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Lin XM, Liu J, Xi CH, Wang J, Yang GD, Wang XF, Yuan C. Compression from a retroperitoneal schwannoma presenting as a subepithelial lesion of the gastric fundus. Endoscopy 2024; 56:E236-E237. [PMID: 38467351 PMCID: PMC10927355 DOI: 10.1055/a-2271-4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Xue-Mei Lin
- Department of Pathology, Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong, China
- Department of Pathology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Juan Liu
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chun-Hui Xi
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jun Wang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Guo-Dong Yang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xian-Fei Wang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Cong Yuan
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Muhammad N, Ajmera S, Lee JYK. Intraoperative visualization of cranial nerve schwannomas using second-window indocyanine green: A case series. Clin Neurol Neurosurg 2024; 240:108241. [PMID: 38522224 DOI: 10.1016/j.clineuro.2024.108241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Second Window Indocyanine Green (SWIG) is a novel intraoperative imaging technique that uses near-infrared (NIR) light for intra-operative tumor visualization using the well-known fluorophore indocyanine green (ICG). Because schwannomas often incorporate the nerve into the encapsulated tumor and impinge on surrounding neural structures, SWIG is a promising technique to improve tumor resection while sparing the nerve. OBJECTIVE To demonstrate the use of SWIG in resection of cranial nerve schwannomas. METHODS Three patients with cranial nerve schwannomas (i.e., trigeminal, vestibular, and vagus) underwent SWIG-guided resection. During surgery, NIR visualization was used intermittently used to detect fluorescence to guide resection. Signal-to-background ratio was then calculated to quantify fluorescence. RESULTS Patients were infused with ICG at a dose of 5.0 mg/kg 24 hours before surgery. Each patient achieved total or near-total resection and relief of symptoms with lack of recurrence at six-month follow-up. The average SBR calculated was 3.79, comparable to values for SWIG-guided resection of other brain and spine tumors. CONCLUSION This case series is the first published report of trigeminal and vagus nerve schwannoma resection using the SWIG technique and suggests that SWIG may be used to detect all schwannomas, alongside many other types of brain tumor. This paper also demonstrates the importance of preoperative ICG infusion timing and discusses the inverse pattern of NIR signal that may be observed when infusion occurs outside of the optimal timing. This provides direction for future studies investigating the administration of SWIG to resect cranial nerve schwannomas and other brain tumors.
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Affiliation(s)
- Najib Muhammad
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 801 Spruce St, Philadelphia, PA 19107, USA
| | - Sonia Ajmera
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 801 Spruce St, Philadelphia, PA 19107, USA
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 801 Spruce St, Philadelphia, PA 19107, USA.
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Mohamad R, Koubaissi SA, Bou Khalil P, Sfeir P. Tracheal Schwannoma Presenting as Subcutaneous Emphysema and Pneumomediastinum. BMJ Case Rep 2024; 17:e256951. [PMID: 38594197 PMCID: PMC11015168 DOI: 10.1136/bcr-2023-256951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 04/11/2024] Open
Abstract
Primary tracheal schwannomas are rare benign tumours. This is a case report, and therefore, no specific methods or results are applicable. We here report a case of a tracheal schwannoma in an early adolescent girl presenting with subcutaneous emphysema and symptoms of airway obstruction. Tracheal resection and reconstruction by primary anastomosis were performed. Pathology confirmed the diagnosis of tracheal schwannoma. This is an unusual life-threatening presentation of a benign rare tracheal tumour with a challenging approach to management.
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Affiliation(s)
- Rayan Mohamad
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Salwa A Koubaissi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pierre Bou Khalil
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Pierre Sfeir
- Department of Surgery, American University of Beirut, Beirut, Lebanon
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Tsuchiya T, Ikemura M, Miyawaki S, Teranishi Y, Ohara K, Ushiku T, Saito N. Clinical and radiological features of intracranial ancient schwannomas: a single-institution, retrospective analysis. Brain Tumor Pathol 2024; 41:73-79. [PMID: 38578531 PMCID: PMC11052856 DOI: 10.1007/s10014-024-00482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
Ancient schwannoma (AS) is a subtype of schwannoma characterized by slow progression despite degenerative changes in pathology. Although it is considered a benign tumor, most previous reports have focused on extracranial AS; therefore, the clinical characteristics of intracranial AS is not clear. We included 174 patients who underwent surgery for sporadic intracranial schwannoma, and 13 patients (7.5%) were diagnosed with AS. Cysts were significantly more common in patients with AS than conventional schwannomas (92.3% vs. 44.7%, p < 0.001), as was bleeding (38.5% vs. 6.9%, p = 0.003) and calcification (15.4% vs. 1.3%, p = 0.029). The maximum tumor diameter was also larger in patients with AS (35 mm vs. 29 mm, p = 0.017). The median duration from symptom onset to surgery (7.0 vs. 12.5 months, p = 0.740) did not significantly differ between groups, nor did the probability of postoperative recurrence (p = 0.949). Intracranial AS was strongly associated with cyst formation and exhibited a benign clinical course with a lower rate of recurrence and need for salvage treatment. Extracranial AS is reportedly characterized by a slow progression through a long-term clinical course, whereas intracranial AS did not progress slowly in our study and exhibited different clinical features to those reported for extracranial AS.
