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Sqalli Houssaini A, Lahfidi A, Guennouni A, Kettani N, Fikri M, Touarsa F, Jiddane M. Primitive neuroectodermal tumor of the lumbosacral nerve plexus: A case report. Radiol Case Rep 2024; 19:5058-5062. [PMID: 39253042 PMCID: PMC11381973 DOI: 10.1016/j.radcr.2024.07.134] [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: 06/11/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 09/11/2024] Open
Abstract
We report an uncommon case of primitive neuroectodermal tumor/ Ewing's sarcoma of the lumbar and sacral nerve plexus in a 17years old boy who presented with an intense pain in the lower back radiating to legs. Magnetic resonance imaging showed a soft tissue mass with thickening of lumbar and sacral spinal nerve roots (L5-S3 level), along with widening of the corresponding foramina. There was also posterior scalloping of L5/S1 vertebrae and invasion of the sacral bone. A Partial resection has been performed, and the ensuing histopathology confirmed the diagnosis of PNET/Ewing's sarcoma. MRI in conjunction with histopathology are the key to narrow down the differential diagnoses list. PNET of lumbosacral area remain scarce, and only few cases have been reported nowadays. Given to the aggressivity of these tumors, the prognosis is poor despite appropriate treatment.
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Affiliation(s)
- Adam Sqalli Houssaini
- Department of Neuroradiology, Specialty Hospital, University Hospital Center Ibn Sina, Faculty of Medicine and Pharmacy, Rabat 10000, Morocco
| | - Amal Lahfidi
- Department of Neuroradiology, Specialty Hospital, University Hospital Center Ibn Sina, Faculty of Medicine and Pharmacy, Rabat 10000, Morocco
| | - Asmae Guennouni
- Department of Neuroradiology, Specialty Hospital, University Hospital Center Ibn Sina, Faculty of Medicine and Pharmacy, Rabat 10000, Morocco
| | - Najoua Kettani
- Department of Neuroradiology, Specialty Hospital, University Hospital Center Ibn Sina, Faculty of Medicine and Pharmacy, Rabat 10000, Morocco
| | - Meriem Fikri
- Department of Neuroradiology, Specialty Hospital, University Hospital Center Ibn Sina, Faculty of Medicine and Pharmacy, Rabat 10000, Morocco
| | - Firdaous Touarsa
- Department of Neuroradiology, Specialty Hospital, University Hospital Center Ibn Sina, Faculty of Medicine and Pharmacy, Rabat 10000, Morocco
| | - Mohamed Jiddane
- Department of Neuroradiology, Specialty Hospital, University Hospital Center Ibn Sina, Faculty of Medicine and Pharmacy, Rabat 10000, Morocco
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Wang X, Liu Y, Liu H, Chen Y, Song L, Xian J. Evaluation of multiparametric MRI differentiating pleomorphic adenoma from schwannoma in parapharyngeal space. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08841-4. [PMID: 39069574 DOI: 10.1007/s00405-024-08841-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE This study aimed to investigate whether multiparametric magnetic resonance imaging (MRI) including dynamic contrast-enhanced (DCE) and diffusion weighted (DW) MRI can differentiate pleomorphic adenoma (PA) from schwannoma in the parapharyngeal space. METHODS Forty-six patients with pathologically proven PAs and 47 schwannomas in the parapharyngeal space were enrolled. All patients underwent conventional MRI, and DW-MRI and DCE-MRI were performed in 30 and 33 patients, respectively. Fisher's exact, Mann-Whitney-U tests and Independent samples t-test were used to compare variables between PAs and schwannomas. Multivariate logistic regression analysis was used to examine the diagnostic performance of MRI parameters. RESULTS The PAs usually show lobulation sign, posterior displacement of ICA and attached to the parotid gland deep leaf, while bird beak configuration, anterior displacement of ICA and involvement of foramen jugular were more commonly seen in the schwannomas(all p < 0.001). The washout rate of PAs was found to be higher than that of schwannomas (p = 0.035), whereas no significance was found in the other DCE-MRI parameters and in ADCs(p > 0.05). Using a combination of conventional MRI features including lobulation sign, bird beak configuration, direction of internal carotid artery(ICA) displacement and attached to the parotid gland in multivariate logistic regression analysis, sensitivity, specificity, and accuracy in differential diagnosis of PAs and schwannomas were 97.8%, 91.5% and 94.6%, respectively. CONCLUSION Conventional MRI can effectively differentiate PAs from schwannomas in the parapharyngeal space with a high diagnostic accuracy. The DCE-MRI and DWI have limited added diagnostic value to conventional MRI in the differential diagnosis.
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Affiliation(s)
- Xinyan Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yunfu Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Hangzhi Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yun Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Liyuan Song
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Yaprak Bayrak B, Yaylacı A, Ozturk M. Clinicopathological Findings of Surgically Treated Nasal Cavity Schwannomas: A Case Series. EAR, NOSE & THROAT JOURNAL 2024:1455613241261004. [PMID: 39049574 DOI: 10.1177/01455613241261004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Objectives: Nasal cavity schwannomas are exceedingly rare, benign neoplasms that pose challenges in clinical differentiation from other nasal tumors. Methods: This study presents 5 cases of nasal cavity schwannoma treated surgically over a 10 year period, along with a review of the literature. Results: The most prevalent symptoms included unilateral nasal obstruction and intermittent nosebleeds. Tumors originated from various nasal sites, including the septum, middle conchae, lateral nasal wall, and alar mucosa. All surgeries were conducted transnasally, with 3 tumors excised en bloc, and the remaining two subjected to piecemeal resection. Ancient schwannoma was identified in 4 cases. No instances of recurrence were observed during the average 61 month follow-up period. Conclusions: The definitive diagnosis of schwannomas necessitates histopathological examination. An endoscopic approach to the nasal cavity, obviating the need for external intervention, proved highly effective and appropriate for both diagnosis and symptom alleviation.
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Affiliation(s)
- Busra Yaprak Bayrak
- Department of Pathology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Atılay Yaylacı
- Department of Otorhinolaryngology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Murat Ozturk
- Department of Otorhinolaryngology, School of Medicine, Kocaeli University, Kocaeli, Turkey
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Mak YH, Ho G. Multicompartmental cystic trigeminal schwannoma as an uncommon differential diagnosis of cerebellopontine angle tumors. Radiol Case Rep 2024; 19:2552-2557. [PMID: 38596177 PMCID: PMC11001620 DOI: 10.1016/j.radcr.2024.03.013] [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: 12/02/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
Trigeminal schwannoma is the second most common intracranial schwannoma yet accounts for less than 0.5% intracranial tumors [1]. Cystic degeneration is uncommon. We would like to report a pathologically proven multicompartmental cystic trigeminal schwannoma in a young adult presenting with chronic headache. A literature review on the imaging features of trigeminal schwannoma is performed to assist radiologists in accurate disease localization and prioritizing differential diagnosis in challenging cases. Confident preoperative radiological diagnosis would directly affect management strategies.
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Affiliation(s)
- Yuen Hei Mak
- Department of Radiology, Queen Mary Hospital, Hong Kong SAR, China, 102 Pokfulam Road, Hong Kong SAR, China
| | - Grace Ho
- Department of Radiology, Queen Mary Hospital, Hong Kong SAR, China, 102 Pokfulam Road, Hong Kong SAR, China
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Yamazaki M, Takamatsu S, Iwata Y, Sakurai T, Taka M, Kobayashi S, Gabata T, Mizuno E. Notch appearance as a novel radiological predictor of transient expansion and good outcome of expanding schwannoma after radiotherapy. Discov Oncol 2024; 15:79. [PMID: 38503989 PMCID: PMC10951174 DOI: 10.1007/s12672-024-00936-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Schwannoma expansion after radiotherapy has not been well-studied despite the clinical importance of distinguishing transient increase from permanent expansion. Thus, this study aimed to identify the underlying mechanism and novel radiological predictors of schwannoma expansion after radiotherapy. MATERIALS & METHODS We retrospectively examined the therapeutic effects of radiotherapy on schwannomas and magnetic resonance images of 43 patients with vestibular schwannomas who underwent stereotactic radiotherapy or radiosurgery at our facility between June 1, 2012 and September 1, 2018. Based on the size change pattern, the treated tumors were classified into six groups, including transient-expansion and consistent-increase groups. The apparent diffusion coefficient (ADC) ratio and appearance of any notch were included as evaluation items based on our hypothesis that transient expansion is due to edema with increased extracellular free water. A log-rank test was performed to evaluate the relationship between the local control rate and radiological signs. RESULTS The mean overall 5-year local control rate was 90%, and the median follow-up period was 62 (24-87) months. Approximately 28% of the tumors showed transient expansion; all ADC ratios synchronized with size change, and 75% showed a new notch appearance. Approximately 9% of tumors showed consistent increase, with no notch on the outline. The log-rank test revealed a difference in the local control rate with or without notch appearance in expanding irradiated schwannomas. All tumors with notch appearance showed a significant regression 5 years after radiation. CONCLUSIONS New notch appearance on the outline could indicate favorable long-term outcomes of expanding schwannomas post-treatment. CLINICAL RELEVANCE STATEMENT Notch appearance can help differentiate a transient schwannoma from a real tumor expansion, and it is a novel predictor of better outcomes of expanding schwannomas after radiotherapy.
