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Khatiwada A, K C S, Bastakoti A, Koirala B, Yadav AK. Low back pain with axillary mass in a perimenopausal woman: A case of schwannomatosis mimicking metastasis. Radiol Case Rep 2024; 19:3710-3714. [PMID: 38983283 PMCID: PMC11231503 DOI: 10.1016/j.radcr.2024.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 07/11/2024] Open
Abstract
Schwannomatosis is a rare neurocutaneous syndrome characterized by the presence of multiple schwannomas along the peripheral nerves, distinctly excluding the vestibular nerves. It is recognized as the third principal form of neurofibromatosis, alongside neurofibromatosis types 1 and 2. In this report, we discuss the case of a 45-year-old woman who initially sought medical attention for low back pain and swelling in her left axilla. Her magnetic resonance imaging revealed multiple enhancing intradural extramedullary lesions, along with a mass in the right upper thoracic region and another in the left axilla, raising suspicions of metastasis. However, a comprehensive analysis that aligned imaging results with histopathological findings confirmed the diagnosis of schwannomatosis. This case highlights the importance of differentiating between various conditions that can cause multiple intradural extramedullary masses, such as nerve sheath tumors, meningiomas, and metastasis. The presence of multiple schwannomas suggests a diagnosis of either neurofibromatosis type 2 or schwannomatosis, making the distinction between these two conditions critical for appropriate management.
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Affiliation(s)
| | - Sharada K C
- Department of Internal Medicine, NAIHS, Nepal
| | - Aashish Bastakoti
- Department of Surgery, Tribhuvan University Teaching Hospital, Nepal
| | - Bibek Koirala
- Department of Radiology, Tribhuvan University Teaching Hospital, Nepal
| | - Aalok Kumar Yadav
- Department of Radiology, Tribhuvan University Teaching Hospital, Nepal
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Thawabtah FAZ, Idkedek M, Nimer H. Left distal sciatic giant solitary myxoid neurofibroma: a case report & literature review. Front Surg 2024; 11:1417418. [PMID: 39175639 PMCID: PMC11338858 DOI: 10.3389/fsurg.2024.1417418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 07/02/2024] [Indexed: 08/24/2024] Open
Abstract
Introduction Neurofibroma, a rare benign tumor of the peripheral nervous system, can manifest anywhere along a nerve from the dorsal ganglion to its terminal branches. Myxoid neurofibroma can present as a solitary non-tender nodule and is often confirmed by positive immunohistochemical staining for S-100 protein. However, in 50% of cases, neurofibromas are associated with neurofibromatosis. Case presentation We present a case of a 34-year-old male with mild pain in the posterior part of his left thigh, accompanied by a slowly-growing swelling particularly noticeable when flexing his knee. It had gradually increased in size over several months, which the patient observed as a decrease in the degree of knee extension. Initial biopsy indicated schwannoma with no evidence of malignancy. Four years later, the swelling increased in size and necessitated resection surgery, revealing an irregular giant tumor measuring 8 *6 *4.5 cm, adherent to adjacent structures, including the femur, muscles, popliteal artery and vein, and a branch of the sciatic nerve. Pathological analysis reclassified the diagnosis to low-grade myxoid neurofibroma. Follow-up MRI three months later showed gross total resection without residual or recurrence of the tumor. Discussion Solitary neurofibromas are often small in size, ranging from 1 to 2 cm in the greatest dimension. Alternatively, tumors that occur as a part of genetic neurofibromatosis tend to be multiple and often grow to large sizes. In our case, the patient didn't have neurofibromatosis as he didn't meet its diagnostic criteria despite having a giant tumor measuring approximately 8*6*4.5 cm. To our knowledge, this is the first report of giant myxoid solitary neurofibroma of the thigh apart from neurofibromatosis. Thus, this type of tumor should be considered in the differential diagnosis of tumors at this location.
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Affiliation(s)
| | - Mayar Idkedek
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hafez Nimer
- Department of Neurosurgery, H-Clinic Hospital, Ramallah, Palestine
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Libell JL, Balar AB, Libell DP, Joseph JT, Hogg JP, Lakhani DA, Khan M. Facial nerve schwannoma: Case report and brief review of the literature. Radiol Case Rep 2023; 18:3442-3447. [PMID: 37502483 PMCID: PMC10369394 DOI: 10.1016/j.radcr.2023.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Schwannomas are rare nerve sheath tumors that can occur throughout the body, and are symptomatic based on location, size, and impingement on adjacent structures. These tumors are often benign lesions and occur sporadically or from genetic conditions such as neurofibromatosis. Schwannomas may arise from peripheral nerves, gastrointestinal nerves, spinal nerve roots and cranial nerves. Facial nerve schwannomas arise from cranial nerve VII, commonly involving the geniculate ganglion, labyrinthine segment, and internal auditory canal. While small lesions are asymptomatic, larger lesions can cause facial nerve paralysis, and facial spasms. Lesions in the internal auditory canal can cause hearing loss, tinnitus, vertigo, and otalgia. High-resolution CT imaging and MRI imaging are useful for distinguishing between other pathologies that arise from the same region. High-resolution CT scans can show bony degeneration of nearby structures such as the labyrinth or ossicles. MRI imaging shows hypo intensity on T1 imaging, and hyperintensity on T2 imaging. On T1 postcontrast, enhancement can be homogenous or heterogeneous with cystic degeneration if the lesion is large. Nodular enhancement is commonly seen on facial nerve schwannomas within the internal auditory canal. Vestibular schwannomas involving CN VIII are more common, and appear similar to facial nerve schwannomas, but can be distinguished apart due to growth in the geniculate ganglion and/or the labyrinthine segment. Management of asymptomatic or mild lesions is typically conservative with follow up imaging, and surgery for larger lesions. Here, we present a case of a facial nerve schwannoma in a 57-year-old woman.
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Affiliation(s)
- Joshua L. Libell
- School of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Aneri B. Balar
- Department of Radiology, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - David P. Libell
- Department of Neurology, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Joe T. Joseph
- Department of Radiology, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Jeffery P. Hogg
- Department of Radiology, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Dhairya A. Lakhani
- Department of Radiology, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Musharaf Khan
- Department of Radiology, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, USA
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Ozoner B, Gungor A, Ture H, Ture U. Surgical Treatment of Trochlear Nerve Schwannomas: Case Series and Systematic Review. World Neurosurg 2022; 162:e288-e300. [PMID: 35276398 DOI: 10.1016/j.wneu.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Cranial nerve schwannomas almost always arise from sensory or mixed nerves. Motor cranial nerves, such as the trochlear nerve, are rarely associated with schwannomas. No consensus has yet been made for surgical intervention because of the low number of reported cases of trochlear nerve schwannomas. This study comprises a systematic review of the literature and our experience for surgically treated trochlear nerve schwannomas. METHODS Three databases (Web of Science, PubMed, and Cochrane Library) were searched without date restrictions. Studies were included if they were published in the English literature and presented patients of any age who underwent surgical treatment for trochlear schwannoma. Data extracted from the included studies were combined with our experience. RESULTS Forty-one studies, presenting 43 patients, met the inclusion criteria. The total number of patients was 45 after our experience was added. The most common symptoms were diplopia (62.2%), headache (46.7%), and motor weakness (37.8%). Mean age during the diagnosis was 45.1 years. Although the subtemporal transtentorial approach (n = 14) is the most preferred method, its application has decreased in recent years. In the last decade, the lateral suboccipital approach (n = 11) has gained popularity. Residual postoperative trochlear nerve deficit was detected in 81% of patients. The probability of neurologic deficit was not statistically associated with tumor volume (P = 0.914), location (P = 0.669), or resection rate (P = 0.554). CONCLUSIONS Although trochlear schwannomas are rare and their treatment involves challenges, total resection with the proper approach provides the most desirable results.
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Affiliation(s)
- Baris Ozoner
- Department of Neurosurgery, Kartal Dr. Lutfi Kirdar Research and Education Hospital, Istanbul, Turkey; Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Abuzer Gungor
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey; Department of Neurosurgery, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Hatice Ture
- Department of Anesthesiology, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Ugur Ture
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey.
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Lin Y, Li P, Chen X, Zhu J, Lu Y, Yu F, Xiao J, Wang J. Predicting the Risk of Postoperative Complications of Schwannoma Surgery: Development and Assessment of a New Predictive Nomogram. J Neurol Surg A Cent Eur Neurosurg 2022; 83:427-434. [PMID: 35537463 DOI: 10.1055/s-0041-1739500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to develop and internally validate a risk nomogram for postoperative complications of schwannoma surgery. METHODS From 2016 to 2020, we reviewed 83 patients who underwent schwannoma resection with a total number of 85 schwannomas. A predictive model was developed based on the dataset of this group. During model construction, univariate and multivariate logistic regression analysis were used to determine the independent predictors of postoperative complications. Assessment of the discriminative function, calibrating proficiency, and clinical usefulness of the predicting model was performed using C-index, calibration plot, receiver operating characteristic (ROC) curve, and decision curve analysis. Internal validation was assessed using bootstrapping validation. RESULTS Predictors contained in the prediction nomogram included age, tumor location, symptoms, and surgical approach. The model displayed satisfying abilities of discrimination and calibration, with a C-index of 0.901 (95% confidence [CI]: 0.837-0.965). A high C-index value of 0.853 was achieved in the interval verification. Decision curve analysis showed that the nomogram was clinically useful when intervention was decided at the complication possibility threshold of 2%. CONCLUSION This new risk nomogram for postoperative complications of schwannoma surgery has taken age, tumor location, symptoms, and surgical approach into account. It has reasonable predictive accuracy and can be conveniently used. It shall help patients understand the risk of postoperative complications before surgery, and offer guidance to surgeons in deciding on the surgical approach.