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Affiliation(s)
- Takahiro Tsuchiya
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masako Ikemura
- Department of Pathology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yu Teranishi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kenta Ohara
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Debs P, Luna R, Fayad LM, Ahlawat S. MRI features of benign peripheral nerve sheath tumors: how do sporadic and syndromic tumors differ? Skeletal Radiol 2024; 53:709-723. [PMID: 37845504 DOI: 10.1007/s00256-023-04479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES To compare MRI features of sporadic and neurofibromatosis syndrome-related localized schwannomas and neurofibromas. METHODS In this retrospective study, our pathology database was searched for "neurofibroma" or "schwannoma" from 2014 to 2019. Exclusion criteria were lack of available MRI and intradural or plexiform tumors. Qualitative and quantitative anatomic (location, size, relationship to nerve, signal, muscle denervation) and functional (arterial enhancement, apparent diffusion-weighted coefficient) MRI features of sporadic and syndrome-related tumors were compared. Statistical significance was assumed for p < 0.05. RESULTS A total of 80 patients with 64 schwannomas (sporadic: 42 (65.6%) v. syndrome-related: 22 (34.4%)) and 19 neurofibromas (sporadic: 7 (36.8%) v. syndrome-related: 12 (41.7%)) were included. Only signal heterogeneity (T2W p=0.001, post-contrast p=0.03) and a diffused-weighted imaging target sign (p=0.04) were more frequent with schwannomas than neurofibromas. Sporadic schwannomas were similar in size to syndrome-related schwannomas (2.9±1.2cm vs. 3.7±3.2 cm, p = 0.6), but with greater heterogeneity (T2W p = 0.02, post-contrast p = 0.01). Sporadic neurofibromas were larger (4.6±1.5cm vs. 3.4±2.4 cm, p = 0.03) than syndrome-related neurofibromas, also with greater heterogeneity (T2W p=0.03, post-contrast p=0.04). Additional tumors along an affected nerve were only observed with syndrome-related tumors). There was no difference in apparent diffusion coefficient values or presence of early perfusion between sporadic and syndrome-related tumors (p > 0.05). CONCLUSIONS Although syndrome-related and sporadic schwannomas and neurofibromas overlap in their anatomic, diffusion and perfusion features, signal heterogeneity and presence of multiple lesions along a nerve are differentiating characteristics of syndrome-related tumors.
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Affiliation(s)
- Patrick Debs
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - Rodrigo Luna
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
- Division of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
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Corazzelli G, Natale G, Cioffi V, Di Colandrea S, Fiorelli A, de Falco R, Bocchetti A. Giant "Dumbbell" Thoracic Schwannoma: Radical Excision of Rare Lesion in One Surgical Time by Combined Neurosurgical and Thoracoscopic Approach. World Neurosurg 2024; 184:38-39. [PMID: 38185456 DOI: 10.1016/j.wneu.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/09/2024]
Abstract
Dumbbell-shaped schwannomas are slow-growing tumors that are typically benign lesions. They account for 6%-14% of spinal neoplasms, with 30% having intradural and extradural components.1 A schwannoma is considered "giant" if it extends beyond the spine by >2.5 cm and involves more than 2 vertebral levels.2 The Eden classification categorizes these tumors into 4 types on the basis of the primary component.3 Surgery is recommended for individuals experiencing prolonged nerve damage and persistent neurogenic pain that cannot be managed.2 There are 3 surgical options for managing thoracic dumbbell schwannomas4: the single-stage posterior-only approach,5 the single-stage anterior-only approach,6 and the single-stage combined posteroanterior neurosurgical and video-assisted thoracoscopic approach. The latter option allows for the most comprehensive lesion control including vascular and nerve structures and optimal hemostasis control. It also avoids spinal instrumentation and provides certainty for complete tumor removal.7Video 1 shows a surgical procedure performed on a 58-year-old woman to remove a thoracic dumbbell neurinoma. The patient consented to the procedure and publication of her image. A simultaneous thoracoscopic and neurosurgical approach was performed. The surgical team successfully removed the schwannoma, and the patient's recovery was smooth, with no neurologic issues or pain. This case highlights the benefits of using a single-stage combined approach for treating Eden II and Eden III giant dumbbell thoracic schwannomas.
