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Bal J, Bruneau M, Berhouma M, Cornelius JF, Cavallo LM, Daniel RT, Froelich S, Jouanneau E, Meling TR, Messerer M, Roche PH, Schroeder HWS, Tatagiba M, Zazpe I, Paraskevopoulos D. Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part II: Trigeminal and facial nerve schwannomas (CN V, VII). Acta Neurochir (Wien) 2022; 164:299-319. [PMID: 35079891 DOI: 10.1007/s00701-021-05092-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogenous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations. METHODS A task force was created by the EANS skull base section committee along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the second of a three-part series describing non-vestibular schwannomas (V, VII). RESULTS A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies, and follow-up management. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the treatment of trigeminal and facial schwannoma. The aim of treatment is maximal safe resection with preservation of function. Careful thought is required to select the appropriate surgical approach. Most middle fossa trigeminal schwannoma tumours can be safely accessed by a subtemporal extradural middle fossa approach. The treatment of facial nerve schwannoma remains controversial.
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Affiliation(s)
- Jarnail Bal
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Michael Bruneau
- Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Moncef Berhouma
- Neuro-Oncologic and Vascular Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, Italy
| | - Roy T Daniel
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Emmanuel Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Torstein R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Idoya Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK.
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Pathologic Laughter as an Early and Unusual Presenting Symptom of Petroclival Meningioma: a Case Report and Review of the Literature. World Neurosurg 2018; 123:161-164. [PMID: 30554003 DOI: 10.1016/j.wneu.2018.11.240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pathologic laughter is inappropriate, involuntary, and unmotivated laughter episodes that may or may not be associated with mirth or amusement. Although associated with many diffuse brain pathologies, its association with intracranial focal mass lesions causing ventrolateral brainstem compression, like petroclival meningioma, is very rare. The exact pathophysiology of this interesting and unusual clinical symptom is unknown, but probably involves disinhibition and release of the so-called coordination center located in the upper brainstem due to compression by the tumor. CASE DESCRIPTION A 26-year-old woman presented with recurrent episodes of inappropriate and involuntary laughter, which significantly affected her quality of life, for 2 years. These episodes did not resolve, and a magnetic resonance imaging of the brain showed a giant petroclival meningioma causing upper brainstem compression. Near-total excision of the tumor was done using an extended middle fossa approach. To our surprise, the pathologic laughter subsided immediately after surgery. CONCLUSIONS Pathologic laughter may be the only symptom of a focal mass lesion causing ventrolateral upper brainstem compression, like petroclival meningioma, well before other neurological sign/symptoms appear. Tumors causing ventral brainstem compression must be ruled out before the patient is sent for a psychiatric evaluation.
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Kumaria A, Ingale HA, Robertson IJA, Ashpole RD. Trigeminal schwannoma presenting as a gelastic seizure: no laughing matter. Br J Neurosurg 2018; 36:88-89. [PMID: 29688073 DOI: 10.1080/02688697.2018.1466999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We present the case of a 66 year old gentleman with trigeminal schwannoma whose only presenting feature was a single gelastic seizure. This is the first case report of pathological laughter in trigeminal schwannoma in the absence of other trigeminal, brainstem, cerebellar or other cranial nerve dysfunction.
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Affiliation(s)
- Ashwin Kumaria
- a Department of Neurosurgery , Queen's Medical Centre , Nottingham , UK
| | - Harshal A Ingale
- a Department of Neurosurgery , Queen's Medical Centre , Nottingham , UK
| | | | - Richard D Ashpole
- a Department of Neurosurgery , Queen's Medical Centre , Nottingham , UK
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Gripp DA, do Souto AA, Gonsales D, Christiani MDMC, Nogueira J, Lopes HF, Torres YC. Giant clival chordoma causing pathological laughter. Surg Neurol Int 2014; 5:18. [PMID: 24778906 PMCID: PMC3994695 DOI: 10.4103/2152-7806.127257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 01/15/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chordomas are rare slowly growing tumors that originate from remnants of the notochord. They have a malignant local behavior, causing symptoms due to bone infiltration and compression of neurovascular structures. Only a few cases of brain tumors associated with pathological laughter have been reported in the literature. CASE DESCRIPTION We report a case of a 42-year-old male patient with this atypical clinical presentation treated at our institution, and discuss the concerning literature. CONCLUSION Although being a very rare presentation of chordomas, pathological laughter is usually expected to improve after brain stem decompression.