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Affiliation(s)
- Yutian Lin
- Department of Hand Surgery and Peripheral Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Peifeng Li
- Department of Hand Surgery and Peripheral Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiangxiang Chen
- Department of Hand Surgery and Peripheral Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junyi Zhu
- Department of Hand Surgery and Peripheral Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yingfeng Lu
- Department of Hand Surgery and Peripheral Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fangzheng Yu
- Department of Hand Surgery and Peripheral Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jian Xiao
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jian Wang
- Department of Hand Surgery and Peripheral Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Lopez J, Hamill EB, Burnstine M. Orbital schwannoma management: a case report, literature review, and potential paradigm shift. Orbit 2022; 41:15-27. [PMID: 33397169 DOI: 10.1080/01676830.2020.1858431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE To present a case of orbital schwannoma and assess the literature on treatment modalities. METHODS A MEDLINE literature search for cases of orbital schwannomas was performed using the PubMed search tool using the search terms "orbital schwannoma" and "orbital neurilemmoma." Papers were included if they were peer-reviewed, published in English, discussed management, and included the search terms. Each article was rated using the scale developed by the British Centre for Evidence-Based Medicine. In addition, we present a case report of an orbital schwannoma. RESULTS A total of 428 articles were found. 102 met the criteria for inclusion. Only two articles met Level 1 evidence and 16 were important to the clinical care process. We report a case of a biopsy-proven orbital schwannoma managed conservatively with observation over a 4-year period due to risk of cosmetic disfigurement with tumor removal. There has been no change in tumor size and no associated complications during follow up. CONCLUSIONS There is a paucity of data on the natural history of orbital schwannomas. Based on our review of the literature, we recommend observation for asymptomatic or minimally symptomatic orbital schwannomas with minimal growth over an extended period of time. For rapidly growing tumors or large tumors affecting key structures causing visual loss, diplopia, aesthetic disfigurement, or patient discomfort, a more aggressive approach may be necessary.
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Affiliation(s)
- Jennifer Lopez
- Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Eric B Hamill
- Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
- Department of Ophthalmology, Roski Eye Institute, Keck School of Medicine, University of Southern Califonrnia, Los Angeles, CA, USA
| | - Michael Burnstine
- Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
- Department of Ophthalmology, Roski Eye Institute, Keck School of Medicine, University of Southern Califonrnia, Los Angeles, CA, USA
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Fiani B, Jarrah R, Griepp DW, Adukuzhiyil J. The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation. Cureus 2021; 13:e15878. [PMID: 34327102 PMCID: PMC8302823 DOI: 10.7759/cureus.15878] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022] Open
Abstract
The development of the three-dimensional (3D) exoscope is a marvel of technological innovation in modern surgical practice. While its predecessor, the operating microscope (OM), has long been the gold-standard surgical visualization modality, its particular limitations in terms of accessibility and ergonomic demand have led to the development of a more sophisticated, 3D model. Specifically, the 3D exoscope allows for an enhanced image quality of the surgical field, while also being more ergonomically favorable. Moreover, this device's ability to handle delicate microsensitve procedures, along with its alleviation of surgeon fatigue, indicates great potential for neurosurgical application. For this narrative review, the authors queried PubMed database using the keyword "exoscope" to identify relevant studies involving the specialty of neurosurgery that were published in English language full text. The search yielded full-text English language-related articles regarding neurosurgical exoscope, its applications and limitations. The 3D exoscope uniquely allows for enhanced surgeon comfort and superior imaging of the patient's real-time anatomy. However, the OM was described to having a slight image favorability with fusion and decompression surgery. Cost analysis is highlighted for its potential disparity. 3D exoscopes will potentially be incorporated with intelligent carriers and robotic surgical systems. Ultimately, with further studies highlighting its use, the 3D exoscope is expected to continue to imprint its status as one of the most efficient technological visualization tools in the future of neurosurgical practice.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Ryan Jarrah
- Neurosurgery, College of Arts and Sciences, University of Michigan - Flint, Flint, USA
| | - Daniel W Griepp
- Neurosurgery, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
| | - Jessica Adukuzhiyil
- Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
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Abstract
Objective This study was performed to analyze the clinical, radiographic, and pathological features of hand angioleiomyoma causing nerve compression and assess the outcomes of surgical excision. Methods This case series included three men and one woman (mean age, 53.3 years; range, 49–56 years). The patients’ chief complaint was numbness of the fingers. The patients’ medical histories were reviewed, and the diagnosis of angioleiomyoma with nerve compression was confirmed by means of imaging examination and pathological analysis. Results Three tumors occurred in the palm and one in the finger, and the average maximum tumor diameter was 1.8 cm (range, 0.8–2.6 cm). Preoperative magnetic resonance imaging demonstrated well-defined masses with isointense signals on T1 sequences, hyperintense signals on T2 sequences, and strong heterogeneous enhancement after injection of contrast material. All tumors were located near nerves, leading to nerve compression. The diagnosis of angioleiomyoma was confirmed by postoperative pathology. Finger sensation recovered and no recurrence was found during an average follow-up of 37 months (range, 25–59 months). Conclusions Angioleiomyoma should be considered among the differential diagnoses of hand tumors and timely resection should be performed, particularly if the mass is causing numbness and/or pain with positive Tinel’s sign and/or tenderness.
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Affiliation(s)
- Qianjun Jin
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, P.R. China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, P.R. China
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Ahmedou AB, Mohamed Amine M, Youssef O, Sami R, Abada R, Mohamed R, Mohamed M, Meriem R, Mehdi K. A rare cause of cervical swelling: Solitary plexiform neurofibroma. Ann Med Surg (Lond) 2021; 64:102225. [PMID: 33786168 PMCID: PMC7988485 DOI: 10.1016/j.amsu.2021.102225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Plexiform cervical neurofibromas are benign neoplasm, extremely rare, difficult to diagnose and to manage. Only some cases have been reported in the literature. CASE PRESENTATION We report the case of a 60-year-old man admitted for a lateral neck mass, for which the surgical indication was the increase in volume of this mass, as well as the aesthetical impairment, the surgical exploration found the tumor attached to the cervical plexus. The excision of the mass was performed without damaging nerve. The pathological study was in favor of a plexiform neurofibroma. DISCUSSION Even though Plexiform cervical neurofibroma are extremely rare, and their diagnosis are not often primary evoked in front of any growing mass of this region, the surgeon must keep in mind the existence of these neoplasms as a differential diagnosis of a neck tumor. CONCLUSION Surgery remains the gold standard in the treatment of these locally invasive tumors. It is essential that the surgeon keep in mind the possibility of these tumors as a differential diagnosis of a neck tumor.
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Affiliation(s)
- Ahmed Brahim Ahmedou
- ENT, Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Mennouni Mohamed Amine
- ENT, Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Oukessou Youssef
- ENT, Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Rouadi Sami
- ENT, Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Redallah Abada
- ENT, Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Roubal Mohamed
- ENT, Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Mahtar Mohamed
- ENT, Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | | | - Karkouri Mehdi
- Pathology Department, Centre IBN ROCHD, Casablanca, Morocco
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Surgical Management of Sporadic Peripheral Nerve Schwannomas in Adults: Indications and Outcome in a Single Center Cohort. Cancers (Basel) 2021; 13:cancers13051017. [PMID: 33804463 PMCID: PMC7957633 DOI: 10.3390/cancers13051017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Peripheral nerve sheath tumors are associated with significant morbidity. Clinical presentation, tumor location, and therapeutic strategies are variable. We aim to provide high-quality data concerning the results of interdisciplinary operative approaches for surgical resection of schwannomas. Understanding the anatomical and functional challenges of surgical interventions in the peripheral nervous system can help to enhance the outcomes of these therapies. We aim to highlight the need for interdisciplinarity and provide evidence for both excellent functional outcomes, as well as improved quality of life for patients undergoing sporadic schwannoma surgery. Abstract Most sporadic peripheral nerve sheath tumors in adults are schwannomas. These tumors usually present with significant pain but can also cause neurological deficits. Symptomatology is diverse, and successful surgical interventions demand interdisciplinarity. We retrospectively reviewed 414 patients treated between 2006 and 2017 for peripheral nerve sheath tumors. We analyzed clinical signs, symptoms, histology, and neurological function in the cohort of adult patients with schwannomas without a neurocutaneous syndrome. In 144 patients, 147 surgical interventions were performed. Mean follow-up was 3.1 years. The indication for surgery was pain (66.0%), neurological deficits (23.8%), significant tumor growth (8.8%), and suspected malignancy (1.4%). Complete tumor resection was achieved on 136/147 occasions (92.5%). The most common location of the tumors was intraspinal (49.0%), within the cervical neurovascular bundles (19.7%), and lower extremities (10.9%). Pain and neurological deficits improved significantly (p ≤ 0.003) after 131/147 interventions (89.1%). One patient had a persistent decrease in motor function after surgery. Complete resection was possible in 67% of recurrent tumors, compared to 94% of primary tumors. There was a significantly lower chance of complete resection for schwannomas of the cervical neurovascular bundle as compared to other locations. The surgical outcome of sporadic schwannoma surgery within the peripheral nervous system is very favorable in experienced peripheral nerve surgery centers. Surgery is safe and effective and needs a multidisciplinary setting. Early surgical resection in adult patients with peripheral nerve sheath tumors with significant growth, pain, neurological deficit, or suspected malignancy is thus recommended.