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Affiliation(s)
- Giuseppe Corazzelli
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, Naples, Italy.
| | - Giovanni Natale
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Valentina Cioffi
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Di Colandrea
- Department of Anaesthesiology and Intensive Care Medicine, Santa Maria delle Grazie Hospital, Naples, Italy
| | - Alfonso Fiorelli
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Raffaele de Falco
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Bocchetti
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
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7
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Luzha J, Kopp M, Wiesmüller M, Taha L, Rupp R, Mantsopoulos K, Koch M, Iro H, Sievert M. Diagnostic Challenges and Imaging Considerations for Intraparotid Facial Nerve Schwannoma: A Case Report and Literature Review. Am J Case Rep 2024; 25:e942870. [PMID: 38549237 PMCID: PMC10985418 DOI: 10.12659/ajcr.942870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/09/2024] [Accepted: 01/12/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND A mass in the parotid gland usually indicates parotid gland neoplasia. Warthin tumors or pleomorphic adenomas are common differential diagnoses. Less frequently, other differential diagnoses and sites of origin are considered. Schwannomas are rare, benign tumors in the head and neck region. Even more rarely, these tumors occur in the intraparotid course of the facial nerve. In the following, we report about 2 patients in whom a mass in the right parotid gland was found incidentally during magnetic resonance imaging (MRI). CASE REPORT We reviewed data from the literature on intraparotid facial nerve schwannomas (IPFNS) and compared them with those from our cases. The focus was on data such as clinical history, clinical symptoms, electroneurography, and various imaging modalities, such as ultrasonography and MRI combined with diffusion-weighted imaging. CONCLUSIONS It is challenging to distinguish facial nerve schwannomas from other neoplasms. Patient's history, clinical symptoms, MRI examination with diffusion-weighted imaging, and high-resolution ultrasound imaging are decisive factors for diagnosis and should be performed when IPFNS is suspected. Diagnosis and therapy for IPFNS remain challenging. A wait-and-scan approach could be an option for patients with small tumors and good facial nerve function. On the other hand, patients with advanced tumors associated with limited facial nerve function can benefit from surgical approaches or stereotactic radiosurgery.
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Affiliation(s)
- Jeton Luzha
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Markus Kopp
- Department of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marco Wiesmüller
- Department of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lava Taha
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robin Rupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Gu Z, Dai W, Chen J, Jiang Q, Lin W, Wang Q, Chen J, Gu C, Li J, Ying G, Zhu Y. Convolutional neural network-based magnetic resonance image differentiation of filum terminale ependymomas from schwannomas. BMC Cancer 2024; 24:350. [PMID: 38504164 PMCID: PMC10949807 DOI: 10.1186/s12885-024-12023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE Preoperative diagnosis of filum terminale ependymomas (FTEs) versus schwannomas is difficult but essential for surgical planning and prognostic assessment. With the advancement of deep-learning approaches based on convolutional neural networks (CNNs), the aim of this study was to determine whether CNN-based interpretation of magnetic resonance (MR) images of these two tumours could be achieved. METHODS Contrast-enhanced MRI data from 50 patients with primary FTE and 50 schwannomas in the lumbosacral spinal canal were retrospectively collected and used as training and internal validation datasets. The diagnostic accuracy of MRI was determined by consistency with postoperative histopathological examination. T1-weighted (T1-WI), T2-weighted (T2-WI) and contrast-enhanced T1-weighted (CE-T1) MR images of the sagittal plane containing the tumour mass were selected for analysis. For each sequence, patient MRI data were randomly allocated to 5 groups that further underwent fivefold cross-validation to evaluate the diagnostic efficacy of the CNN models. An additional 34 pairs of cases were used as an external test dataset to validate the CNN classifiers. RESULTS After comparing multiple backbone CNN models, we developed a diagnostic system using Inception-v3. In the external test dataset, the per-examination combined sensitivities were 0.78 (0.71-0.84, 95% CI) based on T1-weighted images, 0.79 (0.72-0.84, 95% CI) for T2-weighted images, 0.88 (0.83-0.92, 95% CI) for CE-T1 images, and 0.88 (0.83-0.92, 95% CI) for all weighted images. The combined specificities were 0.72 based on T1-WI (0.66-0.78, 95% CI), 0.84 (0.78-0.89, 95% CI) based on T2-WI, 0.74 (0.67-0.80, 95% CI) for CE-T1, and 0.81 (0.76-0.86, 95% CI) for all weighted images. After all three MRI modalities were merged, the receiver operating characteristic (ROC) curve was calculated, and the area under the curve (AUC) was 0.93, with an accuracy of 0.87. CONCLUSIONS CNN based MRI analysis has the potential to accurately differentiate ependymomas from schwannomas in the lumbar segment.
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Affiliation(s)
- Zhaowen Gu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88, Jiefang Road, Hangzhou, China
| | - Wenli Dai
- Zhejiang University School of Mathematical Sciences, Hangzhou, Zhejiang, China
| | - Jiarui Chen
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88, Jiefang Road, Hangzhou, China
| | - Qixuan Jiang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88, Jiefang Road, Hangzhou, China
| | - Weiwei Lin
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88, Jiefang Road, Hangzhou, China
| | - Qiangwei Wang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88, Jiefang Road, Hangzhou, China
| | - Jingyin Chen
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88, Jiefang Road, Hangzhou, China
| | - Chi Gu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88, Jiefang Road, Hangzhou, China
| | - Jia Li
- Ningbo Medical Center Lihuili Hospital, Department of Neurosurgery, Ningbo University, 1111, Jiangnan Road, Ningbo, Zhejiang, China.
| | - Guangyu Ying
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88, Jiefang Road, Hangzhou, China.
| | - Yongjian Zhu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88, Jiefang Road, Hangzhou, China.
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China.
