bernardo Corrêa de Almeida Teixeira
- Neuroradiology Department, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil.,Internal Medicine Department, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Patricia Sens
- Otolaryngology Department, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil
| | - Dante Escuissato
- Internal Medicine Department, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Ricardo Ramina
- Neurosurgery Department, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil
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Inoue T, Shima A, Hirai H, Suzuki F, Matsuda M. Nervus Intermedius Neuralgia Treated with Microvascular Decompression: A Case Report and Review of the Literature. NMC Case Rep J 2017; 4:75-78. [PMID: 28840083 PMCID: PMC5566688 DOI: 10.2176/nmccrj.cr.2016-0261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/11/2017] [Indexed: 11/20/2022] Open
Abstract
Nervus intermedius neuralgia is one of the craniofacial neuralgias, which is extremely rare compared with trigeminal or glossopharyngeal neuralgia. Despite its unique symptom, the aetiology remains unclear. We present a case of a surgically treated 36-year-old woman who suffered from paroxysmal stabbing deep-ear pain for over 10 years. Preoperative magnetic resonance imaging demonstrated a vascular loop compressing the root entry zone of the vestibulocochlear nerve between the seventh and eighth cranial nerves, suggesting nervus intermedius neuralgia as a cause of her pain. Surgical exploration revealed that the nervus intermedius was displaced upward by the anterior inferior cerebellar artery. Transposition of the artery from the brainstem relieved the patient’s neurological symptom immediately after the surgery, supporting the hypothesis that nervus intermedius neuralgia could be caused by neurovascular compression.
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Affiliation(s)
- Takuro Inoue
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Ayako Shima
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Hisao Hirai
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Fumio Suzuki
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Masayuki Matsuda
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
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Neural connections between the nervus intermedius and the facial and vestibulocochlear nerves in the cerebellopontine angle: an anatomic study. Surg Radiol Anat 2015; 38:619-23. [PMID: 26470871 DOI: 10.1007/s00276-015-1571-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Unexpected clinical outcomes following transection of single nerves of the internal acoustic meatus have been reported. Therefore, this study aimed to investigate interneural connections between the nervus intermedius and the adjacent nerves in the cerebellopontine angle. METHODS On 100 cadaveric sides, dissections were made of the facial/vestibulocochlear complex in the cerebellopontine angle with special attention to the nervus intermedius and potential connections between this nerve and the adjacent facial or vestibulocochlear nerves. RESULTS A nervus intermedius was identified on all but ten sides. Histologically confirmed neural connections were found between the nervus intermedius and either the facial or vestibulocochlear nerves on 34 % of sides. The mean diameter of these small interconnecting nerves was 0.1 mm. The fiber orientation of these nerves was usually oblique (anteromedial or posterolateral) in nature, but 13 connections traveled anteroposteriorly. Connecting fibers were single on 81 % of sides, doubled on 16 %, and tripled on 3 %, six sides had connections both with the facial nerve anteriorly and the vestibular nerves posteriorly. On 6.5 % of sides, a connection was between the nervus intermedius and cochlear nerve. For vestibular nerve connections with the nervus intermedius, 76 % were with the superior vestibular nerve and 24 % with the inferior vestibular nerve. CONCLUSIONS Knowledge of the possible neural interconnections found between the nervus intermedius and surrounding nerves may prove useful to surgeons who operate in these regions so that inadvertent traction or transection is avoided. Additionally, unanticipated clinical presentations and exams following surgery may be due to such neural interconnections.
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Free-running EMG monitoring during microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 2015; 157:1505-12. [PMID: 26143309 DOI: 10.1007/s00701-015-2492-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this work is to determine if free-running electromyography (frEMG) can detect activity before and after microvascular decompression (MVD) treatment for hemifacial spasm (HFS), and to evaluate correlations of frEMG findings with abnormal muscle responses (AMRs) or facial motor-evoked potentials (FMEPs). METHODS To elicit nerve responses while carrying out frEMG recording before and after MVD, saline, a lactic solution, or artificial cerebrospinal fluid was injected onto the root exit zone of the facial nerve. RESULTS Significantly higher frEMG activity was observed following saline injection than for the other solutions (p < 0.01). For frEMG activity ratios of ≥ 50 %, there was a trend towards a greater likelihood of persistent AMRs. When frEMG activity decreased after MVD in the mentalis muscles, FMEP amplitude ratios were significantly smaller than when it did not (65 vs. 94 %, p < 0.05). CONCLUSIONS Changes in intraoperative frEMG, AMRs, and FMEPs likely reflect a component of the normalization of hyper-excitability of the facial nerve by MVD for HFS.