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Abstract
Primary thyroid schwannoma is a sporadic non-epithelial tumor of the thyroid gland. Most previous cases reported in the literature presented it as an asymptomatic neck mass. In this report, we describe a rare case of thyroid schwannoma in a 33-year-old female, presented as a left-side neck swelling, accompanied by a change in voice and difficulty swallowing. An ultrasound of the mass showed a large heterogeneous, predominantly cystic, nodule; in contrast to the usual predominantly solid nodule described in the literature. After several pre-operative diagnostic tests, including fine needle aspiration (FNA), the diagnosis remained unclear. In the end, the patient underwent a successful surgical excision of the mass, and the diagnosis of schwannoma was confirmed based on the histopathologic examination which revealed both type A and B Antoni cells as well as positive staining for S-100 protein.
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Affiliation(s)
| | - Shahem Abbarh
- Internal Medicine, Almaarefa University, Riyadh, SAU
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Dai A, Cai JP. Intravascular schwannoma: A review of a rare diagnosis. J Cutan Pathol 2020; 48:314-317. [PMID: 32623758 DOI: 10.1111/cup.13797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
While schwannoma is one of the most common types of benign peripheral nerve tumors in adults, a very unique and specific variant of schwannoma, the intravascular variant, is exceedingly rare. There have only been three previously published cases of intravascular schwannomas. Here we describe a fourth case of an intravascular schwannoma in a 47-year-old man with an enlarging subcutaneous nodule on his posterior calf. This is the second case of an intravascular schwannoma contained within a vein. Also included is an overview of intravascular schwannomas, including a description and discussion of the histopathological diagnosis, differential diagnoses, and schwannoma variants.
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Affiliation(s)
- Annie Dai
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jian-Ping Cai
- Dermatopathology, Florida Division of Dianon Systems/LabCorp, Tampa, Florida, USA
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Zarei S, Popa A, Moghadam B, Reddy A, Mahmoud A. Oversized primary intrapulmonary schwannoma: A case report and a review of the literature. Surg Neurol Int 2020; 11:234. [PMID: 32874737 PMCID: PMC7451151 DOI: 10.25259/sni_60_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Schwannomas, also known as neurilemommas, are benign, well-circumscribed encapsulated peripheral nerve sheath tumors with rather indolent evolution. Made up of cells closely related to normal myelinating Schwann cells, these neoplasms may arise from the peripheral nervous system as well as from spinal or cranial nerves. They are mostly found in the base of the skull, neck, chest wall, posterior mediastinum, posterior spinal roots, cerebellopontine angle, retroperitoneum, and flexor surfaces of the extremities. The incidence rate of spinal schwannoma is 0.3-0.5/100,000 cases per year with an average age of 50 at diagnosis. We report a case of intrapulmonary schwannoma, adding a review of the literature. CASE DESCRIPTION A 20-year-old female patient with no significant medical history, presented with pleuritic chest pain, shortness of breath, right upper limb weakness, and numbness. A computed tomography of the chest and magnetic resonance imaging showed a 7.2 × 10.5 × 8.3 cm mass in the posterior segment of the right upper lobe, arising from the right T5-6 neural foramen; a concurrent 16 mm thick right pleural effusion was also noticed yet without evidence of nodular enhancement. The findings suggested the presence of a neurofibroma or a schwannoma. Complete resection of the tumor was achieved through posterolateral thoracotomy; the ensuing histopathological and immunohistochemical examinations confirmed the presence of a schwannoma. CONCLUSION We believe this rare case of pulmonary invasive schwannoma illustrates the complex dynamics of this extremely rare entity; in this particular case, complete surgical excision proved to be crucial in terms of subacute management and local tumor control, at least at short and middle term. The patient is currently asymptomatic (6 months postsurgery) and remains on follow-up.
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Affiliation(s)
- Sara Zarei
- Departments of Neurology, Riverside Community Hospital, CA, United States
| | - Alina Popa
- Departments of Medicine, Riverside Community Hospital, CA, United States
| | - Bahman Moghadam
- Departments of Medicine, Riverside Community Hospital, CA, United States
| | - Archana Reddy
- Department of Medicine, University of California, CA, United States
| | - Ahmed Mahmoud
- Department of Surgery, Riverside Community Hospital, Riverside, CA, United States
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Matano F, di Russo P, Okano A, Passeri T, Penet N, Fava A, Camara B, Polivka M, Giammattei L, Froelich S. Oculomotor Neurofibroma: A Different Histology Implying an Unsatisfying Clinical Outcome. World Neurosurg 2020; 139:31-38. [PMID: 32289509 DOI: 10.1016/j.wneu.2020.03.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Tumors arising from oculomotor nerve are rare, with few cases reported in the literature. Generally, whereas schwannomas are well encapsulated tumors, neurofibromas tend to invade the entire nerve fibers. These differences influence surgical resection and neurological clinical outcome, with neurofibroma often requiring the sacrifice of the nerve. Accordingly, an incorrect preoperative diagnosis can lead to incomplete patient counseling before surgery. CASE DESCRIPTION We report 2 cases: a patient with oculomotor schwannoma and a patient with oculomotor neurofibroma. After tumor resection, the patient with a diagnosis of schwannoma recovered with 3rd nerve palsy, while patient with the neurofibroma developed a complete oculomotor nerve deficit. For each patient, surgical strategy and neurological outcome are elucidated in relation with differences in preoperative magnetic resonance imaging and histology. CONCLUSIONS To the best of our knowledge, this is the first report of an oculomotor neurofibroma. When an oculomotor nerve tumor is suspected, a careful preoperative evaluation of magnetic resonance imaging guides in distinguishing the different histology, in selecting the treatment strategy, and in correctly informing the patient on expected postoperative neurologic outcome.
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Affiliation(s)
- Fumihiro Matano
- Department of Neurosurgery, Lariboisière Hospital (AP-HP), Paris, France.
| | - Paolo di Russo
- Department of Neurosurgery, Lariboisière Hospital (AP-HP), Paris, France
| | - Atsushi Okano
- Department of Neurosurgery, Lariboisière Hospital (AP-HP), Paris, France
| | - Thibault Passeri
- Department of Neurosurgery, Lariboisière Hospital (AP-HP), University of Paris Diderot, Paris, France
| | - Nicolas Penet
- Department of Neurosurgery, Lariboisière Hospital (AP-HP), University of Paris Diderot, Paris, France
| | - Arianna Fava
- Department of Neurosurgery, Lariboisière Hospital (AP-HP), Paris, France
| | - Breno Camara
- Department of Neurosurgery, Lariboisière Hospital (AP-HP), Paris, France
| | | | - Lorenzo Giammattei
- Department of Neurosurgery, Lariboisière Hospital (AP-HP), University of Paris Diderot, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital (AP-HP), University of Paris Diderot, Paris, France
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15
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Nasrollahi H, Ariafar A, Ahmed F, Mokhtari M, Eslahi A, Ansari M, Chowdhury U. Isolated schwannoma of the urinary bladder: a case report and review of the literature. Pan Afr Med J 2020; 35:108. [PMID: 32637006 PMCID: PMC7320789 DOI: 10.11604/pamj.2020.35.108.17745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/17/2020] [Indexed: 11/11/2022] Open
Abstract
The urinary bladder schwannoma is an extremely rare primary urologic tumor. Schwannoma arises from the Schwann's cells in the nerve sheaths and is almost associated with von Recklinghausen's disease. We report a case of schwannoma in a 35-year old female who presented with urinary frequency for 2 months with absence of evidence of von Recklinghausen disease and successfully treated with transurethral resection of bladder lesion (TUR_B). To the best of our knowledge, this represents only the 10th case of benign schwannoma of the urinary bladder in a patient without von Recklinghausen disease. We report a case of an isolated schwannoma of the urinary bladder, and also searched the English literature as we had access to bladder schwannoma.