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Li S, Wang Z, Li Z, Xie S, Shan X, Cai Z. Intraosseous schwannoma of the mandible: new case series, literature update, and proposal of a classification. Int J Oral Maxillofac Surg 2024; 53:205-211. [PMID: 37716827 DOI: 10.1016/j.ijom.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/15/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
Intraosseous schwannoma of the mandible is rare, with diagnostic and therapeutic challenges. The aims of this study were to report new cases of intraosseous schwannoma of the mandible and to propose a clinical classification, providing suggestions for treatment methods. The cases of 13 patients treated at the authors' hospital and 86 cases reported previously in the literature were reviewed. The most common clinical feature was facial swelling (60/93). The rate of cortical thinning or expansion was 44.8% (43/96); widening of the inferior alveolar nerve canal on radiographs was observed in 15 patients.
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Affiliation(s)
- S Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Haidian District, Beijing, PR China
| | - Z Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Haidian District, Beijing, PR China
| | - Z Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Haidian District, Beijing, PR China
| | - S Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Haidian District, Beijing, PR China
| | - X Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Haidian District, Beijing, PR China
| | - Z Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Haidian District, Beijing, PR China.
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10
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Liaci E, Bertoli G, Di Lella F, Falcioni M. Intralabyrinthine schwannoma: Surgical management and cochlear lumen preservation. Am J Otolaryngol 2024; 45:104158. [PMID: 38157691 DOI: 10.1016/j.amjoto.2023.104158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
The present video reports the surgical removal of an intralabyrinthine schwannoma. The video contains patient's medical history, preoperative radiological evaluations and detailed description of surgical steps of the procedure, consisting in labyrinthectomy, cochleostomy and insertion of a dummy electrode in the preserved cochlear lumen within the context of a subtotal petrosectomy.
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Affiliation(s)
- Enrico Liaci
- Department of Medicine and Surgery, University of Parma and Department of Otolaryngology and Otoneurosurgery, Azienda Ospedaliero-Universitaria di Parma, Italy.
| | - Giulia Bertoli
- Department of Medicine and Surgery, University of Parma and Department of Otolaryngology and Otoneurosurgery, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Filippo Di Lella
- Department of Medicine and Surgery, University of Parma and Department of Otolaryngology and Otoneurosurgery, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Maurizio Falcioni
- Department of Medicine and Surgery, University of Parma and Department of Otolaryngology and Otoneurosurgery, Azienda Ospedaliero-Universitaria di Parma, Italy
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Morgan J, Manickavel S, Sorace A, Hartman Y, Eli A, Massicano A, Gonzalez ML, Warram JM, Walsh E. Utility of Targeted Positron Emission Tomography Imaging to Predict Schwannoma Growth in a Murine Tumor Model. Laryngoscope 2024; 134:1372-1380. [PMID: 37578272 DOI: 10.1002/lary.30943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/31/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To identify if targeted positron emission tomography (PET) imaging with radiolabeled antibodies can predict tumor growth rate and ultimate tumor size in a murine flank schwannoma model. STUDY DESIGN Animal research study. METHODS Rat schwannoma cells were cultured and implanted into 40 athymic nude mice. Once tumors reached 5 mm in diameter, 30 mice were injected with zirconium-89 labeled antibodies (HER2/Neu, vascular endothelial growth factor receptor 2 (VEGFR2), or IgG isotype). PET/CT was performed, and standardized uptake values (SUV) were recorded. Tumors were serially measured until mice were sacrificed per IACUC protocol. Statistical analysis was performed to measure correlations between SUV values, tumor size, and growth. RESULTS Mean tumor sizes in mm3 on Day 0 were 144 ± 162 for anti-HER2/Neu, 212 ± 247 for anti-VEGFR2, and 172 ± 204 for IgG isotype groups respectively. Mean growth rates in mm3 /day were 531 ± 250 for HER2, 584 ± 188 for VEGFR2, and 416 ± 163 for the IgG isotype group. For both initial tumor size and growth rates, there was no significant difference between groups. There were significant correlations between maximum tumor volume and both the SUV max in the HER2 group (p = 0.0218, R2 = 0.5020), and we observed significant correlations between growth rate, and SUV values (p = 0.0156, R2 = 0.5394). Respectively, in the anti-VEGFR2 group, there were no significant correlations. CONCLUSION In a murine schwannoma model, immunotargeted PET imaging with anti-HER2/Neu antibodies predicted tumor growth rate and final tumor size. Laryngoscope, 134:1372-1380, 2024.