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Affiliation(s)
- Masahiro Yamazaki
- Department of Radiology, Kanazawa University School of Medical Science, Kanazawa City, Japan.
| | - Shigeyuki Takamatsu
- Department of Radiology, Kanazawa University School of Medical Science, Kanazawa City, Japan
| | - Yuta Iwata
- Toyama CyberKnife Center, Toyama City, Japan
| | - Takayuki Sakurai
- Department of Radiology, Kanazawa University School of Medical Science, Kanazawa City, Japan
| | - Masashi Taka
- Toyama Prefectural Central Hospital, Toyama City, Japan
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University School of Medical Science, Kanazawa City, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University School of Medical Science, Kanazawa City, Japan
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Tejani AS, Berson E, Phillip J, Feltrin FS, Bazan C, Raj KM, Agarwal AK, Maldjian JA, Lee WC, Yu FF. Diffusion-weighted imaging of the orbit. Clin Radiol 2024; 79:10-18. [PMID: 37926649 DOI: 10.1016/j.crad.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Orbital lesions compose a heterogeneous group of pathologies that often present with non-specific imaging findings on conventional magnetic resonance imaging (MRI) sequences (T1-and T2-weighted). Accordingly, the application of diffusion MRI offers an opportunity to further distinguish between lesions along this spectrum. Diffusion-weighted imaging (DWI) represents the simplest and most frequent clinically utilised diffusion imaging technique. Recent advances in DWI techniques have extended its application to the evaluation of a wider spectrum of neurological pathology, including orbital lesions. This review details the manifestations of select orbital pathology on DWI and underscores specific situations where diffusion imaging allows for increased diagnostic sensitivity compared to more conventional MRI techniques. These examples also describe preferred management for orbital lesions identified by DWI.
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Affiliation(s)
- A S Tejani
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - E Berson
- Department of Radiology, Yale School of Medicine, New Haven, CT, USA
| | - J Phillip
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F S Feltrin
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Bazan
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - K M Raj
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A K Agarwal
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J A Maldjian
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - W-C Lee
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F F Yu
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Bouttelgier RM, Berghe CV, Vantomme N, Cambron M, Casselman JW. Imaging of trochlear nerve schwannomas: a case series and systematic review of the literature. Br J Neurosurg 2023:1-7. [PMID: 37966054 DOI: 10.1080/02688697.2023.2280601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/02/2023] [Indexed: 11/16/2023]
Abstract
Purpose Trochlear nerve schwannomas are rare tumors. So far, only 121 cases have been published. We present four new cases, discuss the imaging characteristics and summarize all previously published cases through a systematic review.Methods Four cases, all treated in AZ Sint-Jan Hospital Brugge-Oostende (Belgium), were collected, including their demographic, clinical and radiological data. All MR imaging was performed with the three-dimensional fluid-attenuated inversion recovery (3D-FLAIR), turbo spin echo T1 high-resolution (TSE T1 HR), three-dimensional balanced fast-field echo (3D b-FFE) and three-dimensional T1 black blood (3D T1 black blood) sequence. We compared our findings with the present literature through a systematic literature review in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.Results Screening with routine unenhanced 3D-FLAIR imaging could identify all schwannomas as hyperintense lesions on the course of the trochlear nerve. The use of 3D T1 black blood sequences was superior in depicting the lesions, while high-resolution 3D b-FFE images enabled us to visualize the anatomic boundaries of the lesions in detail. Most trochlear schwannomas are located in the ambient cistern, at or just below the free edge of the tentorium.Conclusion The majority of trochlear nerve schwannomas are located cisternal and display variable enhancement on contrast administration. 3D-FLAIR imaging is superior in detecting these lesions. Comparison with data collected from previous cases demonstrates the importance of early diagnosis and treatment. Generally, patients with trochlear nerve schwannomas have a good prognosis.
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Affiliation(s)
| | | | - Nikolaas Vantomme
- Department of Neurosurgery, AZ Sint-Jan Hospital, Brugge-Oostende, Belgium
| | - Melissa Cambron
- Department of Neurology, AZ Sint-Jan Hospital, Brugge-Oostende, Belgium
| | - Jan W Casselman
- Department of Radiology, AZ Sint-Jan Hospital, Brugge-Oostende, Belgium
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Halalmeh DR, Asad MY, Atallah OA, Sbeih AI, Alrashdan M, Richardson AM, Moisi MD, Sbeih IA. Predictors of Surgical Outcomes in Patients with Abducens Nerve Schwannoma: A Comprehensive Systematic Review and a Case Report. World Neurosurg 2023; 179:204-215.e4. [PMID: 37652133 DOI: 10.1016/j.wneu.2023.08.100] [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: 07/17/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Abducens nerve (AN) schwannomas are extremely rare tumors. Clinical characteristics and factors that influence postoperative outcomes are not well defined. OBJECTIVE To characterize clinical features of AN schwannomas and predictors of surgical outcomes. METHODS PRISMA-guided systematic review of the literature on AN schwannomas was performed. Subsequently, univariate and multivariate regression analyses were performed to identify the predictive value of variables that influence postoperative outcomes. RESULTS A total of 42 studies with 55 patients were evaluated. The mean age at presentation was 43.9 ± 14.6 years. The most common presenting symptom was cranial nerve VI palsy (69.1%). Cavernous sinus (49.1%) and prepontine cistern (36.3%) were the most commonly involved locations. Complete recovery after surgery was seen in 36.3% at a median follow-up of 28.4 ± 25.8 months. Preoperative AN palsy (P < 0.001), suboccipital approach (P = 0.007), and subtotal resection of tumor (P = 0.044) were significant protective factors for postoperative complications. Prepontine location and postoperative complications were poor prognostic indicators of AN recovery (odds ratio [OR], 0.10, P = 0.030 and OR, 0.10, P = 0.028, respectively). Subtotal resection was significantly correlated with higher odds of AN recovery (OR, 6.06; P = 0.040). CONCLUSIONS AN schwannomas are rare but serious tumors that can cause significant morbidity, with only approximately one third of patients showing complete recovery after surgery. The suboccipital approach was a protective factor for postoperative complications, especially when combined with subtotal resection. Knowledge of these factors along with tumor characteristics helps optimize surgical planning and preoperative counseling.
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Affiliation(s)
- Dia R Halalmeh
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA.
| | - Mahmoud Y Asad
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Omar A Atallah
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | | | | | - Angela M Richardson
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marc D Moisi
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
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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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Cavalcanti GST, Lemos A, Moretti EC, Lucena CMGA, Gomes JGR, Muniz LF, Venâncio LGA, Caldas S, Leal MC. Cochlear radiation dose and hearing loss in patients with vestibular schwannoma undergoing radiosurgery: systematic review. Braz J Otorhinolaryngol 2023; 89:101300. [PMID: 37579571 PMCID: PMC10448415 DOI: 10.1016/j.bjorl.2023.101300] [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: 05/29/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVES To determine the cut-off point of the cochlear radiation dose as a risk factor for hearing loss in patients with vestibular schwannoma treated with radiosurgery. METHODS A systematic review of the literature was performed without language or publication year restrictions in the MEDLINE/PubMed, EMBASE, Web of Science, LILACS/VHL and Cochrane Library databases. Studies that met the following criteria were included: 1) population: adults of both sexes who underwent radiosurgery for vestibular schwannoma treatment; 2) exposure: cochlear radiation; 3) outcome: hearing loss; 4) type of study: cohort. Two independent reviewers conducted the entire review process. The registration number in PROSPERO was CRD42020206128. RESULTS From the 333 articles identified in the searches, seven were included after applying the eligibility criteria. There was no standardization as to how to measure exposure or outcome in the included studies, and most studies did not present sufficient data to enable meta-analysis. CONCLUSION It was not possible to determine a cut-off point for high cochlear dose that could be considered a risk factor for hearing loss.
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Affiliation(s)
| | - Andrea Lemos
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Recife, PE, Brazil
| | - Eduarda C Moretti
- Universidade Federal de Alagoas, Instituto de Ciências Biológicas e da Saúde, Maceió, AL, Brazil
| | | | | | - Lílian F Muniz
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Recife, PE, Brazil
| | | | - Silvio Caldas
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Recife, PE, Brazil
| | - Mariana C Leal
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Recife, PE, Brazil
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11
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Huynh BQ, Hung ND, Khuong NH, Anh NN, Duc NM. A rare case of a primary central nervous system neuroblastoma mimicking a trigeminal schwannoma in an adult. Radiol Case Rep 2023; 18:2697-2703. [PMID: 37273727 PMCID: PMC10238263 DOI: 10.1016/j.radcr.2023.05.028] [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: 02/02/2023] [Revised: 04/03/2023] [Accepted: 05/07/2023] [Indexed: 06/06/2023] Open
Abstract
Neuroblastoma is a malignant extra-cranial tumor that frequently arises in the pediatric population aged <5 years but is rare in adults. Only a few cases of primary central nervous system neuroblastoma (PCN-NB) have been documented, with most occurring in young patients. In this article, we report an adult case with a PCN-NB in the cerebellopontine angle-middle cranial fossa region that mimicked another neoplasm. We also discuss the magnetic resonance imaging features and pathological characteristics of PCN-NB and differential diagnosis strategies.