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Affiliation(s)
- Hamid Nasrollahi
- Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ariafar
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, Ibb University of Medical Sciences, Ibb, Yemen
| | - Maral Mokhtari
- Pathology Department, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz Iran
| | - Ali Eslahi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansour Ansari
- Radiation Oncology, Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz Iran
| | - Umayir Chowdhury
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Ilagan C, Poliakin L, Asarian A, Xiao P, Sirsi S. Anterior knee schwannoma. J Surg Case Rep 2019; 2019:rjz236. [PMID: 31807267 PMCID: PMC6889750 DOI: 10.1093/jscr/rjz236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/19/2022] Open
Abstract
Peripheral nerve tumors are relatively uncommon with schwannomas being the most common type. Schwannomas are usually benign encapsulated tumors composed of neoplastic Schwann cells that generally do not transform to malignancy. Many are discovered incidentally as solitary tumors. The cause is unknown. Most occur spontaneously, while some develop in association with genetic disorders such as neurofibromatosis type 2 or schwannomatosis. Schwannomas can occur anywhere in the body. They affect all ages, with peaking incidence between ages 20 and 50 years, without predilection to sex or race. Many are asymptomatic; however, presenting signs and symptoms, such as paresthesia and pain, are due to mass effect and direct nerve invasion. Diagnosing includes combinations of thorough physical examination, imaging modalities such as magnetic resonance imaging and surgical biopsy. Treatment depends on factors such as location of the tumor and severity of symptoms. Asymptomatic patients are treated conservatively while symptomatic patients undergo surgical resection with favorable prognosis.
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Affiliation(s)
- Charmaine Ilagan
- St. George’s University School of Medicine, True Blue, Grenada, WI
- Correspondence address. Department of Pathology, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA. Tel: +718-250-8207; Fax: +718-250-8056; E-mail:
| | - Lauren Poliakin
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
| | - Armand Asarian
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
| | - Philip Xiao
- Department of Pathology, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
| | - Sandeep Sirsi
- Department of Surgery, New York University Langone Hospital Brooklyn, Brooklyn, NY 11220, USA
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17
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Abstract
Benign peripheral nerve tumors encompass a wide range of neoplasms and non-neoplastic tumor like lesions. Some of these lesions if not encountered in the setting of genetic syndromes, are occurring sporadically. The principles of oncology should be respectfully followed in every step of diagnostic approach and surgical management. Albeit, classified as benign, some of them do have different level of malignant potential, thus the treating physicians should be aware of that to avoid possible pitfalls with devastating outcomes. This article reviews the most common benign peripheral nerve tumors discussing the clinicopathological findings, imaging appearance and the current trend in their approach.
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Affiliation(s)
- Zinon T Kokkalis
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Rio-Patras, Greece.
| | - Nikolaos A Stavropoulos
- Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Andreas Panagopoulos
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Rio-Patras, Greece
| | - Panayotis N Soucacos
- "Panayotis N. Soucacos" Orthopaedic Research & Education Center (OREC), National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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18
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Galli R, Uckermann O, Sehm T, Leipnitz E, Hartmann C, Sahm F, Koch E, Schackert G, Steiner G, Kirsch M. Identification of distinctive features in human intracranial tumors by label-free nonlinear multimodal microscopy. JOURNAL OF BIOPHOTONICS 2019; 12:e201800465. [PMID: 31194284 DOI: 10.1002/jbio.201800465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/08/2019] [Accepted: 06/12/2019] [Indexed: 06/09/2023]
Abstract
Nonlinear multimodal microscopy offers a series of label-free techniques with potential for intraoperative identification of tumor borders in situ using novel endoscopic devices. Here, we combined coherent anti-Stokes Raman scattering, two-photon excited fluorescence (TPEF) and second harmonic generation imaging to analyze biopsies of different human brain tumors, with the aim to understand whether the morphological information carried by single field of view images, similar to what delivered by present endoscopic systems, is sufficient for tumor recognition. We imaged 40 human biopsies of high and low grade glioma, meningioma, as well as brain metastases of melanoma, breast, lung and renal carcinoma, in comparison with normal brain parenchyma. Furthermore, five biopsies of schwannoma were analyzed and compared with nonpathological nerve tissue. Besides the high cellularity, the typical features of tumor, which were identified and quantified, are intracellular and extracellular lipid droplets, aberrant vessels, extracellular matrix collagen and diffuse TPEF. Each tumor type displayed a particular morphochemistry characterized by specific patterns of the above-mentioned features. Nonlinear multimodal microscopy performed on fresh unprocessed biopsies confirmed that the technique has the ability to visualize tumor structures and discern normal from neoplastic tissue likewise in conditions close to in situ.
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Affiliation(s)
- Roberta Galli
- Clinical Sensoring and Monitoring, Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ortrud Uckermann
- Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tina Sehm
- Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Elke Leipnitz
- Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- CCU Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany
| | - Edmund Koch
- Clinical Sensoring and Monitoring, Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Schackert
- Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gerald Steiner
- Clinical Sensoring and Monitoring, Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Matthias Kirsch
- Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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19
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An Unusual Case of Median Neuropathy: Application of Short Segmental Sensory Nerve Stimulation. J Clin Neurophysiol 2019; 36:468-470. [PMID: 31274708 DOI: 10.1097/wnp.0000000000000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 55-year-old woman presented with an 18-month history of intermittent left-hand paresthesias affecting her first, second, and third digits. A small, immobile, nontender midline mass on the volar aspect of the left wrist was also present. Evaluation included normal routine nerve conduction studies and needle electromyography. An ultrasound was performed in the electromyography laboratory, verifying median nerve involvement of the mass within the proximal carpal tunnel. This finding guided the electromyographer to perform the unconventional technique of sensory nerve short segmental stimulation across the carpal tunnel, which confirmed focal slowing across the lesion, achieving electrodiagnostic confirmation of median nerve impairment. This case of atypical carpal tunnel syndrome due to a median nerve schwannoma demonstrates both the utility and specificity of short segmental sensory stimulation in some cases of median neuropathy at the wrist and the value of sonography in the electromyography laboratory.
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20
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Lavorato A, Titolo P, Vincitorio F, Cofano F, Garbossa D. In Reply to the “Letter to the Editor Regarding Intraneural Ewing Sarcoma of the Fibular Nerve—Case Report, Radiologic Findings and Review of Literature”. World Neurosurg 2019; 126:687. [DOI: 10.1016/j.wneu.2019.02.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/29/2022]
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21
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Magnetic resonance neurography appearance and diagnostic evaluation of peripheral nerve sheath tumors. Sci Rep 2019; 9:6939. [PMID: 31061436 PMCID: PMC6502820 DOI: 10.1038/s41598-019-43450-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/24/2019] [Indexed: 02/07/2023] Open
Abstract
Imaging appearances of peripheral nerve sheath tumors by MRI are difficult distinguish from soft-tissue tumors. The objective of this study was to evaluate the feasibility and imaging appearance of high-resolution 3-T magnetic resonance neurography (MRN) of the diagnosis of peripheral nerve sheath tumors (PNSTs) using sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) sequences. We retrospectively evaluated the MRI and 3D Short tau inversion recovery sampling perfection with application-optimized contrasts using varying flip-angle evolutions (3D-STIR SPACE) sequences of 30 patients with PNSTs diagnosed by surgery and pathology. The contrast-enhanced 3D-STIR SPACE images were retrospectively analyzed and evaluated for the visualization of PNSTs. The tumors were evaluated by their number, location, morphology, size, signal intensity and enhancement characteristics. The imaging findings and characteristic signs of conventional MRI scanning and contrast-enhanced 3D-STIR SPACE sequences were compared. In these cases, conventional MRI images display the location, number, shape, size and signal characteristics of the lesions. These tumors were mostly solitary and had a well-defined boundary. Compared to conventional MRI images, imaging appearances including neurogenic origin, length of the peripheral nerves and relation to the nerve of PNSTs on 3D-STIR SPACE images were more accuracy (P < 0.05). Compared to 3D-STIR SPACE images, contrast-enhanced images can more clearly display background suppression of the peripheral nerves. The “split fat” sign and “target” sign were seen in some patients. 3D STIR SPACE sequences demonstrate its significant capacity to diagnostic evaluate and location of PNSTs. This article comprehensively reviews radiologic findings and illustrates the MRN features of PNSTs. 3D-STIR SPACE sequences be used for preoperative evaluation of PNSTs.