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Affiliation(s)
- Jake Morgan
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sudhir Manickavel
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anna Sorace
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yolanda Hartman
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abbigael Eli
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adriana Massicano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Manuel Lora Gonzalez
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jason M Warram
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erika Walsh
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kehayov I, Davarski A, Angelova P, Kitov B. Sacral nerve root metastasis in a patient with lung carcinoma resembling neurinoma - a case report and literature review. Folia Med (Plovdiv) 2024; 66:136-141. [PMID: 38426477 DOI: 10.3897/folmed.66.e111619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/10/2023] [Indexed: 03/02/2024] Open
Abstract
Intradural extramedullary metastases from systemic neoplasms are very rare, with an incidence ranging from 2% to 5% of all secondary spinal diseases. We present the case of a 53-year-old man diagnosed with lung adenocarcinoma with symptoms of severe back pain and tibial paresis. The magnetic resonance imaging (MRI) revealed an intradural lesion originating from the right S1 nerve root mimicking neurinoma. Total tumor removal was achieved via posterior midline approach. The histological examination was consistent with lung carcinoma metastasis. Due to the rarity of single nodular nerve root metastases, MRI images may be misinterpreted as nerve sheath tumors, such as schwannomas or neurofibromas. We performed a brief literature review outlining the mainstay of diagnosis, therapeutic approach, and the prognosis of these rare lesions.
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Affiliation(s)
- Ivo Kehayov
- Medical University of Plovdiv, Plovdiv, Bulgaria
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13
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Nassiri F, Liang A, Agnoletto GJ, Couldwell WT. Transmaxillary approach for resection of maxillary division trigeminal schwannoma at foramen rotundum. Acta Neurochir (Wien) 2024; 166:107. [PMID: 38407650 DOI: 10.1007/s00701-024-05996-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/07/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The foramen rotundum and anterior cavernous sinus have traditionally been accessed by transcranial approaches that are limited by the high density of critical neurovascular structures. The transmaxillary approach provides an entirely extradural route to the foramen rotundum and anterior cavernous sinus. METHOD This patient with neurofibromatosis and facial pain with trigeminal schwannoma at the foramen rotundum was successfully treated by transmaxillary resection of the tumor. This approach allowed for a direct extradural access to the pathology, with bony decompression and tumor resection, avoiding transcranial routes. CONCLUSION The transmaxillary approach provides a safe and entirely extradural corridor to access smaller localized skull base lesions at and surrounding the cavernous sinus.
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Affiliation(s)
- Farshad Nassiri
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Allison Liang
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Guilherme J Agnoletto
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.
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14
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Bulisani BM, Ströher M, Rossi FMB, de Oliveira Leite MA, Rodrigues MR, Gomes LGL, Waisberg J. Robotic-Assisted Resection of a Benign Schwannoma of the Obturator Nerve: A Rare Case. Am J Case Rep 2024; 25:e942083. [PMID: 38347715 PMCID: PMC10877639 DOI: 10.12659/ajcr.942083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/31/2023] [Accepted: 12/11/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Neurilemmomas are rare tumors derived from the Schwann cells that comprise the peripheral nerve sheaths. They have a slow growth and rarely display malignancy. Early diagnosis is rare, and the treatment consists by surgical resection. Although robotic-assisted surgery is commonly used for treating retroperitoneal diseases, there are few reports of resection of retroperitoneal and pelvic schwannoma through robotic-assisted surgery. In the present study, we reported a case of complete excision of a benign retroperitoneal schwannoma of the obturator nerve by robotic-assisted surgery. CASE REPORT A 51-year-old woman was referred by her gynecologist for left pelvic discomfort of a 3-month duration. The physical examination was normal, but a computerized tomography scan of the abdomen and pelvis showed an expansive pelvic lesion in the topography of the left iliac vessels, a hypodense contrast enhancement measuring 4.6×3.4 cm. Magnetic resonance imaging showed an extraperitoneal lesion located medially and inferiorly to the left external iliac vessels, with a size of 4.9×3.7 cm, and of probable neural etiology. Surgical resection of the tumor was recommended because of the diagnostic hypothesis of obturator nerve schwannoma. CONCLUSIONS This case showed that retroperitoneal neurilemmomas are difficult to diagnose owing to a lack of specific symptoms, and the best treatment is complete tumor resection. The use of robotic techniques gives greater dexterity to the surgeon, since it provides high-definition 3-dimensional vision, which can make the removal of retroperitoneal tumors susceptible to minimally invasive resection in a safe and effective way.
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Affiliation(s)
| | - Marina Ströher
- Department of General Surgery, Universidade Municipal de São Caetano do Sul, São Caetano do Sul, SP, Brazil
| | | | | | - Murilo Rocha Rodrigues
- Surgery of the Digestive System, RR Médicos Cirurgiões, São Bernardo do Campo, SP, Brazil
| | | | - Jaques Waisberg
- Department of Surgery, Centro Universitário FMABC/Faculdade de Medicina do ABC, Santo André, SP, Brazil
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15
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Xu M, Wang Y, Xu J, Zhong P. Far lateral approach for dumbbell-shaped C1 schwannomas: how I do it. Acta Neurochir (Wien) 2024; 166:78. [PMID: 38340183 DOI: 10.1007/s00701-024-05987-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Dumbbell-shaped C1 schwannomas are rare lesions that involve both intra- and extradural compartments. Because of the intimate relationships these lesions develop with the third and fourth segments of the vertebral artery, surgical removal of these lesions remains a challenge. METHOD We describe the key steps of the far lateral approach for dumbbell-shaped C1 schwannomas with a video illustration. The surgical anatomy is described along with the techniques for protecting the vertebral artery. CONCLUSION Dumbbell-shaped C1 schwannomas can be safely removed by using the far lateral approach, surgical anatomy expertise, and intraoperative microvascular Doppler.