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Affiliation(s)
- Daniel Andrade Gripp
- Department of Neurosurgery, National Institute of Cancer, INCA, Centro, Rio de Janeiro, Brazil
| | - Antonio Aversa do Souto
- Department of Neurosurgery, National Institute of Cancer, INCA, Centro, Rio de Janeiro, Brazil
| | - Douglas Gonsales
- Department of Neurosurgery, National Institute of Cancer, INCA, Centro, Rio de Janeiro, Brazil
| | | | - Janio Nogueira
- Department of Neurosurgery, National Institute of Cancer, INCA, Centro, Rio de Janeiro, Brazil
| | - Helio Ferreira Lopes
- Department of Neurosurgery, National Institute of Cancer, INCA, Centro, Rio de Janeiro, Brazil
| | - Yasmine Coura Torres
- Department of Neurosurgery, National Institute of Cancer, INCA, Centro, Rio de Janeiro, Brazil
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Abstract
OBJECTIVE To explain relatively common phenomenon of laughing during sleep and help to better define criteria for differentiating between physiological and pathological sleep-laughing. METHODS Observational study of patients who underwent a sleep assessment in a referential tertiary health facility. RESULTS A total of ten patients exhibited sleep laughing, nine of whom had episodes associated with rapid eye movement (REM) sleep. Also, in one of the patients sleep-laughing was one of the symptoms of REM sleep Behaviour Disorder, and in another patient sleep-laughing was associated with NREM sleep arousal parasomnia. CONCLUSION The collected data and review of literature suggests that hypnogely in majority of the cases presents as a benign physiological phenomenon related to dreaming and REM sleep. Typically, these dreams are odd, bizarre or even unfunny for a person when awake. Nevertheless, they bring a sense of mirth and a genuine behavioural response. In a minority of cases, sleep-laughing appears to be a symptom of neurological disorders affecting the central nervous system. In these patients the behavioural substrate differs when compared to physiological laughing, and the sense of mirth is usually absent.
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King RR, Reiss JP. The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration. Degener Neurol Neuromuscul Dis 2013; 3:23-31. [PMID: 30890891 PMCID: PMC6065587 DOI: 10.2147/dnnd.s34160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Pseudobulbar affect is a disorder resulting from neurologic damage manifesting as sudden, stereotyped affective outbursts that are not reflective of internal emotion. A literature review was completed to examine the current understanding of the epidemiology, characterization, diagnosis, pathophysiology, and treatment of pseudobulbar affect. This review revealed that it is common in neurodegenerative disorders but is poorly recognized, placing significant impacts on patients and their families. The disorder appears to result from a disruption of the cortico-limbic-subcortical-thalamic-pontocerebellar network involved in emotional expression and regulation with resulting disruptions of neurotransmitter systems. Effective treatment is available with agents such as selective serotonin reuptake inhibitors and dextromethorphan combined with quinidine, but further well-designed comparative studies are needed. Advances in technology such as neuroimaging may enhance knowledge about the pathophysiology of this disorder, and help guide future interventions.