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22
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Fenlon JB, Khattab MH, Ferguson DC, Luo G, Keedy VL, Chambless LB, Kirschner AN. Linear Accelerator-Based Stereotactic Radiosurgery for Cranial Intraparenchymal Metastasis of a Malignant Peripheral Nerve Sheath Tumor: Case Report and Review of the Literature. World Neurosurg 2018; 123:123-127. [PMID: 30529515 DOI: 10.1016/j.wneu.2018.11.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/28/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive soft tissue sarcomas. MPNST intracranial metastasis is exceedingly rare with only 22 documented cases in the literature and, to our knowledge, only 1 case with intraparenchymal brain metastasis. Most have been managed surgically; however, 2 documented cases were treated with Gamma Knife radiosurgery. Excluding this case report, there are no other documented cases of linear accelerator-based stereotactic radiosurgery (SRS) to treat MPNST brain metastasis. CASE DESCRIPTION A 41-year-old man with MPNST of the lung initially underwent tumor resection. He developed multiple systemic metastases that were managed with directed radiation therapy. A parietal brain metastasis was treated with linear accelerator-based SRS. Following SRS therapy, the patient was treated with a tropomyosin receptor kinase inhibitor. Complete resolution of brain metastasis was seen on brain magnetic resonance imaging 5 months after treatment with SRS. At 11 months after SRS, there was no evidence of recurrence or progression of the intraparenchymal disease. The patient continued to have stable extracranial disease on his ninth cycle of systemic treatment. CONCLUSIONS This report provides important insights into efficacy of linear accelerator-based SRS to treat MPNST brain metastases.
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Affiliation(s)
- Jordan B Fenlon
- Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
| | - Mohamed H Khattab
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donna C Ferguson
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Guozhen Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vicki L Keedy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Austin N Kirschner
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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23
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Evaluation of the most commonly used (semi-)quantitative parameters of 18F-FDG PET/CT to detect malignant transformation of neurofibromas in neurofibromatosis type 1. Nucl Med Commun 2018; 39:961-968. [PMID: 30106798 DOI: 10.1097/mnm.0000000000000889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In patients with neurofibromatosis type 1, transformation of neurofibromas into a malignant peripheral nerve sheath tumor (MPNST) is a severe complication of the disease. Fluorine-18-fluorodeoxyglucose PET/computed tomography (PET/CT) is a viable option for detecting malignant tumors in neurofibromatosis type 1 patients. The aim of this review was to assess the diagnostic performance of the most frequently used parameters of PET/CT in detecting MPNST. An extensive computer search was performed using the Cochrane Library, Pubmed, and Medline/Embase databases. Two reviewers independently extracted data of relevant studies and assessed the methodological quality (QUADAS-2). The diagnostic performance of PET/CT parameters in individual studies was determined by calculating a diagnostic odds ratio (DOR) using the absolute numbers of true-positive, true-negative, false-positive, and false-negative test results. A total of eight studies were included, of which three evaluated the standardized uptake value as a diagnostic parameter, two assessed the tumor-to-liver (T/L) ratio, and three articles described both parameters. The cut-off values for maximum standardized uptake value (SUVmax) ranged from 3.2 to 4.5; for the T/L ratio, the cut-off values were between 1.0 and 4.3. The sensitivity and specificity ranged from 90 to 100% and from 80 to 100%, respectively (SUVmax). T/L ratios were associated with 92-100% sensitivity and 72-94% specificity. The corresponding DORs ranged from 57 to 145 (SUVmax) and 35 to 655 (T/L ratio). Both the SUV and the T/L ratio are associated with high sensitivity combined with acceptable specificity in detecting MPNST. There is a tendency toward higher DORs using the T/L ratio, but the number of studies is limited.
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24
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Roman M, Burbidge O, McCulloch T, Majewski A. Endobronchial benign nerve sheath tumour presenting with significant shortness of breath and haemoptysis. Oxf Med Case Reports 2018; 2018:omy033. [PMID: 30026957 PMCID: PMC6047445 DOI: 10.1093/omcr/omy033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 11/13/2022] Open
Abstract
Peripheral nerve sheath tumours are rare within the thoracic cavity, with non-specific presentation. A 29-year-old patient presented with shortness of breath, cough, haemoptysis and recurrent chest infections. Suspicion of a primary lung carcinoma or a neuroendocrine tumour was raised following a CT and PET-CT. An endobronchial tumour suggested on histology a diagnosis of benign nerve sheath tumour, with positive staining for S100, CD56 and CD34. Following lung resection, the patient complained of fatigue and developed subcutaneous erythematous nodules on the anterior right chest, which raised the suspicion for a differential diagnosis of neurofibromatosis type I. The nodules resolved spontaneously within two weeks and the diagnosis of neurofibromatosis was ruled out on subsequent magnetic resonance imaging head and chest.
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Affiliation(s)
- Marius Roman
- Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Oliver Burbidge
- Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tom McCulloch
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrzej Majewski
- Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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25
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Guzzo M, Ferraro L, Ibba T, Quattrone P, Bianchi R, Rezzonico S, Scaramellini G. Schwannoma in the Parotid Gland. Experience at Our Institute and Review of the Literature. TUMORI JOURNAL 2018; 95:846-51. [DOI: 10.1177/030089160909500636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Schwannoma of the parotid gland is an uncommon tumor. When the facial nerve is involved by the tumor at the time of the operation, the surgical approach requires careful evaluation. The purpose of this study is to provide indications which can support the decision, taking into account the different clinical presentations of parotid schwannoma. In a retrospective study, eight cases of parotid schwannoma were collected between 1975 and 2006. In three cases the tumor affected the facial nerve itself and in the remaining ones it originated from intraparotid nonfacial peripheral nerves. When the facial nerve is involved by the tumor a conservative approach should always be considered. The indication for a surgical procedure should be discussed with the patient. If a conservative strategy is chosen, yearly follow-up by means of MRI and clinical observation should be planned.
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Affiliation(s)
- Marco Guzzo
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Letizia Ferraro
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tullio Ibba
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pasquale Quattrone
- Pathology and Cytology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Bianchi
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Rezzonico
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriele Scaramellini
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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26
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Niño-Nuván FC, Gómez-Rueda PA, Lozano-Triana CJ, Quintero EM. Neurofibroma del hipogloso en un niño colombiano. Reporte de caso. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n1.56914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Se presenta el caso de un paciente masculino de 14 años de edad, con antecedente de dos intervenciones quirúrgicas debidas a la presencia de una masa a nivel sublingual —la primera a los 8 meses de edad y la segunda a los 13 años— y sin información de estudios histopatológicos. Cerca de 8 meses después de la última intervención quirúrgica es valorado por el Servicio de Cirugía Maxilofacial de la Fundación Hospital Pediátrico de La Misericordia en Bogotá D.C., Colombia, por crecimiento acelerado de la misma lesión y por problemas en la deglución y el lenguaje. En la revisión del paciente se encuentra una masa importante sublingual, dificultad en el lenguaje, deformidad mandibular y alteraciones en la mordida, por lo que se decide intervenir quirúrgicamente de nuevo. El resultado de la biopsia es un tumor mesenquimal benigno característico de neurofibroma, que por su ubicación sugiere probable compromiso del nervio hipogloso.
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27
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Shaterian A, Bota D, Leis A. Expression of the BRAF L597Q mutation in sporadic neurofibromas of the upper extremity. Exp Mol Pathol 2017; 103:276-278. [DOI: 10.1016/j.yexmp.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/18/2017] [Indexed: 12/21/2022]
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28
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Ji JH, Park JS, Kang CM, Yoon DS, Lee WJ. Laparoscopic resection of retroperitoneal benign neurilemmoma. Ann Surg Treat Res 2017; 92:149-155. [PMID: 28289669 PMCID: PMC5344805 DOI: 10.4174/astr.2017.92.3.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 01/01/2023] Open
Abstract
Purpose The aim of this study was to verify that laparoscopic resection for treating retroperitoneal benign neurilemmoma (NL) is expected to be favorable for complete resection of tumor with technical feasibility and safety. Methods We retrospectively analyzed 47 operations for retroperitoneal neurogenic tumor at Yonsei University College of Medicine, Severance Hospital and Gangnam Severance Hospital between January 2005 and September 2015. After excluding 21 patients, the remaining 26 were divided into 2 groups: those who underwent open surgery (OS) and those who underwent laparoscopic surgery (LS). We compared clinicopathological features between the 2 groups. Results There was no significant difference in operation time, estimated blood loss, transfusion, complication, recurrence, or follow-up period between 2 groups. Postoperative hospital stay was significantly shorter in the LS group versus the OS group (OS vs. LS, 7.00 ± 3.43 days vs. 4.50 ± 2.16 days; P = 0.031). Conclusion We suggest that laparoscopic resection of retroperitoneal benign NL is feasible and safe by obtaining complete resection of the tumor. LS for treating retroperitoneal benign NL could be useful with appropriate laparoscopic technique and proper patient selection.