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Affiliation(s)
| | - Nguyen Duy Hung
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Ha Khuong
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Ngoc Anh
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 Distric, Ho Chi Minh City, 700000, Vietnam
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12
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Freeman E, Hecht L, Crum J, Lutz M. Anterior Nasal Schwannoma: A Rare Sinonasal Neoplasm. Cureus 2023; 15:e41300. [PMID: 37539410 PMCID: PMC10394659 DOI: 10.7759/cureus.41300] [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] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Schwannomas are the most common type of benign peripheral nerve tumor in adults. Schwann cells assist in the conduction of nerve impulses and wrap around peripheral nerves to provide protection and support. Schwannomas typically arise from a single fascicle within the main nerve. Although they can occur anywhere in the body, nasal schwannomas are exceptionally rare. This case study presents a 65-year-old Caucasian female who had been experiencing obstructive nasal symptoms for three months. The in-office physical examination revealed a soft tissue expansile mass involving the submucosal tissues of the bilateral anterior nasal cavity, located just posterior to the columella. The mass was surgically excised in the operating room, and the diagnosis was confirmed through histopathology. With only 32 reported cases, nasal septal schwannomas are exceedingly rare. Diagnosis relies on histopathology for confirmation. However, their clinical presentation can mimic other sinonasal pathologies. A septal schwannoma should be considered as a differential diagnosis for a unilateral sinonasal mass. Complete excision is the definitive treatment and is associated with a low recurrence rate. The patient had no signs of reoccurrence on nasal endoscopy three months postoperatively. Surveillance MRI will be completed at one year.
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Affiliation(s)
- Eric Freeman
- Otolaryngology - Head and Neck Surgery, Western Reserve Hospital, Cuyahoga Falls, USA
| | - Lauren Hecht
- Otolaryngology - Head and Neck Surgery, Heritage College of Osteopathic Medicine, Athens, USA
| | - Joel Crum
- Otolaryngology - Head and Neck Surgery, Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Matthew Lutz
- Otolaryngology - Head and Neck Surgery, Western Reserve Hospital, Cuyahoga Falls, USA
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13
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Battal B, Zamora C. Imaging of Skull Base Tumors. Tomography 2023; 9:1196-1235. [PMID: 37489465 PMCID: PMC10366931 DOI: 10.3390/tomography9040097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/26/2023] Open
Abstract
The skull base provides a platform for supporting the brain while serving as a conduit for major neurovascular structures. In addition to malignant lesions originating in the skull base, there are many benign entities and developmental variants that may simulate disease. Therefore, a basic understanding of the relevant embryology is essential. Lesions centered in the skull base can extend to the adjacent intracranial and extracranial compartments; conversely, the skull base can be secondarily involved by primary extracranial and intracranial disease. CT and MRI are the mainstay imaging methods and are complementary in the evaluation of skull base lesions. Advances in cross-sectional imaging have been crucial in the management of patients with skull base pathology, as this represents a complex anatomical area that is hidden from direct clinical exam. Furthermore, the clinician must rely on imaging studies for therapy planning and to monitor treatment response. It is crucial to have a thorough understanding of skull base anatomy and its various pathologies, as well as to recognize the appearance of treatment-related changes. In this review, we aim to describe skull base tumors and tumor-like lesions in an anatomical compartmental approach and present imaging methods that aid in diagnosis, management, and follow-up.
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Affiliation(s)
- Bilal Battal
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Carlos Zamora
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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Stoian AR, Rahnea-Nita G, Ciuhu AN, Gales L, Anghel RM, Rebegea LF, Rahnea-Nita RA, Andronache LF, Soare I, Stoleriu G. The Benefits and Challenges of the Multimodal Treatment in Advanced/Metastatic Malignant Melanoma. Diagnostics (Basel) 2023; 13:diagnostics13091635. [PMID: 37175025 PMCID: PMC10178057 DOI: 10.3390/diagnostics13091635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Currently, the treatment of malignant melanoma offers the longest and the most studied experience of innovative treatments in malignant pathology. The algorithm of the therapeutic decision in advanced or metastatic melanoma must comprise: the timing of the therapeutic initiation, the sequencing of the specific oncological treatment (radiotherapy and chemotherapy still being therapeutic alternatives in selected cases), the diagnosis and the management of adverse reactions. We present the case of a patient diagnosed with metastatic malignant melanoma in November 2019, who progressed successively under new systemic treatment throughout the 3 years of treatment and experienced skin reactions of various degrees of severity. The comprehensive response to secondary hilar pulmonary lymphatic determinations under subsequent chemotherapy was specific to the presented case. The occurrence of vitiligo secondary to immunotherapy is a favorable prognostic factor, but the occurrence of secondary cerebral determinations is an extremely severe prognostic factor in malignant melanoma and a challenge in making the therapeutic decision. Previous treatment with immune checkpoint inhibitors may trigger a favorable response to systemic chemotherapy. The early and accurate diagnosis of the adverse events of the new therapies requires a multidisciplinary approach, because it can radically change the therapeutic decision.
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Affiliation(s)
- Alexandru-Rares Stoian
- Clinical Department, Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari Street, 050474 Bucharest, Romania
- "Bagdasar-Arseni" Emergency Clinical Hospital, 041915 Bucharest, Romania
| | - Gabriela Rahnea-Nita
- Clinical Department, Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari Street, 050474 Bucharest, Romania
- "Sf. Luca" Chronic Disease Hospital, 041915 Bucharest, Romania
| | | | - Laurentia Gales
- Clinical Department, Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari Street, 050474 Bucharest, Romania
- The Oncological Institute "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
| | - Rodica-Maricela Anghel
- Clinical Department, Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari Street, 050474 Bucharest, Romania
- The Oncological Institute "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
| | - Laura-Florentina Rebegea
- Radiotherapy Department, "Sf. Ap. Andrei" County Emergency Clinical Hospital, 800579 Galati, Romania
- Clinical Department, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800008 Galati, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, 800010 Galati, Romania
| | - Roxana-Andreea Rahnea-Nita
- Clinical Department, Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari Street, 050474 Bucharest, Romania
- "Sf. Luca" Chronic Disease Hospital, 041915 Bucharest, Romania
| | - Liliana-Florina Andronache
- Clinical Department, Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari Street, 050474 Bucharest, Romania
| | - Ioana Soare
- Clinical Department, The Faculty of Medicine, "Titu Maiorescu" University, 040051 Bucharest, Romania
| | - Gabriela Stoleriu
- Clinical Department, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800008 Galati, Romania
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Saifi AM, Kapoor P, Bajaj A, Agarwal A. Sinonasal and Infratemporal Schwannoma: Rare Case Report with Literature Review. Indian J Otolaryngol Head Neck Surg 2023; 75:234-241. [PMID: 37206829 PMCID: PMC10188860 DOI: 10.1007/s12070-022-03424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Schwann cells are responsible for the production of the myelin sheath around the axons of the peripheral nervous system. Benign neoplasms which originate from Schwann cells are hence termed Schwannomas or Neurilemmomas. They present as slow-growing, solitary, encapsulated, benign masses usually in association with nerve trunks. Schwannomas are relatively rare tumors with 25-45% occurring in the head and neck region. These case reports aim to describe the presentations, work-up, and treatment of two patients with head and neck schwannoma in atypical locations. Both patients had a history of gradually increasing swelling, the first originating from the sino-nasal region and the second from the temporal/ infratemporal region. Complete surgical excision of the tumor was done in both cases with no reported recurrence at 18 months follow-up. The final diagnosis was made based on histopathology and immunohistochemistry findings. Schwannomas often present a diagnostic dilemma and should be considered a possibility in all head and neck tumors. Recurrence is rare.
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Affiliation(s)
- Aamir Malick Saifi
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, 70/71 New Azad Puram, Chawani Ashraf Khan, Hartman College Road, Bareilly, Uttar Pradesh 243122 India
| | | | - Ankita Bajaj
- Hira Hospital Dental and Maxillofacial, Bareilly, India
| | - Arjun Agarwal
- Department of Surgical Oncology, Rohilkhand Medical College and Hospital, Bareilly, India
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16
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Corrêa DG, Hygino da Cruz LC, Freddi TDAL. The Vestibulocochlear Nerve: Anatomy and Pathology. Semin Ultrasound CT MR 2023; 44:81-94. [PMID: 37055143 DOI: 10.1053/j.sult.2023.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
The vestibulocochlear nerve is the eighth cranial nerve, entering the brainstem in the medullopontine sulcus after crossing the internal auditory canal and cerebellopontine angle cistern. It is a purely sensitive nerve, originating from the Scarpa's and spiral ganglions, responsible for balance and hearing. It has 6 nuclei located in the lower pons. Magnetic resonance imaging (MRI) is useful for evaluating the vestibulocochlear nerve, although computed tomography may have a complementary role in assessing bone lesions. A heavily T2-weighted sequence, such as fast imaging employing steady-state acquisition (FIESTA) or constructive interference steady state (CISS), is crucial in imaging exams to depict the canalicular and cisternal segments of the vestibulocochlear nerve, as well as the fluid signal intensity in the membranous labyrinth. The vestibulocochlear nerve can be affected by several diseases, such as congenital malformations, trauma, inflammatory or infectious diseases, vascular disorders, and neoplasms. The purpose of this article is to review the vestibulocochlear nerve anatomy, discuss the best MRI techniques to evaluate this nerve and demonstrate the imaging aspect of the main diseases that affect it.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil.; Department of Radiology, Federal Fluminense University, Niterói, RJ, Brazil..