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Prell J, Strauss C, Rachinger J, Scheller C, Alfieri A, Herfurth K, Rampp S. The intermedius nerve as a confounding variable for monitoring of the free-running electromyogram. Clin Neurophysiol 2015; 126:1833-9. [PMID: 25655939 DOI: 10.1016/j.clinph.2014.11.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/08/2014] [Accepted: 11/10/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A-trains, a facial nerve EMG-pattern, are correlated with postoperative functional impairment. However, an unknown confounder is suspected to cause false positive monitoring results. The intermedius nerve contains motor fibers targeting lower facial muscles; their significance for facial nerve monitoring is yet unknown. METHODS Intraoperative videotapes and free-running 9-channel facial nerve EMG assessed from 87 patients undergoing surgery for vestibular schwannoma were evaluated, and presence/absence of an identifiable intermedius nerve was determined. The prognostic value of train time, a quantitative measure for A-train activity, was evaluated for both the groups with and without an identifiable intermedius nerve. RESULTS Correlation between traintime and outcome (Spearman's Rho) rose to 0.73 (p<0.001) when only patients without an identified intermedius nerve were considered, and fell to 0.43 (p<0.05) with the other patient group. This difference was statistically significant (p=0.036), was more prominent in the channels monitoring perioral facial muscles, and resulted from additional A-train activity in patients with an identifiable intermedius nerve. CONCLUSIONS A separate intermedius nerve may be more prone to manipulation, leading to A-train activity without clinical correlate, thus causing false positive monitoring results. SIGNIFICANCE For interpretation of the free-running EMG, the intermedius nerve needs to be taken into account as a confounder.
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Affiliation(s)
- Julian Prell
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06097 Halle, Germany.
| | - Christian Strauss
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06097 Halle, Germany
| | - Jens Rachinger
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06097 Halle, Germany
| | - Christian Scheller
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06097 Halle, Germany
| | - Alex Alfieri
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06097 Halle, Germany
| | - Kirsten Herfurth
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06097 Halle, Germany
| | - Stefan Rampp
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06097 Halle, Germany
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Duransoy YK, Mete M, Akçay E, Selçuki M. Differences in individual susceptibility affect the development of trigeminal neuralgia. Neural Regen Res 2014; 8:1337-42. [PMID: 25206428 PMCID: PMC4107645 DOI: 10.3969/j.issn.1673-5374.2013.14.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/07/2013] [Indexed: 11/18/2022] Open
Abstract
Trigeminal neuralgia is a syndrome due to dysfunctional hyperactivity of the trigeminal nerve, and is characterized by a sudden, usually unilateral, recurrent lancinating pain arising from one or more divisions of the nerve. The most accepted pathogenetic mechanism for trigeminal neuralgia is compression of the nerve at its dorsal root entry zone or in its distal course. In this paper, we report four cases with trigeminal neuralgia due to an unknown mechanism after an intracranial intervention. The onset of trigeminal neuralgia after surgical interventions that are unrelated to the trigeminal nerve suggests that in patients with greater individual susceptibility, nerve contact with the vascular structure due to postoperative pressure and changes in cerebrospinal fluid flow may cause the onset of pain.
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Affiliation(s)
| | - Mesut Mete
- Department of Neurosurgery, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Emrah Akçay
- Clinic of Neurosurgery, Anamur State Hospital, Mersin, Turkey
| | - Mehmet Selçuki
- Department of Neurosurgery, Celal Bayar University School of Medicine, Manisa, Turkey
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Abstract
It has been known for over a century that these cranial nerves exist, and that they are not typographical errors nor a sensational event reported in the medical literature. A number of scientific articles on anatomy highlight how textbooks on descriptive anatomy do not always consider variables such as differences related to the geographical areas where people live, and these differences do exist. This is an important concept not only for surgeons, but also for all medical professionals who use manual techniques when treating their patients, ie, osteopaths, chiropractors, physiotherapists, and other manual therapists. This paper highlights the latest developments regarding these cranial nerves, offering at the same time some ideas for further reflection when looking at clinical scenarios that appear to bear little relationship to each other. Inclusion of these concepts in everyday anamnesis is encouraged.
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Affiliation(s)
- Bruno Bordoni
- Don Carlo Gnocchi IRCCS, Department of Cardiology, Milan
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Alfieri A, Fleischhammer J, Peschke E, Strauss C. The nervus intermedius as a variable landmark and critical structure in cerebellopontine angle surgery: an anatomical study and classification. Acta Neurochir (Wien) 2012; 154:1263-8. [PMID: 22555552 DOI: 10.1007/s00701-012-1359-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/09/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND An understanding of the normal topography during cerebellopontine angle surgery is necessary to obviate the anatomical distortions caused by tumors. OBJECTIVE The aim of this study was to analyze the morphological features of the nervus intermedius (NI) and its related structures in the cerebellopontine angle (CPA). METHODS Forty-three isolated human brainstems were examined to collect comprehensive morphometric and topographical data of the NI in its course from the brainstem to the ganglion geniculi, and discover its anatomical relationship with the other neurovascular structures in the CPA as well as within the meatus acusticus internus. RESULTS A total of 84 NI were analyzed. The number of bundles comprising the NI varied from one to five. The mean length of the cisternal segment of the NI was 11.47 mm. In most cases, a vein between the root entry/exit zones of the facial and the vestibulocochlear nerve (VN) was documented. In all cases the NI joined the facial nerve, typically (85 %) distally to the the porus within the meatus acusticus internus. The entry/exit zone of the NI can be categorized into four types: in type A, they arise directly from the brainstem; in type B, they arise solely from the facial nerve; in type C solely from the VN; and in type D, where the bundle or bundles arise from both the brainstem and the VN or the facial nerve. CONCLUSION The anatomical features of the NI can provide an additional variable landmark and critical structure during cerebellopontine microsurgery. Our study of the nerve's anatomy and topographical relations may contribute to preventing intraoperative nerve injuries.
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Affiliation(s)
- Alex Alfieri
- Department of Neurosurgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str., 40, 06120, Halle (Saale), Germany.
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