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Affiliation(s)
- Rebecca R King
- Department of Psychiatry, University of Western Ontario, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada,
| | - Jeffrey P Reiss
- Department of Psychiatry, University of Western Ontario, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada,
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Aguirregomozcorta M, Ramió-Torrentà LI, Gich J, Quiles A, Genís D. Paroxysmal dystonia and pathological laughter as a first manifestation of multiple sclerosis. Mult Scler 2007; 14:262-5. [DOI: 10.1177/1352458507082053] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Paroxysmal dystonia is an uncommon but well-established feature of multiple sclerosis (MS). Attacks can occur in established MS and may even occasionally be the initial symptom of this disorder. Pathological laughter is usually seen as a pseudobulbar palsy in some diffuse neurological diseases, but cases have been described, mostly in ischaemic attacks or tumours, where it is presented as bursts of laughter of variable duration. The pathogenesis of neither of the two phenomena has been fully established but both have been reported as being positive phenomena resulting from ectopic activation with ephaptic spread. We describe the first reported case of a paroxysmal hemidystonia together with bursts of pathological laughter as the first manifestation of MS. Multiple Sclerosis 2008; 14: 262—265. http://msj.sagepub.com
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Affiliation(s)
- M. Aguirregomozcorta
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Dr Josep Trueta, Girona, Spain,
| | - LI Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Dr Josep Trueta, Girona, Spain
| | - J. Gich
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Dr Josep Trueta, Girona, Spain
| | - A. Quiles
- MRI Unit - IDI, Department of Radiology, Hospital Dr Josep Trueta, Girona, Spain
| | - D. Genís
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Dr Josep Trueta, Girona, Spain
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Kouyialis AT, Stranjalis G, Papadogiorgakis N, Papavlassopoulos F, Ziaka DS, Petsinis V, Sakas DE. Giant dumbbell-shaped middle cranial fossa trigeminal schwannoma with extension to the infratemporal and posterior fossae. Acta Neurochir (Wien) 2007; 149:959-63; discussion 964. [PMID: 17534571 DOI: 10.1007/s00701-007-1173-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 04/24/2007] [Indexed: 10/23/2022]
Abstract
We present a 38-year-old female with a giant dumbbell-shaped trigeminal neurinoma originating primarily in the middle cranial fossa, extending to the infratemporal and posterior fossae through the foramen ovale and Meckel's cave, respectively. Because of the large tumour extension into the Infratemporal Fossa, a combined skull base approach (zygomatic infratemporal - transmandibular) was utilised for tumour removal, with a subsequent excellent outcome. An extensive literature review since 1935, revealed 580 cases of surgically treated trigeminal neurinomas. Among these, only three were located in three distinct compartments, making this the rarest developmental pattern for trigeminal neurinomas.
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Affiliation(s)
- A T Kouyialis
- Department of Neurosurgery, Evangelismos Hospital, University of Athens Medical School, Athens, Greece.
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Jagetia A, Pratap Kumar N, Singh D, Sinha S. Pathological laughter in trigeminal schwannoma: case report and review of the literature. Neurosurg Rev 2006; 29:348-52; discussion 352. [PMID: 16953451 DOI: 10.1007/s10143-006-0038-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Revised: 03/08/2006] [Accepted: 06/08/2006] [Indexed: 10/24/2022]
Abstract
Pathological laughter is an uncommon manifestation of neurosurgical diseases. Very few cases of trigeminal schwannoma have been reported in the literature presenting with pathological laughter as a predominant symptom. We are reporting on a case of multi-compartmental trigeminal schwannoma presenting as pathological laughter and discuss a review of the literature. A 23-year-old lady presented with pathological laughter, along with symptoms pertaining to other cranial nerves and cerebellar dysfunction. Magnetic resonance imaging (MRI) of the brain was suggestive of a dumbbell-shaped mass in the middle and posterior cranial fossa on the left side, causing significant compression of the pons. She was investigated and operated for multi-compartmental trigeminal schwannoma. Following surgery, abnormal laughter disappeared immediately and no recurrence of symptoms was -present for a follow-up of 16 months. This case supports the role of the brainstem, especially the pons, in the control of laughter and, perhaps, of the medial temporal lobe too.
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Affiliation(s)
- Anita Jagetia
- Department of Neurosurgery, G.B. Pant Hospital and Associated Maulana Azad Medical College, New Delhi 110002, India.
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