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Affiliation(s)
- Jung Hwan Ji
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | | | - Chang Moo Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.; Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Institute of Gastroenterology Severance Hospital, Seoul, Korea
| | | | - Woo Jung Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.; Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Institute of Gastroenterology Severance Hospital, Seoul, Korea
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29
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Singh A, Okonkwo L, Hoffmann JC, Mazzie JP, Baadh AS. Nonamyloid tumoral light-chain-deposition disease (aggregoma) of the paraspinal region. Skeletal Radiol 2015; 44:1839-43. [PMID: 26253133 DOI: 10.1007/s00256-015-2223-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/18/2015] [Accepted: 07/21/2015] [Indexed: 02/02/2023]
Abstract
Aggregomas are rare localized masses of monoclonal nonamyloid immunoglobulin light-chain deposits. To date, there have been only a few reports of isolated aggregomas, with the majority detailing renal, lymph node and brain deposition. We present a rare case of paraspinal aggregoma in a 67-year-old female who presented with a complaint of cough and chest pain. Imaging demonstrated a left-sided paravertebral mass extending from T7-T10. Pathological analysis showed lamellar deposition of extracellular eosinophilic material with an associated lymphoplasmacytic nonamyloid infiltrate. To our knowledge, this is the first report of a paraspinal aggregoma. While exceedingly rare, this tumor can be included in the radiologic differential diagnosis of paravertebral soft tissue tumors in adults. The observation of our case adds to the limited understanding of the etiology, pathogenesis, natural history, and treatment of nonamyloid light-chain depositions.
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Affiliation(s)
- Ayushi Singh
- Department of Radiology, Winthrop University Hospital, 259 1st ST, Mineola, NY, 11501, USA
| | - Linda Okonkwo
- Department of Pathology, Winthrop University Hospital, 259 1st ST, Mineola, NY, 11501, USA.
| | - Jason C Hoffmann
- Department of Radiology, Winthrop University Hospital, 259 1st ST, Mineola, NY, 11501, USA
| | - Joseph P Mazzie
- Department of Radiology, Winthrop University Hospital, 259 1st ST, Mineola, NY, 11501, USA
| | - Amanjit S Baadh
- Department of Radiology, Winthrop University Hospital, 259 1st ST, Mineola, NY, 11501, USA.
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Pianta M, Chock E, Schlicht S, McCombe D. Accuracy and complications of CT-guided core needle biopsy of peripheral nerve sheath tumours. Skeletal Radiol 2015; 44:1341-9. [PMID: 26078215 DOI: 10.1007/s00256-015-2185-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 04/23/2015] [Accepted: 05/28/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This single-centre study retrospectively reviews the complications in patients that have occurred following peripheral nerve sheath tumour biopsy, and assesses whether there is an association with biopsy technique or underlying lesion characteristics. MATERIALS AND METHODS 41 consecutive core needle biopsies of proven peripheral nerve sheath tumours over a 2-year period in a tertiary teaching hospital were reviewed. Patient demographics and symptoms, tumour characteristics and radiological appearances were recorded. Biopsy and surgical histology were correlated, and post-biopsy and surgical complications analyzed. RESULTS 41 biopsies were performed in 38 patients. 68% schwannomas, 24% neurofibromas and 7% malignant peripheral nerve sheath tumours. Biopsy histology correlated with surgery in all cases. 71% of lesions were surgically excised. 60% of patients reported pain related to their lesion. Following the biopsy, 12% reported increased pain, which resolved in all cases. Pain exacerbation was noted in tumours smaller in size, more superficial and in closer proximity of the biopsy needle tip to the traversing nerve. Number of biopsy needle passes was not associated with an increased incidence of procedure-related pain. CONCLUSION Core biopsy of a suspected peripheral nerve sheath tumour may be performed safely before excisional surgery to confirm lesion histology and assist prognosis. There is excellent correlation between core biopsy and excised surgical specimen histology. The most common complication of pain exacerbation is seen in a minority and is temporary, and more likely with smaller, more superficial lesions and a closer needle-tip to traversing nerve distance during biopsy.
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Affiliation(s)
- Marcus Pianta
- St Vincent's Hospital, 41 Victoria Parade, Fitzroy, 3065, VIC, Australia,
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Intraoperative neurophysiological monitoring in peripheral nerve surgery: Technical description and experience in a center. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Herrera-Pérez M, Oller-Boix A, Pérez-Lorensu PJ, de Bergua-Domingo J, Gonzalez-Casamayor S, Márquez-Marfil F, Díaz-Flores L, Pais-Brito JL. Intraoperative neurophysiological monitoring in peripheral nerve surgery: Technical description and experience in a centre. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:266-74. [PMID: 25572819 DOI: 10.1016/j.recot.2014.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/05/2014] [Accepted: 11/08/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Intraoperative neurophysiological monitoring has experienced a spectacular development in the past 20 years, particularly in the fields of neurosurgery and spine surgery. it has become a useful, almost indispensable, tool in preventing nerve damage during surgery. The aim of this article is to describe the intraoperative technique and analyze its results in the field of peripheral nerve surgery. OBJECTIVE To describe the usefulness of a technique in peripheral nerve surgery, the technique used and the experience in a centre. PATIENTS AND METHODS A retrospective study was conducted on 30 cases of peripheral nerve surgery performed in this centre from 2009 to 2013, using the intraoperative monitoring technique. RESULTS Of the total of 13 peripheral nerve tumors recorded, there were 11 excellent results and 2 good results, one temporary hypoesthesia and one with almost complete sensory, except for motor, recovery. Traumatic injury was recorded in 17 cases, of which 6 required performing a graft, and the remaining 11 cases only neurolysis was performed, with complete motor and sensory recovery. CONCLUSIONS Intraoperative neurophysiological monitoring is a useful tool in the secondary surgery of peripheral nerve injury and the intraneural tumor pathology.
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Affiliation(s)
- M Herrera-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España; Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, España.
| | - A Oller-Boix
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - P J Pérez-Lorensu
- Unidad de Monitorización Neurofisiológica Intraoperatoria, Servicio de Neurofisiología Clínica, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - J de Bergua-Domingo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - S Gonzalez-Casamayor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - F Márquez-Marfil
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - L Díaz-Flores
- Servicio de Radiodiagnóstico, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - J L Pais-Brito
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España; Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, España
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Yang T, Juric-Sekhar G, Born D, Sekhar LN. A case of malignant peripheral nerve sheath tumor of the hypoglossal nerve after stereotactic radiosurgery treatment. J Neurol Surg Rep 2014; 75:e42-6. [PMID: 25083387 PMCID: PMC4110120 DOI: 10.1055/s-0033-1358797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 09/08/2013] [Indexed: 10/28/2022] Open
Abstract
Objectives Hypoglossal schwannomas are rare. Surgical resection has been the standard treatment modality. Radiosurgery has been increasingly used for treatment. Radiation-associated secondary malignancy/malignant transformation has not been documented in the literature for the treatment of nonvestibular schwannomas. Setting The patient was a 52-year-old man with an enlarging high cervical/skull base lesion 8.5 years after CyberKnife treatment of a presumed vagal schwannoma. A decision was made for surgical resection, and the tumor was found to originate from the hypoglossal nerve intraoperatively. Final pathology diagnosis was malignant peripheral nerve sheath tumor. Results Patient had a gross total resection. Three months after resection, he received fractionated radiation of 50 Gy in 25 fractions and a boost gamma knife radiosurgery of 10 Gy to the 50% isodose surface. He remained tumor free on repeat magnetic resonance imaging 9 months after the resection. Conclusion Although extremely rare, radiation treatment of nonvestibular schwannomas can potentially cause malignant transformation.
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Affiliation(s)
- Tong Yang
- Department of Neurosurgery, University of Washington, School of Medicine, Seattle, Washington, United States
| | - Gordana Juric-Sekhar
- Department of Pathology, University of Washington, School of Medicine, Seattle, Washington, United States
| | - Donald Born
- Department of Pathology, University of Washington, School of Medicine, Seattle, Washington, United States
| | - Laligam N Sekhar
- Department of Neurosurgery, University of Washington, School of Medicine, Seattle, Washington, United States
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Pediatric and adult malignant peripheral nerve sheath tumors: an analysis of data from the surveillance, epidemiology, and end results program. J Neurooncol 2014; 116:609-16. [PMID: 24390465 DOI: 10.1007/s11060-013-1345-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/29/2013] [Indexed: 10/25/2022]
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft tissue sarcomas that arise predominantly from Schwann cells. Despite the fact that MPNSTs have high local recurrence rates and are generally associated with poor prognosis, little is known about prognostic factors or effective clinical management for this tumor type. The purpose of this study was to describe the distributions of patient and tumor characteristics and to identify predictors of cause-specific survival among MPNST cases reported to SEER between 1973 and 2008. Patient and tumor characteristics were compared between pediatric and adult MPNST cases. Cox regression and tree-based survival analysis were used to examine factors associated with MPNST-related mortality separately among adults and children. A total of 1,315 MPNST cases were isolated from the 1973-2008 SEER dataset. Among pediatric cases, sex, race, and radiation therapy predicted MPNST survival, whereas among adults, tumor site, tumor grade, number of primary tumors, and tumor size were significant predictors. As tumor size at diagnosis/resection may be the only somewhat "modifiable" prognostic factor, future studies should aim to identify biological and social attributes associated with tumor size at diagnosis, separately among individuals with and without NF-1, in order to help identify earlier opportunities for clinical intervention.