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17
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Simon B, Wogram E, Camp AT, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : A 43-year-old Patient Presenting with a Right-sided, Slowly Progressing, Painless Exophthalmos and Ptosis. Clin Neuroradiol 2023; 33:255-260. [PMID: 36805296 PMCID: PMC10014779 DOI: 10.1007/s00062-023-01267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Affiliation(s)
- B Simon
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - E Wogram
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - A T Camp
- Department of Ophthalmology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany.
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.
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18
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Brahmbhatt P, Kumar T, Bhatt AA, Vibhute P, Patel V, Desai A, Gupta V, Agarwal A. Sinonasal Schwannomas: Imaging Findings and Review of Literature. EAR, NOSE & THROAT JOURNAL 2023:1455613221150573. [PMID: 36775665 DOI: 10.1177/01455613221150573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE Schwannomas are common nerve sheath tumors and may occur anywhere in the body. 4% of head and neck schwannomas occur in the sinonasal cavity, and fewer yet have an intracranial component, making these presentations extremely rare. Furthermore, schwannomas present with nonspecific imaging signs and can only be definitively differentiated via histopathologic review, leading to misdiagnosis as various nasal tumors. We aim to conduct a review of published literature on sinonasal schwannomas with and without intracranial extension and provide additional case representations. METHODS A literature review was conducted using the PubMed Database with the terms "sinonasal schwannoma," "intracranial," "anterior skull base," and "schwannoma." Results were reviewed, and additional cases identified were referenced and included in the study. Inclusion criteria were any case with intracranial extension of the schwannoma. There were no exclusion criteria. Review data was compiled into Excel and used for data analysis and comparison. Additionally, a search was done within our institution to identify additional cases of sinonasal schwannoma. RESULTS We identified 17 cases of sinonasal schwannoma with intracranial extension, five from our institution and twelve from literature. Analysis revealed: 8 females (47%), 9 males (53%), 9 patients presented with headaches (53%), 6 patients presented with anosmia (35%), 4 patients presented with nasal obstruction (24%), and 2 patients with no symptoms (12%). Mean age and median were 39.4 ± 10.1 and 40, respectively. For treatment, 4 patients underwent endoscopic resection (24%), 11 underwent craniotomy (65%), and data was unavailable for 2 patients. Post-treatment complications occurred in 6 patients, 5 had CSF leaks (29%) and 1 had a hematoma (6%). CONCLUSION We identified and discussed 17 cases of sinonasal schwannoma with intracranial extension. We hope our review provides insight for clinicians to maintain schwannoma as a potential differential when evaluating nasal and anterior skull base masses.
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Affiliation(s)
| | - Tushar Kumar
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Alok A Bhatt
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Vishal Patel
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Amit Desai
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Vivek Gupta
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Amit Agarwal
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
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19
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Lei J, Li Y, Wan X, Wang J, You C, Zhao K, Niu H. Hemorrhagic schwannoma of the trochlear nerve: Case report and a review of the literature. Front Oncol 2023; 12:1097155. [PMID: 36713505 PMCID: PMC9880228 DOI: 10.3389/fonc.2022.1097155] [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: 11/13/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
Background Schwannomas of the trochlear nerve with the absence of systemic neurofibromatosis are considerably uncommon, especially complicated by intra-tumoral hemorrhage. Due to the lack of typical clinical manifestations and imaging findings, a definite diagnosis of trochlear schwannomas before surgery is particularly difficult. Case presentation We report the case of a 64-year-old female patient who presented with a unilaterally intermittent headache of 2-month duration and without a remarkable neurological deficit at admission. Imaging studies revealed a well-demarcated cystic-solid lesion with mixed signals beside the brainstem and suprasellar cisterna. The patient underwent a surgical operation with total resection of the tumor by a subtemporal surgical approach. The tumor was intraoperatively found to originate from the trochlear nerve and was pathologically confirmed as a hemorrhagic schwannoma with cystic degeneration. Conclusions We describe this case in detail and conduct a concomitant survey of the literature, summarizing the clinical presentations, radiological features, surgical treatment, and the possible mechanisms of hemorrhage in relevance to trochlear nerve schwannoma.
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Affiliation(s)
| | | | | | | | | | - Kai Zhao
- *Correspondence: Kai Zhao, ; Hongquan Niu,
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20
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Aregawi AB. A Rare Case of Cervical Vagal Nerve Schwannoma in a 30-Year-Old Ethiopian Man. Int Med Case Rep J 2023; 16:141-151. [PMID: 36936185 PMCID: PMC10018219 DOI: 10.2147/imcrj.s401858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/04/2023] [Indexed: 03/12/2023] Open
Abstract
Schwannoma is a slowly growing benign tumor that arises from Schwann cells. Schwannomas affect both genders equally. It occurs in any age group, but most cases are seen between the third and fifth decade. About one-fourth to one-third of extracranial schwannomas cases originate in the head and neck region. The vagus nerve, followed by the cervical sympathetic chain, is the leading site of origin in the neck region. The majority of patients with schwannomas are asymptomatic. Patients with vagal nerve schwannomas in the neck primarily present with hoarseness of voice due to paralysis of the vocal cords. Because of their rarity and the lack of a neurologic deficit as a presenting symptom, preoperative consideration of schwannomas is tough, and several differential diagnoses may be entertained.The mainstay of treatment for vagal nerve schwannoma is complete surgical excision. Here we present a rare case of cervical vagal nerve schwannoma in a 30-year-old male farmer from Ethiopia. The patient presented with a gradually increasing neck swelling of 10 years duration. He started to have hoarseness in his voice five months prior to his presentation. On examination, he had a huge anterior neck swelling. He had two FNAC results, which were inconclusive, and a neck CT. With the consideration of multinodular goiter versus spindle cell neoplasm, the neck was explored, and complete excision of the mass was done. The excisional biopsy turned out to be a classical cervical schwannoma. So this report aims to make physicians aware of the rare case of schwannomas, particularly vagal nerve schwannomas. Clinicians should consider schwannomas in the differential diagnosis of a patient presenting with a cervical mass. Furthermore, they need to be well aware of the diagnostic workup, mainly the imaging modalities, which are essential for proper preoperative planning, surgical treatment, and postoperative complications of cervical schwannomas.
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Affiliation(s)
- Alazar Berhe Aregawi
- Department of Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa University, Hawassa, Sidama, Ethiopia
- Correspondence: Alazar Berhe Aregawi, Email
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Sheikhghomi S, Shafaat M, Hasani H. Eyelid Schwannoma. A Case Report. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2023; 79:325-328. [PMID: 37996247 DOI: 10.31348/2023/34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
In this case report, we describe a 53-year-old woman who presented with a slow-growing lower lid mass in her right eye. On gross examination, a remarkable lower lid bulging was noted. On palpation, a subcutaneous oval-shaped mass with a firm consistency, measuring about 2cm, was noted. The uncorrected visual acuities of the patient were 20/20 (by Snellen chart) bilaterally, and the examinations of the anterior and posterior segments of both eyes were unremarkable. On the orbital Computed Tomography scan of the patient, a solitary and homogenous solid globular mass with the same density of the brain tissue was obvious. The patient underwent surgical excision. Microscopic assessment of the lesion revealed a biphasic hypercellular area (Antoni A) and myxoid hypocellular areas (Antoni B), containing slender cells with tapered ends, interspersed with collagen fibers, consistent with a diagnosis of schwannoma. In addition, some foci of nuclear palisading around the fibrillary process (Verocay bodies) could frequently be found throughout the highly cellular regions. Schwannomas rarely occur in the eyelids, but have clinical and paraclinical indicators which indicate the probable diagnosis. In conclusion, we suggest that eyelid schwannoma be considered as an element of the differential diagnoses list for subcutaneous lesions of the eyelid.
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Intravascular papillary hemangioendothelioma disguised as a peripheral sheath tumor of median nerve at the wrist: a case report and literature review. Skeletal Radiol 2022; 52:1421-1426. [PMID: 36513787 DOI: 10.1007/s00256-022-04250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intravascular papillary hemangioendothelioma (IVPH) is a benign lesion previously reported in the nasal cavity, neck, upper extremities, and breast. Diagnosis with cross-sectional imaging can prove difficult, with histopathological examination necessary for diagnosis. IVPH resulting in carpal tunnel symptoms is quite rare. CASE PRESENTATION We report the case of a 37-year-old woman who presented with a radial, volar right wrist mass enlarging over the span of 5 years. She noted numbness and tingling in her wrist and thumb, exacerbated by minor accidental collisions and wrist hyperextension. There was no antecedent trauma. On examination, a mildly tender, mobile mass was evident at the volar aspect of the right wrist. Magnetic resonance imaging (MRI) with contrast demonstrated a lobulated, predominantly T2 hyperintense, heterogeneously enhancing mass thought to be a peripheral nerve sheath tumor. The patient elected for surgical excision of the mass, and the histopathological examination showed organizing thrombi with prominent papillary endothelial hyperplasia. At the 2-month follow-up, the patient had full range of motion of her fingers and wrist, with subjectively normal sensation in the distribution of the median nerve. CONCLUSION Carpal tunnel syndrome, in exceedingly rare occasions, can result from an IVPH. MRI findings may be confused with more common entities. Histopathological confirmation remains necessary for conclusive diagnosis.