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Affiliation(s)
- Ming Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery, Chinese Academy of Medical Sciences, Shanghai, China
| | - Ying Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jian Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery, Chinese Academy of Medical Sciences, Shanghai, China
| | - Ping Zhong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
- National Center for Neurological Disorders, Shanghai, China.
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.
- Neurosurgical Institute of Fudan University, Shanghai, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.
- Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery, Chinese Academy of Medical Sciences, Shanghai, China.
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Xu P, Wang B, Sun Q, Bian L, Sun Y. O-arm guided minimally invasive resection of intrathoracic epidural schwannoma: how I do it. Acta Neurochir (Wien) 2024; 166:68. [PMID: 38319454 DOI: 10.1007/s00701-024-05916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/09/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Schwannomas are the most common intrathoracic neurogenic tumors. In the past, they were often treated by traditional open surgery. Video-assisted thoracic surgery (VATS) has also been used for some large tumors. Recently, minimally invasive posterior neurosurgical technique provides a new option for some of these tumors. METHOD Here, we describe the specific steps involved in the O-arm guided minimally invasive removal of intrathoracic epidural schwannoma, as well as its advantages and limitations. CONCLUSION O-arm guided minimally invasive resection of intrathoracic epidural schwannoma is safe and effective and causes little damage.
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Affiliation(s)
- Pengcheng Xu
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baofeng Wang
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfang Sun
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liuguan Bian
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhao Sun
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Lorandi LL, Ceccon FP, Callegari FM, Bacchi CE, Haddad L. Benign cervical schwannoma with tracheal invasion. Einstein (Sao Paulo) 2024; 22:eRC0528. [PMID: 38324847 PMCID: PMC10948098 DOI: 10.31744/einstein_journal/2024rc0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/21/2023] [Indexed: 02/09/2024] Open
Abstract
Schwannomas commonly develop in the cervical region, 25% - 45% of cases are diagnosed in this anatomical region. Tracheal neurogenic tumors are exceedingly rare and can be misdiagnosed as invasive thyroid carcinomas or other infiltrating malignancies when present at the level of the thyroid gland. Here, we present a case of synchronous benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma in a patient who was initially hospitalized for COVID-19. The patient presented with dyspnea that was later found to be caused by tracheal extension of a cervical tumor. Surgical excision was performed, and the surgical team proceeded with segmental tracheal resection, removal of the cervical mass, and total thyroidectomy. The specimen was sent for pathological analysis, which revealed synchronous findings of a benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma. The literature on this subject, together with the present case report, suggests that neurogenic tumors should be included in the differential diagnosis of obstructing tracheal cervical masses. Surgical excision is the first-line of treatment for benign cervical schwannomas.
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Affiliation(s)
- Leonardo Lima Lorandi
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein , Hospital Israelita Albert Einstein , São Paulo , SP , Brazil .
| | - Fabio Pupo Ceccon
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein , São Paulo , SP , Brazil .
| | - Fabiano Mesquita Callegari
- Pathology DepartmentUniversidade Federal de São PauloSão PauloSPBrazil Pathology Department , Universidade Federal de São Paulo , São Paulo , SP , Brazil .
| | - Carlos Eduardo Bacchi
- Laboratorio de Patologia Bacchi LtdaBotucatuSPBrazil Laboratorio de Patologia Bacchi Ltda , Botucatu , SP , Brazil .
| | - Leonardo Haddad
- Department of Otorhinolaryngology and Head and Neck SurgeryEscola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazil Department of Otorhinolaryngology and Head and Neck Surgery , Escola Paulista de Medicina , Universidade Federal de São Paulo , São Paulo , SP , Brazil .
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Nishida M, Suzuki M, Hirai M, Imoto T, Shimizu R, Harada M, Hishima T, Horio H. [Surgically Resected Cases of Mediastinal Ganglioneuroma Detected in Adults]. Kyobu Geka 2024; 77:115-120. [PMID: 38459861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
A ganglioneuroma is a rare, benign, neurogenic tumor originating from the sympathetic ganglion. Mediastinal ganglioneuroma are mostly detected in children, typically around 10 years of age, and are rarely identified in adults. Herein, we report two surgically resected cases of mediastinal ganglioneuroma in adults. In Case 1, a 53-year-old man, without any symptom, underwent a computed tomography, revealing a 3.2 cm well-defined paravertebral superior mediastinal tumor with long craniocaudal axis. In case 2, a 29-year-old woman presented with newly-developed ptosis and a history of left-sided facial hypohidrosis since the age of 10. Chest computed tomography (CT) revealed a 7.8 cm well-defined paravertebral superior mediastinal tumor with long craniocaudal axis. Both patients were initially suspected to have neurogenic tumors, particularly schwannomas. They underwent mediastinal tumor resections, requiring sympathetic nerve trunk dissection. Pathological examination confirmed the diagnosis of ganglioneuromas in both cases. Mediastinal ganglioneuroma must be differentiated from schwannoma, the most common neurogenic tumor in adults. Unlike schwannoma, ganglioneuroma cannot be enucleated, therefore attention should be focused on complications associated with sympathetic nerve trunk dissection, such as Horner's syndrome, hyperhidrosis, and arrhythmia. Identifying this rare entity and its characteristic imaging aids in preoperative differentiation, strategizing surgical approaches, and predicting complications.