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Rapidly Progressive Epithelioid Malignant Peripheral Nerve Sheath Tumor of the Vestibular Nerve. Otol Neurotol 2013; 34:1739-42. [DOI: 10.1097/mao.0b013e31829ab8be] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Kellner CP, Sussman E, Bar-David T, Winfree CJ. Schwannomas of the foot and ankle: a technical report. J Foot Ankle Surg 2013; 53:505-10. [PMID: 23932119 DOI: 10.1053/j.jfas.2013.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Indexed: 02/03/2023]
Abstract
The present technical report provides a detailed description of open surgical resection of peripheral nerve sheath tumors in the foot and ankle. We present 3 cases to illustrate important differences in the technique based on the presentation, anatomic location, and intraoperative neurophysiologic monitoring findings. It is important for surgeons to understand that surgical excision of many peripheral nerve sheath tumors can be undertaken without en bloc resection of the entire nerve trunk.
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Affiliation(s)
- Christopher P Kellner
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
| | - Eric Sussman
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Tzvi Bar-David
- Department of Podiatry, Columbia University College of Physicians and Surgeons, New York, NY
| | - Christopher J Winfree
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY
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38
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Go MH, Kim SH, Cho KH. Brachial plexus tumors in a consecutive series of twenty one patients. J Korean Neurosurg Soc 2012; 52:138-43. [PMID: 23091673 PMCID: PMC3467372 DOI: 10.3340/jkns.2012.52.2.138] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 05/07/2012] [Accepted: 08/19/2012] [Indexed: 12/30/2022] Open
Abstract
Objective This is a retrospective review of 22 surgically treated benign and malignant tumors of brachial plexus region to describe clinical presentation, the characteristics of brachial plexus tumor and clinical outcomes with a literature review. Methods Twenty-one patients with consecutive 22 surgeries for primary brachial plexus tumors were enrolled between February 2002 and November 2011 were included in this study. The medical records of all patients were reviewed. Results Eleven male and 10 female patients were enrolled. Mean age was 39 years. Three patients had brachial plexus tumor associated with neurofibromatosis (13.6%). Presenting signs and symptoms included parenthesis and numbness (54.5%), radiating pain (22.7%), direct tenderness and pain (27.2%), palpable mass (77.3%). Twelve patients presented preoperative sensory deficit (54.5%) and 9 patients presented preoperative motor deficit (40.9%). Twenty tumors (90.9%) were benign and 2 tumors (9.1%) were malignant. Benign tumors included 15 schwannomas (68.2%), 4 neurofibromas (18.2%) and 1 granular cell tumor (4.5%). There were 1 malignant peripheral nerve sheath tumor (MPNST) and 1 malignant granular cell tumor. Gross total resection was achieved in 16 patients (72.7%), including all schwannomas, 1 neurofibroma. Subtotal resection was performed in 6 tumors (27.3%), including 3 neurofibromatosis associated with brachial plexus neurofibromas, 1 MPNST and 2 granular cell tumor in one patient. Conclusion Resection of tumor is the choice of tumor in the most of benign and malignant brachial plexus tumors. Postoperative outcomes are related to grade of resection at surgery and pathological features of tumor.
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Affiliation(s)
- Myeong Hoon Go
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
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Chatzistefanou A, Mantatzis M, Deftereos S, Mintzopoulou P, Prassopoulos P. Peripheral nerve sheath tumors. Benign or malignant? The role of MRI and ultrasonography in a case report. J Neuroimaging 2012; 24:308-10. [PMID: 22913746 DOI: 10.1111/j.1552-6569.2012.00731.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 04/03/2012] [Accepted: 05/06/2012] [Indexed: 11/26/2022] Open
Abstract
A 31-year-old male patient admitted to another hospital for investigation of a localized painful hump in the medial surface of his left leg. The clinical examination revealed a painful palpable lump in the medial surface of left thigh that was initially thought to be a hematoma due to a history of recent trauma. However, an ultrasound was requested to exclude deep venous thrombosis (DVT). The US examination revealed a heterogeneous, fusiform lesion with elongated proximal and distal projections in close proximity to superficial femoral artery and vein and could not definitely exclude the DVT hypothesis. In a second ultrasound examination performed in our department, a neurogenic origin of the lesion was proposed. A consequent MRI examination confirmed the presence of a fusiform tumor in the anatomic path of the saphenous nerve. This was further confirmed intraoperatively, and pathologically was diagnosed as a malignant peripheral nerve sheath tumor (MPNST). In this present study the role of ultrasonography, the correlation between MRI and ultrasonographic findings are discussed and a review of the literature is presented.
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Affiliation(s)
- Alexandros Chatzistefanou
- Department of Radiology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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40
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Zhao M, Li X, Wang J, Li W, Huang Z. Retroperitoneal schwannoma treated with percutaneous computed tomography-guided radiofrequency ablation. J Neurosurg Spine 2012; 17:173-6. [PMID: 22657948 DOI: 10.3171/2012.4.spine111061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Retroperitoneal schwannomas (RSs) are particularly rare tumors, and resection is the first choice for symptomatic patients. However, some RSs with anatomical complexities pose great challenges for surgeons attempting radical resection without sacrificing the nearby critical structures, and subtotal resection leads to local recurrence, especially in refractory malignant RSs. The authors have successfully applied percutaneous CT-guided radiofrequency ablation in 2 cases of RSs, with favorable long-term progression-free survival.
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Affiliation(s)
- Ming Zhao
- Minimally Invasive Interventional Division, Medical Imaging Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Guangzhou, Guangdong, People's Republic of China.
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Merlin/NF2 regulates angiogenesis in schwannomas through a Rac1/semaphorin 3F-dependent mechanism. Neoplasia 2012; 14:84-94. [PMID: 22431917 DOI: 10.1593/neo.111600] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 02/03/2012] [Accepted: 02/03/2012] [Indexed: 12/14/2022] Open
Abstract
Neurofibromatosis type 2 (NF2) is an autosomal-dominant multiple neoplasia syndrome that results from mutations in the NF2 tumor suppressor gene. Patients with NF2 develop hallmark schwannomas that require surgery or radiation, both of which have significant adverse effects. Recent studies have indicated that the tumor microenvironment-in particular, tumor blood vessels-of schwannomas may be an important therapeutic target. Furthermore, although much has been done to understand how merlin, the NF2 gene product, functions as a tumor suppressor gene in schwannoma cells, the functional role of merlin in the tumor microenvironment and the mechanism(s) by which merlin regulates angiogenesis to support schwannoma growth is largely unexplored. Here we report that the expression of semaphorin 3F (SEMA3F) was specifically downregulated in schwannoma cells lacking merlin/NF2. When we reintroduced SEMA3F in schwannoma cells, we observed normalized tumor blood vessels, reduced tumor burden, and extended survival in nude mice bearing merlin-deficient brain tumors. Next, using chemical inhibitors and gene knockdown with RNA interference, we found that merlin regulated expression of SEMA3F through Rho GTPase family member Rac1. This study shows that, in addition to the tumor-suppressing activity of merlin, it also functions to maintain physiological angiogenesis in the nervous system by regulating antiangiogenic factors such as SEMA3F. Restoring the relative balance of proangiogenic and antiangiogenic factors, such as increases in SEMA3F, in schwannoma microenvironment may represent a novel strategy to alleviate the clinical symptoms of NF2-related schwannomas.
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Abstract
INTRODUCTION Neurofibromatosis 1 is a tumor predisposition genetic syndrome with autosomal dominant inheritance and virtually 100% penetrance by the age of 5 years. NF1 results from a loss-of-function mutation in the NF1 gene, resulting in decreased levels of neurofibromin in the cell. Neurofibromin is a negative regulator of various intracellular signaling pathways involved in the cellular proliferation. Although the loss of heterozygosity in the NF1 gene may predispose NF1 patients to certain malignancies, additional genetic alterations are a prerequisite for their development. The precise nature of these additional genetic alterations is not well defined, and genetic testing of all malignancies in NF1 patients becomes an essential component of future research in this subset of patients. In addition to germline NF1 mutations, alteration of the somatic NF1 gene is associated with sporadic malignancies such as adenocarcinoma of the colon, myelodysplastic syndrome, and anaplastic astrocytoma. MATERIALS AND METHODS A comprehensive English and non-English language search for all articles pertinent to malignancies associated with NF1 was conducted using PubMed, a search engine provided by the U.S. National Library of Medicine and the National Institutes of Health. Key words searched included the following: "malignancies associated with NF1", "tumors associated with NF1", and "NF1 and malignancies". A comprehensive analysis in terms age and mode of presentation, investigation and therapeutic modalities, and outcome of the published data was performed and compared with similar information on the sporadic cases. RESULTS Malignancies in NF1 patients typically occur at an earlier age and, with an exception of optic pathway gliomas, certain types of malignancies carry a poor prognosis compared with their sporadic counterparts. Malignancies are the leading cause of death in NF1 patients, resulting in a 10- to 15-year decreased life expectancy compared with the general population. CONCLUSIONS The lack of well-defined screening tests for early detection and the nonspecific clinical presentation contributes to a poorer outcome in malignancies associated with NF1. Small study group size, mixed patient population, and a lack of uniformity in reporting research results make comparison of treatment outcome for this group difficult. An International Consensus Meeting to address and recommend best practices for screening, diagnosis, management, and follow-up of malignancies associated with NF1 is needed.