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Muacevic A, Adler JR, Awad A, Farhat Y, Shabani S, Mueller W, Zwagerman NT. Large Middle Cranial Fossa Schwannoma: A Rare Presentation of Vestibular Schwannoma. Cureus 2022; 14:e33186. [PMID: 36726879 PMCID: PMC9886273 DOI: 10.7759/cureus.33186] [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] [Accepted: 12/31/2022] [Indexed: 01/02/2023] Open
Abstract
Schwannomas are benign tumors composed of neoplastic Schwann cells and rarely occur in the central nervous system. Schwannomas account for approximately 8% of intracranial tumors and most commonly originate from cranial nerve VIII at the cerebellopontine angle in the posterior fossa. Herein, we report two cases of vestibular schwannomas extending in the middle fossa. The first case shows a 51-year-old male who presented with a history of mild headaches for one year associated with acute nausea, vomiting, and word-finding difficulties. Imaging revealed a large multicystic contrast-enhancing lesion in the left middle cranial fossa. The middle fossa lesion was resected with pathology indicating a schwannoma. The second case shows a 63-year-old woman who presented with seizures, right-sided hearing loss, and right-sided facial weakness. On MRI, she is found to have a large right middle fossa lesion originating from the right internal auditory canal and consistent with vestibular schwannoma with a 9 mm leftward midline shift. The histopathologic examination of the excised tumor indicated a schwannoma. Schwannomas most commonly occur in the posterior fossa when they present intracranially. However, in rare occurrences, they may present as middle fossa masses with significant intracranial compression.
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Dosemane D, Kabekkodu S, Jaipuria B, Sreedharan S, Shenoy V. Extracranial non-vestibular head and neck schwannomas: a case series with the review of literature. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S9-S17. [PMID: 34154970 DOI: 10.1016/j.bjorl.2021.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Schwannomas are tumous that arise from Schwann cells. Schwannoma is one of the differential diagnosis for lateral neck swelling. OBJECTIVE In this study, we aim to describe the incidence, presenting clinical features and management of extracranial, non-vestibular schwannomas of head and neck region, along with the review of the literature. METHODS Patients treated at our tertiary care hospital for head and neck schwannomas for the past 15 years were included in the study. A review of literature on the extracranial head and neck schwannoma was also done. RESULTS Twenty-five cases were assessed in this study. Nineteen cases presented as a neck swelling during the initial evaluation. Vagus nerve was the most common nerve of origin, followed by the cervical sympathetic plexus. A rare presentation arising from brachial plexus C5 nerve root was also encountered. A few rare cases of schwannomas arose from the nasal cavity, paranasal sinuses, and oral cavity. Surgical excision was done in all the cases with histopathology suggestive of schwannoma. The nerve of origin of the tumor was identified in nineteen patients. Among them, 11 (58%) were from the vagus nerve, 7 (37%) from the cervical sympathetic chain, and 1 (4%) from the brachial plexus C5 nerve root. CONCLUSION A long-standing unilateral neck mass is the most common presenting complaint in head and neck schwannoma. The diagnosis is mainly based on clinical features and investigations such as imaging. The mainstay of treatment is complete surgical excision. The diagnosis is confirmed on the histopathological study after excision of the lesion. Due to the proximity of the tumor with the involved nerve, palsy may occur. Hence, an accurate preoperative diagnosis of schwannoma is essential.
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Affiliation(s)
- Deviprasad Dosemane
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Department of Otorhinolaryngology & Head and Neck Surgery, Karnataka, India
| | - Sushmitha Kabekkodu
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Department of Otorhinolaryngology & Head and Neck Surgery, Karnataka, India.
| | - Bhagyashree Jaipuria
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Department of Otorhinolaryngology & Head and Neck Surgery, Karnataka, India; Mumbai, Maharashtra, India
| | - Suja Sreedharan
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Department of Otorhinolaryngology & Head and Neck Surgery, Karnataka, India
| | - Vijendra Shenoy
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Department of Otorhinolaryngology & Head and Neck Surgery, Karnataka, India
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25
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Ottaiano AC, Gomez GD, Freddi TDAL. The Facial Nerve: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 44:71-80. [PMID: 37055142 DOI: 10.1053/j.sult.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The facial nerve is the seventh cranial nerve and consists of motor, parasympathetic and sensory branches, which arise from the brainstem through 3 different nuclei (1). After leaving the brainstem, the facial nerve divides into 5 intracranial segments (cisternal, canalicular, labyrinthine, tympanic, and mastoid) and continues as the intraparotid extracranial segment (2). A wide variety of pathologies, including congenital abnormalities, traumatic disorders, infectious and inflammatory disease, and neoplastic conditions, can affect the facial nerve along its pathway and lead to weakness or paralysis of the facial musculature (1,2). The knowledge of its complex anatomical pathway is essential to clinical and imaging evaluation to establish if the cause of the facial dysfunction is a central nervous system process or a peripheral disease. Both computed tomography (CT) and magnetic resonance imaging (MRI) are the modalities of choice for facial nerve assessment, each of them providing complementary information in this evaluation (1).
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Kons ZA, Regenhardt RW, Dmytriw AA, Vranic JE, Huynh A, Frosch MP, Borges LF, Patel AB, Romero JM, Stapleton CJ. T2 Hypointense Schwannoma Masquerading As A Vascular Lesion: A Case Report. Neurohospitalist 2022; 12:659-663. [PMID: 36147770 PMCID: PMC9485699 DOI: 10.1177/19418744221112539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Spinal schwannomas are rare nerve root tumors that typically produce subtle symptoms from nerve root compression. These tumors are known to be heterogeneously hyperintense on T2-weighted MRI and avidly enhance with contrast. However, here we describe an L5 spinal schwannoma in a 66-year-old woman that was hypointense on T2-weighted imaging with other radiographic findings more closely aligning with a vascular lesion. The neuroradiologic characteristics on MRI, time resolved MR angiography, and catheter digital subtraction angiography are presented. The patient underwent a full workup for possible dural arteriovenous fistula and thrombosed venous varix before the nerve sheath tumor was discovered intraoperatively and confirmed as a schwannoma on histopathology.
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Affiliation(s)
- Zachary A. Kons
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Robert W. Regenhardt
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam A. Dmytriw
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Justin E. Vranic
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anh. Huynh
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew P. Frosch
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lawrence F. Borges
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aman B. Patel
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Javier M. Romero
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J. Stapleton
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Lee SH, Kwok KY, Wong SM, Chan CXJ, Wong YT, Tsang ML. Chordoma at the skull base, spine, and sacrum: A pictorial essay. J Clin Imaging Sci 2022; 12:44. [PMID: 36128361 PMCID: PMC9479632 DOI: 10.25259/jcis_62_2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022] Open
Abstract
Chordomas are rare tumors believed to be arising from the notochord remnant in the axial skeleton. Diagnosis is often difficult since they show overlapping imaging features with other more common disease including metastases. Since individualized papers are only discussing the imaging features at different locations, the aim of this pictorial review is to have a comprehensive review on the common imaging findings of chordomas along the entire neuroaxis with a series of pathological proven cases in a local tertiary hospital in Hong Kong.
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Affiliation(s)
- Sin Hang Lee
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong,
| | - Kai Yan Kwok
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong,
| | - Sin Man Wong
- Department of Radiology, CUHK Medical Centre, Sha Tin, Hong Kong,
| | | | - Yu Ting Wong
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong,
| | - Man Lung Tsang
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong,
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28
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Cochinski R, Agarwal M, Albuquerque J, A de Almeida C, Stricker RP, F Uberti M, K Casqueiro AP, S Mendonça G, do Nascimento GRS, Miraldi F, Decnop M. Anatomy and Diseases of the Greater Wings of the Sphenoid Bone. Radiographics 2022; 42:1177-1195. [PMID: 35657765 DOI: 10.1148/rg.210094] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The greater wings of the sphenoid bone (GWS) comprise the components of the sphenoid bone that make up most of the posterior orbital wall and form the anterior and medial parts of the floor of the middle cranial fossa. Many important skull base foramina, which transmit vital neurovascular structures, are present in these paired wings on either side of the central body of the sphenoid bone. A wide variety of diseases can affect the GWS, ranging from benign osseus lesions to malignant primary and secondary bone abnormalities. The complex three-dimensional curved (winged) shape of the GWS and the wide array of pathologic entities that affect this bone can make it challenging for the radiologist to report the imaging findings accurately, especially in relation to the important skull base foramina. The authors describe a systematic approach to understanding the three-dimensional anatomy of the GWS and review important diseases, with the aid of imaging examples. Useful imaging "pearls" that can help in making specific diagnoses are provided throughout the article. ©RSNA, 2022.
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Affiliation(s)
- Renata Cochinski
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Mohit Agarwal
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Jessica Albuquerque
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Carolina A de Almeida
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Rafaela P Stricker
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Marcela F Uberti
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Ana Paula K Casqueiro
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Gabriel S Mendonça
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Galba R S do Nascimento
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Fernanda Miraldi
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Marcos Decnop
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
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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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30
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Lubomirsky B, Jenner ZB, Jude MB, Shahlaie K, Assadsangabi R, Ivanovic V. Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches. Neuroradiol J 2022; 35:269-283. [PMID: 34856828 PMCID: PMC9244752 DOI: 10.1177/19714009211055195] [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] [Indexed: 12/12/2022] Open
Abstract
The sellar, suprasellar, and parasellar space contain a vast array of pathologies, including neoplastic, congenital, vascular, inflammatory, and infectious etiologies. Symptoms, if present, include a combination of headache, eye pain, ophthalmoplegia, visual field deficits, cranial neuropathy, and endocrine manifestations. A special focus is paid to key features on CT and MRI that can help in differentiating different pathologies. While most lesions ultimately require histopathologic evaluation, expert knowledge of skull base anatomy in combination with awareness of key imaging features can be useful in limiting the differential diagnosis and guiding management. Surgical techniques, including endoscopic endonasal and transcranial neurosurgical approaches are described in detail.