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Affiliation(s)
- Masayo Nishida
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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19
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Chen J, Bui C, Loh H, Mansberg R. Gastric Schwannoma Demonstrated on 18 F FDG PET/CT With Pathological Correlation. Clin Nucl Med 2024; 49:166-168. [PMID: 38108854 DOI: 10.1097/rlu.0000000000005016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
ABSTRACT A 66-year-old man with background hypertension and type 2 diabetes presented with 1 month history of epigastric pain for investigation. Abdominal CT and MRI identified round homogeneously enhancing mass arising from the lesser curvature of the stomach. On 18 F-FDG PET/CT, the gastric mass demonstrated intense FDG uptake (SUV max , 9.6). The patient subsequently underwent partial gastrectomy, with pathological features and immunohistochemical patterns consistent with gastric schwannoma.
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Affiliation(s)
- Jeffrey Chen
- From the Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood
| | - Chuong Bui
- From the Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood
| | - Han Loh
- From the Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood
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20
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Landriel F, Padilla Lichtenberger F, Guiroy A, Soto M, Molina C, Hem S. Minimally Invasive Approaches for Lumbosacral Plexus Schwannomas. Oper Neurosurg (Hagerstown) 2024; 26:149-155. [PMID: 37831977 DOI: 10.1227/ons.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/16/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Lumbosacral plexus schwannomas (LSPSs) are benign, slow-growing tumors that arise from the myelin sheath of the lumbar or sacral plexus nerves. Surgery is the treatment of choice for symptomatic LSPSs. Conventional retroperitoneal or transabdominal approaches provide wide exposure of the lesion but are often associated with complications in the abdominal wall, lumbar or sacral plexus, ureter, and intraperitoneal organs. Advances in technology and minimally invasive (MIS) techniques have provided alternative approaches with reliable efficacy compared with traditional open surgery. We describe 3 MIS approaches using tubular retractor systems according to the lesion level. METHODS This was a multicenter, retrospective observational cohort study to evaluate the use of MIS tubular approaches for surgical resection of LSPSs. We included 23 lumbar and upper sacral plexus schwannomas. Clinical presentation, spinal level, surgical duration, degree of resection, days of hospitalization, pathological anatomy of the tumor, approach-related surgical difficulties, and outcomes were collected. RESULTS The posterior oblique approach was used in 43.5% of the cases, the transpsoas approach in 39.1%, and the transiliac in 17.4%. The mean operative time was 3.3 hours, and the mean hospitalization was 2.5 days. All tumors were WHO grade 1 schwannoma. Postoperative MRI confirms gross total resection in 91.3% of the patients. No patient requires instrumentation. The pros and cons of each approach were summarized. CONCLUSION The MIS approaches adapted to the lumbar level may improve surgeons' comfort allowing a safe resection of retroperitoneal LSPS.
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Affiliation(s)
- Federico Landriel
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
| | | | - Alfredo Guiroy
- Elite Spine Health and Wellness, Fort Lauderdale , Florida , USA
| | - Manuel Soto
- Spine Clinic, The American-British Cowdray Medical Center I.A.P., Mexico City , Mexico
| | - Camilo Molina
- Neurosurgical Department, Spine Unit, Washington University School of Medicine in St. Louis, St. Louis , Washington , USA
| | - Santiago Hem
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
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Graffeo CS, Pacult MA, Cole TS, Srinivasan VM, Lawton MT. Extended Retrosigmoid Craniotomy for Resection of an Abducens Schwannoma. World Neurosurg 2024; 182:42. [PMID: 37925148 DOI: 10.1016/j.wneu.2023.10.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Christopher S Graffeo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark A Pacult
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Candelo E, Otamendi-Lopez A, Chaichana KL, Donaldson AM. Endoscopic Endonasal Anterior Cranial Fossa Approach for Rare Giant Olfactory Schwannoma Resection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:232. [PMID: 37747334 DOI: 10.1227/ons.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/28/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Estephania Candelo
- Otolaryngology and Head-Neck Department, Mayo Clinic, Jacksonville , Florida , USA
| | | | - Kaisorn L Chaichana
- Department of Neurological Surgery, Mayo Clinic, Jacksonville , Florida , USA
| | - Angela M Donaldson
- Otolaryngology and Head-Neck Department, Mayo Clinic, Jacksonville , Florida , USA
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23