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Affiliation(s)
- Sachin Patil
- Department of Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, New Jersey 07039, USA
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Peripheral and cranial nerve sheath tumors-a clinical spectrum. Indian J Surg 2012; 74:371-5. [PMID: 24082588 DOI: 10.1007/s12262-011-0392-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 12/21/2011] [Indexed: 10/14/2022] Open
Abstract
To analyze the incidence of nerve sheath tumors in a tertiary care hospital over a period of 5 years and review the literature. Medical case records from last 5 years were retrieved and histopathology and operative details were studied in a retrospective analysis. There is a slight male preponderance when it comes to nerve sheath tumors and acoustic schwannomas accounted for the largest fraction among schwannomas. Nerve sheath tumors include a wide spectrum of schwannomas, neurofibromas and malignant peripheral nerve sheath tumors. Hence combination of clinical, pathological and surgical expertise is needed to diagnose accurately.
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Management of benign retroperitoneal schwannomas: a single-center experience. Am J Surg 2011; 202:194-8. [DOI: 10.1016/j.amjsurg.2010.06.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 06/25/2010] [Accepted: 06/25/2010] [Indexed: 11/22/2022]
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Karami KJ, Kelkar PS, Verdon MP, Grills IS, Bojrab DI, Pieper DR. Malignant Peripheral Nerve Sheath Tumor of the Vestibulocochlear Nerve and Brainstem. Neurosurgery 2011; 69:E1152-65; discussion E1165. [DOI: 10.1227/neu.0b013e318223bc2a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Malignant peripheral nerve sheath tumors are the most common malignant mesenchymal tumors of soft tissues, but they are very rare when found to arise from a cranial nerve and when not in association with neurofibromatosis. These tumors are highly malignant and carry a poor prognosis with survival usually less than 6 months.
CLINICAL PRESENTATION
The authors report the case of a 23-year-old female with no history of phakomatoses, previous irradiation, or known genetic disorders, who presented with a malignant peripheral nerve sheath tumor of the vestibulocochlear nerve and brainstem. Multiple staged skull base approaches were carried out with maximal possible resection. Adjunctive therapies including standard radiation therapy, intensity-modulated radiation therapy, and stereotactic gamma knife radiosurgery were used with an ultimate patient survival of 27 months.
CONCLUSION
To our knowledge, this is the first report describing a patient with a malignant peripheral nerve sheath tumor of the vestibulocochlear nerve and brainstem treated with staged surgical approaches in conjunction with multiple forms of radiotherapy and having a significant survival of more than 2 years.
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Affiliation(s)
- Kristophe J. Karami
- Department of Neurosurgery, St John Providence Hospital and Medical Centers, Michigan State University, Southfield, Michigan
| | - Prashant S. Kelkar
- Department of Neurosurgery, St John Providence Hospital and Medical Centers, Michigan State University, Southfield, Michigan
| | - Michael P. Verdon
- Department of Neurosurgery, St John Providence Hospital and Medical Centers, Michigan State University, Southfield, Michigan
| | - Inga S. Grills
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Dennis I. Bojrab
- Department of Otolaryngology, Michigan Ear Institute, Farmington Hills, Michigan
| | - Daniel R. Pieper
- Department of Neurosurgery, St John Providence Hospital and Medical Centers, Michigan State University, Southfield, Michigan
- Department of Neurosurgery, Michigan Head & Spine Institute, William Beaumont Hospital, Royal Oak, Michigan
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Cavalcanti DD, Martirosyan NL, Verma K, Safavi-Abbasi S, Porter RW, Theodore N, Sonntag VKH, Dickman CA, Spetzler RF. Surgical management and outcome of schwannomas in the craniocervical region. J Neurosurg 2011; 114:1257-67. [DOI: 10.3171/2010.5.jns0966] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Schwannomas occupying the craniocervical junction (CCJ) are rare and usually originate from the jugular foramen, hypoglossal nerves, and C-1 and C-2 nerves. Although they may have different origins, they may share the same symptoms, surgical approaches, and complications. An extension of these lesions along the posterior fossa cisterns, foramina, and spinal canal—usually involving various cranial nerves (CNs) and the vertebral and cerebellar arteries—poses a surgical challenge. The primary goals of both surgical and radiosurgical management of schwannomas in the CCJ are the preservation and restoration of function of the lower CNs, and of hearing and facial nerve function. The origins of schwannomas in the CCJ and their clinical presentation, surgical management, adjuvant stereotactic radiosurgery, and outcomes in 36 patients treated at Barrow Neurological Institute (BNI) are presented.
Methods
Between 1989 and 2009, 36 patients (mean age 43.6 years, range 17–68 years) with craniocervical schwannomas underwent surgical resection at BNI. The records were reviewed retrospectively regarding clinical presentation, radiographic assessment, surgical approaches, adjuvant therapies, and follow-up outcomes.
Results
Headache or neck pain was present in 72.2% of patients. Cranial nerve impairments, mainly involving the vagus nerve, were present in 14 patients (38.9%). Motor deficits were found in 27.8% of the patients. Sixteen tumors were intra- and extradural, 15 were intradural, and 5 were extradural. Gross-total resection was achieved in 25 patients (69.4%). Adjunctive radiosurgery was used in the management of residual tumor in 8 patients; tumor control was ultimately obtained in all cases.
Conclusions
Surgical removal, which is the treatment of choice, is curative when schwannomas in the CCJ are excised completely. The far-lateral approach and its variations are our preferred approaches for managing these lesions. Most common complications involve deficits of the lower CNs, and their early recognition and rehabilitation are needed. Stereotactic radiosurgery, an important tool for the management of these tumors as adjuvant therapy, can help decrease morbidity rates.
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Affiliation(s)
| | | | - Ketan Verma
- 2Neuroscience Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Sam Safavi-Abbasi
- 3Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma
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Chieng GH, Bhatnagar A, Mirza M. Solitary plexiform neurofibroma, a pitfall in diagnosis of lipoma. BMJ Case Rep 2010; 2010:2010/sep17_1/bcr0120102696. [PMID: 22778282 DOI: 10.1136/bcr.01.2010.2696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Plexiform neurofibromatosis is almost invariably associated with neurofibromatosis type I. A case of an isolated back plexiform neurofibroma, initially thought to be a lipoma, is presented, with emphasis on the importance of eliciting family history in reaching a diagnosis of neurofibromatosis. Currently, surgical resection is still the treatment of choice though a management plan is not well defined. Patients need appropriate regular follow-up to detect malignancy or early recurrence.
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Affiliation(s)
- G H Chieng
- Department of General Surgery, Sandwell & West Birmingham Hospitals, Birmingham, UK.
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Abstract
OPINION STATEMENT Nonvestibulocochlear cranial nerve schwannomas traditionally have been managed by surgical excision. Although debulking surgery is still considered the first treatment option for larger tumors, stereotactic radiosurgery is now preferred for smaller tumors because of its high tumor control rate and low treatment-related morbidity. Furthermore, an initial period of radiologic and clinical observation following the diagnosis should be strongly considered for smaller tumors because some may not grow or may grow at a slow rate. Medical management of tumor-associated symptoms (when present) should not be ignored. Most importantly, the time has come to embark on the first randomized controlled trials comparing clinical and radiologic observation, surgery, and radiosurgery in the management of cranial nerve schwannomas.
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Affiliation(s)
- Luis J Mejico
- Departments of Neurology and Ophthalmology, SUNY Upstate Medical University, 90 Presidential Plaza, Syracuse, NY, 13202, USA,
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Sachanandani NS, Brown JM, Zaidman C, Brown SS, Mackinnon SE. Intraneural perineurioma of the median nerve: case report and literature review. Hand (N Y) 2010; 5:286-93. [PMID: 19876692 PMCID: PMC2920385 DOI: 10.1007/s11552-009-9228-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 09/23/2009] [Indexed: 01/25/2023]
Abstract
Intraneural perineurioma is a benign peripheral nerve sheath tumor of perineurial cell origin. We present the case of an intraneural perineurioma of the median nerve in a 23-year-old woman which posed a diagnostic challenge. Ultrasonography was found to be a quick, easy, and effective screening tool for identifying the source of the deficit followed by MRI to further elucidate the lesion. We discuss surgical management options for optimizing functional outcomes when addressing such lesions.
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Affiliation(s)
- Neil S. Sachanandani
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Justin M. Brown
- Department of Neurosurgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8057 St. Louis, MO 63110 USA ,Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Craig Zaidman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO USA
| | - Stephanie S. Brown
- Department of Pathology, Washington University School of Medicine, St. Louis, MO USA
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO USA
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