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Affiliation(s)
- Bryan Lubomirsky
- Department of Radiology, Section of
Neuroradiology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Zachary B Jenner
- Department of Radiology, Diagnostic
and Interventional Radiology Residency, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Morgan B Jude
- School of Medicine, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Reza Assadsangabi
- Department of Radiology, Section of
Neuroradiology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Vladimir Ivanovic
- Department of Radiology, Section of
Neuroradiology, University of California Davis
Medical Center, Sacramento, CA, USA
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31
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Ota Y, Liao E, Capizzano AA, Baba A, Kurokawa R, Kurokawa M, Srinivasan A. Intracranial paragangliomas versus schwannomas: Role of dynamic susceptibility contrast perfusion and diffusion MRI. J Neuroimaging 2022; 32:875-883. [PMID: 35562184 PMCID: PMC9546409 DOI: 10.1111/jon.13002] [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: 03/22/2022] [Revised: 04/09/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Differentiating paragangliomas from schwannomas and distinguishing sporadic from neurofibromatosis type 2 (NF 2)-related schwannomas is challenging but clinically important. This study aimed to assess the utility of dynamic susceptibility contrast perfusion MRI (DSC-MRI) and diffusion-weighted imaging (DWI) in discriminating infratentorial extra-axial schwannomas from paragangliomas and NF2-related schwannomas. METHODS This retrospective study included 41 patients diagnosed with paragangliomas, sporadic schwannomas, and NF2-related schwannomas in the infratentorial extra-axial space between April 2013 and August 2021. All cases had pretreatment DSC-MRI and DWI. Normalized mean apparent diffusion coefficient (nADCmean), normalized relative cerebral blood volume (nrCBV), and normalized relative cerebral blood flow (nrCBF) were compared between paragangliomas and schwannomas and between sporadic and NF2-related schwannomas as appropriate. RESULTS nrCBV and nrCBF were significantly higher in paragangliomas than in sporadic/NF2-related schwannomas (nrCBV: median 11.5 vs. 1.14/3.74; p < .001 and .004, nrCBF: median 7.43 vs. 1.13/2.85; p < .001 and .007, respectively), while nADCmean were not. The corresponding diagnostic performances were area under the curves (AUCs) of .99/.92 and 1.0/.90 with cutoffs of 2.56/4.22 and 1.94/3.36, respectively. nADCmean were lower, and nrCBV and nrCBF were higher in NF2-related than in sporadic schwannomas (nADCmean: median 1.23 vs. 1.58, nrCBV: median 3.74 vs. 1.14, nrCBF: median 2.85 vs. 1.13; all p < .001), and the corresponding diagnostic performances were AUCs of .93, .91, and .95 with cutoffs of 1.37, 2.63, and 2.48, respectively. CONCLUSIONS DSC-MRI and DWI both can aid in differentiating paragangliomas from schwannomas and sporadic from NF2-related schwannomas.
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Affiliation(s)
- Yoshiaki Ota
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Liao
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aristides A Capizzano
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Akira Baba
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryo Kurokawa
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariko Kurokawa
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
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Corrêa DG, Hygino da Cruz LC, Freddi TDAL. The oculomotor nerve: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 43:389-399. [DOI: 10.1053/j.sult.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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33
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Moeller AA, Sokol LA, Ho CY. Schwannoma-associated third nerve palsy: A pediatric case report. Heliyon 2022; 8:e09211. [PMID: 35368884 PMCID: PMC8971305 DOI: 10.1016/j.heliyon.2022.e09211] [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: 03/18/2021] [Revised: 01/03/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Acquired third nerve palsies are infrequently seen in children, but are often associated with serious pathologies. This article presents a pediatric case of tumor-associated, isolated third nerve palsy, which took two years to diagnose. The patient initially presented with an isolated, dilated pupil and progressed over several months to a complete third nerve palsy. In this case, high-resolution neuroimaging eventually led to the diagnosis of a presumed schwannoma as the cause of her third nerve palsy. We review her case, the importance of high-resolution imaging, and management options.
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Affiliation(s)
- Ashley A. Moeller
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, United States
- Corresponding author.
| | | | - Chang Y. Ho
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, United States
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34
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Parashar V, Mathur V. Cisternal oculomotor schwannoma: a rare cause of anisocoria with ptosis in a child. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-021-00438-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primary nerve sheath tumor of cranial nerve is a rare intracranial space occupying lesion that most commonly involves vestibular nerve. Oculomotor nerve schwannoma, without neurofibromatosis, is an extremely uncommon entity especially in children. Though any cranial nerve can be involved by schwannoma except I and II nerve as these cranial nerves lack a Schwann cell sheath.
Case presentation
We herein report a 14-year-old boy presenting with an oculomotor schwannoma in the absence of features of neurofibromatosis, manifesting as progressive diplopia, ptosis, and blurring of vision.
Conclusions
Most similar previous case reports in literature reported oculomotor schwannoma in adults, unlike our case. The detection rate of such rare lesions has, however, increased in the last two decades due to neuroimaging advances.
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Xu T, Liu Y, Li S, Zheng L. Pre-operative embolization and excision of vagal schwannoma with rich vascular supply: A case report and literature review. Medicine (Baltimore) 2022; 101:e28760. [PMID: 35089254 PMCID: PMC8797582 DOI: 10.1097/md.0000000000028760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/17/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Schwannomas are benign tumors wrapped in the nerve sheath and can originate from the myelin sheath of the cranial nerve. In previous literature reports, most of the tumors were solid tumors, which can be removed only by surgery. This case report describes a unique case of vagal schwannoma, which, unlike previous cases, involves a dominant arterial supply, and discusses the pre-operative evaluation, relevant radiographic findings, and surgical process of the case in detail. PATIENT CONCERNS A 31-year-old woman sought treatment for pain in the left side of the neck when turning her head. A mass on the left side of the neck was found on enhanced computed tomography with a maximum diameter of 6.8 cm, along with multiple tortuous, thickened vascular shadows, and pressure on the left pharyngeal cavity. DIAGNOSIS The pathological results showed schwannoma. INTERVENTIONS Considering the unusual size of the tumor and thickened blood vessels revealed by pre-operative computed tomography, general anesthesia and biopsy were conducted first to confirm the diagnosis. Excessive bleeding occurred during the process; thus, the tumor was only partially removed before the wound closed after hemostasis. Digital subtraction angiography indicated that the tumor was supplied by multiple arteries, and the tumor was removed by pre-operative embolization plus intra-operative removal. OUTCOMES Combined with embolization and surgical resection, the tumor was completely removed, the nerve was partially preserved, and the patient had postoperative hoarseness. LESSON The present case indicates the possibility of vascularly supplied vagal schwannoma; thus, it is necessary to conduct pre-operative digital subtraction angiography.
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Ota Y, Liao E, Capizzano AA, Baba A, Kurokawa R, Kurokawa M, Srinivasan A. Neurofibromatosis type 2 versus sporadic vestibular schwannoma: The utility of MR diffusion and dynamic contrast-enhanced imaging. J Neuroimaging 2022; 32:554-560. [PMID: 35037337 DOI: 10.1111/jon.12966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE The goal of this study was to assess the utility of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to distinguish sporadic vestibular schwannomas (VSs) from those related to neurofibromatosis type 2 (NF2). METHODS We retrospectively reviewed 265 patients pathologically diagnosed with VSs between January 2015 and October 2020 in a single institution. There were 28 patients (male: 19, female: 9; age 11-67 years) including 23 sporadic and five NF2-related VSs, who had pretreatment DWI and DCE-MRI. Normalized mean apparent diffusion coefficient (nADCmean) and DCE-MRI parameters along with tumor characteristics were compared between sporadic and NF2-related VSs as appropriate. The diagnostic performances were calculated based on the receiver operating characteristic curve analysis for the values that showed significant differences. To identify significant modalities, multivariate logistic regression analysis was performed using nADCmean and the combination of statistically significant DCE-MRI parameters. RESULTS NADCmean, fractional volume of extracellular space (Ve), and forward volume transfer constant (Ktrans) were significantly different between sporadic and NF2-related VSs (nADCmean: median 1.62 vs. 1.16, P = .002; Ve: median 0.40 vs. 0.66, P = .007; Ktrans: median 0.17 vs. 0.33, P = .007), whereas fractional plasma volume (Vp), reverse reflux rate constant (Kep), and tumor characteristics were not. The diagnostic performances of nADCmean, Ve, and Ktrans were 0.93, 0.90, and 0.90 area under the curves with cutoffs of 1.46, 0.51, and 0.29, respectively. nADCmean and the combination of Ve and Ktrans were both chosen as significant differentiators by multivariate logistic regression analysis (P = .027). CONCLUSIONS DWI and DCE-MRI are both promising modalities to distinguish sporadic and NF2-related VSs.
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Affiliation(s)
- Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Liao
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aristides A Capizzano
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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Ota Y, Liao E, Zhao R, Lobo R, Capizzano AA, Bapuraj JR, Shah G, Baba A, Srinivasan A. Advanced MRI to differentiate schwannomas and metastases in the cerebellopontine angle/internal auditory canal. J Neuroimaging 2022; 32:1177-1184. [PMID: 35879866 PMCID: PMC9796724 DOI: 10.1111/jon.13028] [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: 05/19/2022] [Revised: 06/26/2022] [Accepted: 07/11/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Differentiating schwannomas and metastases in the cerebellopontine angles (CPA)/internal auditory canals (IAC) can be challenging. This study aimed to assess the role of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) to differentiate schwannomas and metastases in the CPA/IAC. METHODS We retrospectively reviewed 368 patients who were diagnosed with schwannomas or metastases in the CPA/IAC between April 2017 and February 2022 in a single academic center. Forty-three patients had pretreatment DWI and DCE-MRI along with conventional MRI. Normalized mean apparent diffusion coefficient ratio (nADCmean) and DCE-MRI parameters of fractional plasma volume (Vp), flux rate constant (Kep), and forward volume transfer constant were compared along with patients' demographics and conventional imaging features between schwannomas and metastases as appropriate. The diagnostic performances and multivariate logistic regression analysis were performed using the significantly different values. RESULTS Between 23 schwannomas (15 males; median 48 years) and 20 metastases (9 males; median 61 years), nADCmean (median: 1.69 vs. 1.43; p = .002), Vp (median: 0.05 vs. 0.20; p < .001), and Kep (median: 0.41 vs. 0.81 minute-1 ; p < .001) were significantly different. The diagnostic performances of nADCmean, Vp, and Kep were 0.77, 0.90, and 0.83 area under the curves, with cutoff values of 1.68, 0.12, and 0.53, respectively. Vp was identified as the most significant parameter for the tumor differentiation in the multivariate logistic regression analysis (p < .001). CONCLUSIONS DWI and DCE-MRI can help differentiate CPA/IAC schwannomas and metastases, and Vp is the most significant parameter.
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Affiliation(s)
- Yoshiaki Ota
- Division of Neuroradiology, Department of RadiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Eric Liao
- Division of Neuroradiology, Department of RadiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Raymond Zhao
- Division of Neuroradiology, Department of RadiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Remy Lobo
- Division of Neuroradiology, Department of RadiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Aristides A. Capizzano
- Division of Neuroradiology, Department of RadiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Jayapalli Rajiv Bapuraj
- Division of Neuroradiology, Department of RadiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Gaurang Shah
- Division of Neuroradiology, Department of RadiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Akira Baba
- Division of Neuroradiology, Department of RadiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of RadiologyUniversity of MichiganAnn ArborMichiganUSA
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Mahajan A, Voosala S, Shukla S, Agarwal U. Vascular relations: A guide to differentiating common carotid space lesions. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_266_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Ota Y, Liao E, Capizzano AA, Yokota H, Baba A, Kurokawa R, Kurokawa M, Moritani T, Yoshii K, Srinivasan A. MR diffusion and dynamic-contrast enhanced imaging to distinguish meningioma, paraganglioma, and schwannoma in the cerebellopontine angle and jugular foramen. J Neuroimaging 2021; 32:502-510. [PMID: 34936708 DOI: 10.1111/jon.12959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/27/2021] [Accepted: 12/02/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Differentiation of meningiomas, paragangliomas, and schwannomas in the cerebellopontine angle and jugular foramen remains challenging when conventional MRI findings are inconclusive. This study aimed to assess the clinical utility of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) findings for tumor type differentiation and to identify the most significant diagnostic parameters. METHODS This retrospective study included 57 patients with pathologically confirmed meningiomas, paragangliomas, and schwannomas, diagnosed between January 2018 and August 2021. DWI and DCE-MRI were obtained before surgery. The apparent diffusion coefficient (ADC) and DCE-MRI parameters were calculated. The Kruskal-Wallis H test and post hoc test with Bonferroni correction and receiver operating characteristic curve were used for statistical analysis. RESULTS There were 20 meningiomas (6 men; 62.3 ± 17.8 years), 23 paragangliomas (3 men; 51.6 ± 17.0 years), and 14 schwannomas (7 men; 37.7 ± 20.0 years). Vp showed a significant difference in each comparison (p < .001, <.001, and <.001, respectively), Ve showed significant differences both in meningiomas and paragangliomas, and paragangliomas and schwannomas (p < .001 and .017, respectively), and Ktrans showed significant differences both in meningiomas and paragangliomas, and meningiomas and schwannomas (p = .0018 and <.001, respectively), though there was no significant difference in ADC. Vp diagnostic performance values for each pair of tumors were area under the curve of 0.89-1.00, with cutoff values of 0.14-0.27. CONCLUSION DCE-MRI can provide promising parameters to differentiate meningiomas, paragangliomas, and schwannomas in the cerebellopontine angle and jugular foramen.
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Affiliation(s)
- Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Liao
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aristides A Capizzano
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kengo Yoshii
- Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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Kovalainen A, Haeren R, Paetau A, Lehecka M. Brainstem intraparenchymal schwannoma: A case report and literature review. Surg Neurol Int 2021; 12:508. [PMID: 34754558 PMCID: PMC8571199 DOI: 10.25259/sni_621_2021] [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: 06/22/2021] [Accepted: 09/15/2021] [Indexed: 11/07/2022] Open
Abstract
Background: Intracranial intraparenchymal schwannomas (IS) are rare tumors that have mainly been described in case reports. Here, we report on a case of a brainstem IS and included a comprehensive literature review. Case Description: A 74-year-old man presented with progressive gait disturbances. CT- and MRI-imaging revealed a contrast-enhancing mass accompanied by a cyst in the dorsolateral pons. Hemangioblastoma was suspected and surgery was advised. During surgery, gross total resection of a non-invasive tumor was performed. Postoperative recovery was uneventful. Based on histopathological examination, the intraparenchymal brainstem tumor was diagnosed as schwannoma. Conclusion: Our extensive review illustrates that ISs are benign tumors that most often present in relatively young patients. Malignant cases have been described but form an extremely rare entity. Preoperative diagnosis based on radiological features is difficult but should be considered when peritumoral edema, calcifications, and cysts are noted. In benign cases, gross total resection of the lesion is curative. To adequately select this treatment and adjust the surgical strategy accordingly, it is important to include IS in the preoperative differential diagnosis when the abovementioned radiological features are present.
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Affiliation(s)
- Anselmi Kovalainen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Roel Haeren
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Anders Paetau
- Department of Pathology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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41
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Buechner S, Capone L. Ice Pack Test Eased Ptosis in a Patient Presenting with a Possible Oculomotor Nerve Schwannoma: A Case Report. Neurol Int 2021; 13:510-516. [PMID: 34698277 PMCID: PMC8544292 DOI: 10.3390/neurolint13040050] [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: 06/08/2021] [Revised: 08/15/2021] [Accepted: 09/10/2021] [Indexed: 11/21/2022] Open
Abstract
A 32-year-old man presented with complete third nerve palsy. Brain magnetic resonance imaging revealed a possible sporadic oculomotor nerve schwannoma in the left cavernous sinus. Interestingly, the patient’s ptosis was fluctuating and eased immediately after application of ice over his eyelid. The ice pack test (IPT) is a simple and fast method that can help diagnose myasthenia gravis (MG) in patients with ptosis. Additional diagnostic investigations (antibody assays and repetitive stimulation) excluded associated MG in the patient. Tumor treatment with Gamma Knife radiosurgery was planned. This case highlights the finding that IPT can also be positive in neurogenic (non-myasthenic) ptosis, but its usefulness in other disorders associated with muscle weakness and fatigability remains questionable.
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42
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Tanwar M, Branstetter Iv BF. Mimics of perineural tumor spread in the head and neck. Br J Radiol 2021; 94:20210099. [PMID: 34491810 DOI: 10.1259/bjr.20210099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Perineural spread (PNS) is an important potential complication of head and neck malignancy, as it is associated with decreased survival and a higher risk of local recurrence and metastasis. There are many review articles focused on the imaging findings of PNS. However, a false-positive diagnosis of PNS can be just as harmful to the patient as an overlooked case. In this manuscript, we delineate and classify various imaging mimics of PNS. Mimics can be divided into the following categories: normal variants (including vascular structures and failed fat suppression), infections, inflammatory disease (including granulomatous disease and demyelination), neoplasms, and post-traumatic/surgical changes. Knowledge of potential mimics of PNS will prevent false-positive imaging interpretation, and enable appropriate oncologic management.
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Affiliation(s)
- Manoj Tanwar
- Section of Neuroradiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barton F Branstetter Iv
- Section of Neuroradiology, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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43
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Nguyen TKL, Vo NQ, Ngo DHA, Le TB, Nguyen TM, Nguyen Thanh T. Giant lumbar spinal schwannoma: a case report and literature review. Radiol Case Rep 2021; 16:2388-2392. [PMID: 34257767 PMCID: PMC8260763 DOI: 10.1016/j.radcr.2021.06.004] [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: 05/03/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022] Open
Abstract
We report a case of a 40-year-old female patient admitted to the hospital due to lumbar pain that spread to both legs and was associated with weakness of the lower extremities. Magnetic resonance imaging revealed an intradural - extramedullary tumor at the level of the T12 - L2 vertebra. The lesion was over 7 cm in greatest diameter and compressed the conus medullaris. The patient underwent surgery to remove the entire tumor. Postoperative pathology confirmed the diagnosis of schwannoma. The symptoms resolved almost completely without significant complications.
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Affiliation(s)
- Thi Kieu Loan Nguyen
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, 53000, Vietnam
| | - Nhu Quynh Vo
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, 53000, Vietnam
| | - Dac Hong An Ngo
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, 53000, Vietnam
| | - Trong Binh Le
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, 53000, Vietnam
| | - Thanh Minh Nguyen
- Department of Surgery, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thao Nguyen Thanh
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, 53000, Vietnam
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Gupta A, Lee ECH, Kelly HR, Chen RC. Clinical and Imaging Manifestations of Trochlear Nerve Schwannomas-A Case Series. J Neuroophthalmol 2021; 41:e339-e342. [PMID: 32956233 DOI: 10.1097/wno.0000000000001059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Arvind Gupta
- Department of Opthalmology, Counties Manukau DHB and Auckland DHB (AG), Auckland, New Zealand; Department of Diagnostic Radiology, SingHealth Institution (ELCH, RCC), Singapore ; Massachusetts Eye and Ear (HRK), Boston, Massachusetts; Department of Diagnostic Radiology, Massachusetts General Hospital (HRK), Harvard Medical School, Boston, Massachusetts; and Duke Medical School (RCC), Singapore
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Bewley AF, Azhdam AM, Borrelli M. Intraparotid Facial Nerve Schwannoma Mimicking Primary Parotid Neoplasm. EAR, NOSE & THROAT JOURNAL 2021; 100:881S-883S. [PMID: 34402315 DOI: 10.1177/01455613211040372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The following report is of a 36-year-old male who presented with a growing mass in the region of the parotid gland. Initial fine needle aspiration biopsy suggested a primary neoplasm of the parotid gland, but subsequent frozen section analysis intraoperatively demonstrated a schwannoma of the facial nerve. An intracapsular enucleation of the schwannoma was performed in order to preserve the fibers of the motor nerve.
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Affiliation(s)
- Arnaud F Bewley
- Department of Otolaryngology/Head and Neck Surgery, University of California, Davis, CA, USA
| | - Ariel M Azhdam
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, Chicago, IL, USA
| | - Michela Borrelli
- Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
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Glutig K, Pfeil A, Renz DM. [Imaging of tumor predisposition syndromes]. Radiologe 2021; 61:658-666. [PMID: 34170362 DOI: 10.1007/s00117-021-00861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
CLINICAL ISSUE Tumor predisposition syndromes (TPS) are a heterogeneous group of genetic cancers. About 10% of the approximately 2200 malignancies in the childhood in Germany develop due to an inherited disposition, whereby TPS may be underdiagnosed. The focus of this review is set on imaging of Li-Fraumeni syndrome, neurofibromatoses, tuberous sclerosis, overgrowth, and neuroendocrine syndromes. STANDARD RADIOLOGICAL METHODS In order to detect tumors at an early stage, screening at specific time intervals for each TPS are required. Ultrasonography and magnetic resonance imaging (MRI), especially whole-body MRI, are particularly important imaging modalities. METHODOLOGICAL INNOVATIONS Innovative MRI techniques can increase image quality and patient comfort. MRI acquisition time can be significantly reduced through optimized acceleration factors, motion robust radial sequences and joint acquisition and readout of multiple slices during excitation. Thus, shorter MRI examinations can be performed in younger children without anesthesia. PRACTICAL RECOMMENDATION Regular screening with ultrasound and MRI can reduce the morbidity and mortality of the patients affected with TPS.
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Affiliation(s)
- K Glutig
- Institut für Diagnostische und Interventionelle Radiologie, Sektion Kinderradiologie, Universitätsklinikum Jena, 07740, Jena, Deutschland.
| | - A Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, 07740, Jena, Deutschland
| | - D M Renz
- Institut für Diagnostische und Interventionelle Radiologie, Arbeitsbereich Kinderradiologie, Medizinische Hochschule Hannover, 30625, Hannover, Deutschland
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47
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Parmar HA, Ibrahim M. Imaging of Anterior Skull Base. Semin Ultrasound CT MR 2021; 42:281-294. [PMID: 34147163 DOI: 10.1053/j.sult.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hemant A Parmar
- Department of Radiology, University of Michigan, Ann Arbor, MI.
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48
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Teixeira BCDA, Constanzo F, Sens P, Ramina R, Escuissato DL. Brainstem hyperintensity in patients with vestibular schwannoma is associated with labyrinth signal on magnetic resonance imaging but not vestibulocochlear tests. Neuroradiol J 2021; 34:180-186. [PMID: 33325805 PMCID: PMC8165906 DOI: 10.1177/1971400920980165] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Focal hyperintensity in the dorsal brainstem (HDB) has been described in large cerebellopontine angle tumours and is thought to represent vestibular nuclei degeneration, but its functional significance has not been thoroughly investigated. Our aim was to analyse its relationship to imaging characteristics of the tumour and inner-ear structures and to vestibulocochlear functional tests. METHODS We retrospectively reviewed 54 patients with a histological diagnosis of vestibular schwannoma (VS). Magnetic resonance imaging tumour characteristics (size, cystic composition and distance from the cochlear aperture), signal intensity ratio of the cochlea and vestibule in fluid-attenuated inversion recovery (FLAIR) and fast imaging employing steady-state acquisition (FIESTA)/fast spin-echo imaging with variable flip angles (CUBE) and vestibulocochlear function tests (audiometry, auditory brainstem response (ABR) and video head impulse testing (vHIT)) were obtained. Statistical analyses were performed to evaluate their relation to focal HDB. RESULTS Focal HDB was found in 22% of VS. It was significantly associated with large (p < 0.001) and cystic (p = 0.004) tumours and also with tumours located further from the cochlear aperture (p = 0.039). The signal intensity ratio of the cochlea on FLAIR was higher in patients with HDB (p < 0.014), but this difference was not observed in FIESTA/CUBE (p = 0.981). Audiometry, ABR and vHIT results did not significantly differ in patients with HDB, but ABR results were worse in patients with higher cochlear signal intensity on FLAIR sequences (p = 0.026). CONCLUSIONS Focal HDB in patients with VS was associated with increased signal intensity ratio of the cochlea on FLAIR in patients with VS but not directly to the results of vestibulocochlear function tests.
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Affiliation(s)
- Bernardo Corrêa de Almeida Teixeira
- Department of Neuroradiology, Neurological Institute of Curitiba (INC), Brazil
- Department of Internal Medicine, Federal University of Paraná (UFPR), Brazil
| | - Felipe Constanzo
- Department of Neurosurgery, Neurological Institute of Curitiba (INC), Brazil
| | - Patricia Sens
- Department of Otorhinolaryngology, Neurological Institute of Curitiba (INC), Brazil
| | - Ricardo Ramina
- Department of Neurosurgery, Neurological Institute of Curitiba (INC), Brazil
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Jain V. The role of imaging in the evaluation of hoarseness: A review. J Neuroimaging 2021; 31:665-685. [PMID: 34018650 DOI: 10.1111/jon.12866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022] Open
Abstract
Hoarseness is a common symptom indicating an abnormal change in the quality of voice and has a lifetime prevalence of around 30%. There are multiple causes of hoarseness, ranging from acute laryngitis, chronic laryngitis, laryngopharyngeal reflux, functional dysphonia due to vocal overuse or abuse, vocal cord paralysis (VCP), to various pathologies and masses in the larynx. A detailed history and thorough physical examination, and in many cases, laryngoscopy by a clinician are the initial steps in its management. Laryngoscopy should be considered if hoarseness persists for more than 2 weeks without a known benign cause. An Ear Nose and Throat surgeon performs direct visualization by laryngoscopy to rule out VCP or a lesion in the larynx, and it should be performed before ordering any imaging. CT with contrast is the imaging of choice to evaluate the laryngeal tumors and find the etiology of VCP. Typical findings of VCP are ipsilateral dilatation of the pyriform sinus and laryngeal ventricle, thickening and medialization of the ipsilateral aryepiglottic fold, medialization of the arytenoid cartilage and posterior aspect of the true vocal cord (TVC) atrophy of the TVC, and loss of the subglottic arch. The lesions causing the VCP may extend from the medulla, jugular foramen, carotid space, and upper mediastinum. CT neck must cover the aorticopulmonary window when evaluating the left VCP to cover the left recurrent laryngeal nerve's origin.
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Affiliation(s)
- Vikas Jain
- Radiology Department, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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50
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Chang YS, Moonis G, Juliano AF. Posterior Skull Base Anatomy and Pathology. Semin Ultrasound CT MR 2021; 42:295-306. [PMID: 34147164 DOI: 10.1053/j.sult.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A posterior skull base lesion is an uncommon radiological finding that may be noted incidentally or during targeted imaging of patients with clinical symptoms attributable to the lesion. It may be inflammatory or neoplastic in etiology, or may simply be an anatomic variant or a "don't-touch" lesion that should not be misinterpreted as something more ominous. A systematic approach to the evaluation of the posterior skull base is therefore required in order to differentiate lesions requiring immediate attention from those requiring a less urgent course of action or none at all. This review will focus on the imaging features of pathologic conditions that are more commonly encountered in posterior skull base CT and MR examinations.
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Affiliation(s)
- Yuh-Shin Chang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gul Moonis
- Columbia University Irving Medical Center, New York, New York
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
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