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El-Hajj VG, Singh A, Norin C, Edström E, Bohman E, Elmi-Terander A. Conservative or surgical management of orbital schwannomas: a population-based case series. Acta Neurochir (Wien) 2024; 166:9. [PMID: 38217694 PMCID: PMC10787905 DOI: 10.1007/s00701-024-05899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/10/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Orbital schwannomas (OS) are rare occurrences with no more than 500 cases reported in the literature. The tumor's potential to compromise the delicate neuro-ophthalmic structures within the orbit prompts surgical removal. Tumor removal is performed by ophthalmologists, often requiring a multidisciplinary surgical approach. The literature contains a very limited number of cases managed non-surgically. However, the inherent risks of orbital surgery warrant a comparison of the outcomes of conservative and surgical management strategies. AIMS To review the national Swedish experience with the management of orbital schwannomas. METHODS The study center is the primary Swedish referral center for the multidisciplinary management of orbital tumors, including schwannomas. During the period of 2005 to 2021, 16 patients with an OS diagnosis were managed at the center. RESULTS Four patients initially underwent surgery where gross total resection (GTR) was achieved in three (75%) and subtotal resection (STR) in one (25%) case. The remaining 12 patients, who had a low risk of neuro-ophthalmic impairment, were managed conservatively with radiological and clinical examinations at regular intervals. After an average follow-up of 17 months, surgery was performed in three of these cases (25%). No recurrences or tumor growths were detected on radiological follow-ups (mean 50 months), and all patients experienced postoperative improvement at clinical follow-up (mean 65 months). The remainder of the conservatively treated patients (n=9) experienced no clinical progression (mean 30 months). A slight radiological tumor progression was detected in one patient after 17 months. CONCLUSION There were no differences in long-term outcome between patients who had been managed with early surgery and those operated later after an initially conservative management. Conservatively treated patients had minimal to no symptoms and remained clinically stable throughout the follow-up period. Based on these findings, conservative management may successfully be adopted in cases with mild symptoms, no signs of compressive optic neuropathy and low risk of neuro-ophthalmic impairment. Conversion to surgical management is indicated upon clinical deterioration or tumor growth. Based on the findings of this study a decision tree for the management of orbital schwannomas is suggested.
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Affiliation(s)
| | - Aman Singh
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Norin
- Division of Ophthalmology and Vision, St. Erik Eye Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, 194 02 Upplands-Väsby, Box 2074, Stockholm, Sweden
| | - Elin Bohman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Ophthalmology and Vision, St. Erik Eye Hospital, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Capio Spine Center Stockholm, Löwenströmska Hospital, 194 02 Upplands-Väsby, Box 2074, Stockholm, Sweden.
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Song C, Kim HS, Lee JH, Yoon YC, Lee S, Lee SH, Kim ES. Development of a novel prediction model for differential diagnosis between spinal myxopapillary ependymoma and schwannoma. Sci Rep 2024; 14:149. [PMID: 38167614 PMCID: PMC10762031 DOI: 10.1038/s41598-023-50806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
Spinal myxopapillary ependymoma (MPE) and schwannoma represent clinically distinct intradural extramedullary tumors, albeit with shared and overlapping magnetic resonance imaging (MRI) characteristics. We aimed to identify significant MRI features that can differentiate between MPE and schwannoma and develop a novel prediction model using these features. In this study, 77 patients with MPE (n = 24) or schwannoma (n = 53) who underwent preoperative MRI and surgical removal between January 2012 and December 2022 were included. MRI features, including intratumoral T2 dark signals, subarachnoid hemorrhage (SAH), leptomeningeal seeding, and enhancement patterns, were analyzed. Logistic regression analysis was conducted to distinguish between MPE and schwannomas based on MRI parameters, and a prediction model was developed using significant MRI parameters. The model was validated internally using a stratified tenfold cross-validation. The area under the curve (AUC) was calculated based on the receiver operating characteristic curve analysis. MPEs had a significantly larger mean size (p = 0.0035), higher frequency of intratumoral T2 dark signals (p = 0.0021), associated SAH (p = 0.0377), and leptomeningeal seeding (p = 0.0377). Focal and diffuse heterogeneous enhancement patterns were significantly more common in MPEs (p = 0.0049 and 0.0038, respectively). Multivariable analyses showed that intratumoral T2 dark signal (p = 0.0439) and focal (p = 0.0029) and diffuse enhancement patterns (p = 0.0398) were independent factors. The prediction model showed an AUC of 0.9204 (95% CI 0.8532-0.9876) and the average AUC for internal validation was 0.9210 (95% CI 0.9160-0.9270). MRI provides useful data for differentiating spinal MPEs from schwannomas. The prediction model developed based on the MRI features demonstrated excellent discriminatory performance.
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Affiliation(s)
- Chorog Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sungjoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Niranjan A, Faramand A, Raju SS, Lee CC, Yang HC, Nabeel AM, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Reda WA, Álvarez RM, Moreno NEM, Liscak R, May J, Mathieu D, Langlois AM, Snyder MH, Shepard MJ, Sheehan J, Muhsen BA, Borghei-Razavi H, Barnett G, Kondziolka D, Golfinos JG, Attuati L, Picozzi P, McInerney J, Daggubati LC, Warnick RE, Feliciano CE, Carro E, McCarthy D, Starke RM, Landy HJ, Cifarelli CP, Vargo JA, Flickinger J, Lunsford LD. Clinical and Imaging Outcomes After Trigeminal Schwannoma Radiosurgery: Results From a Multicenter, International Cohort Study. Neurosurgery 2024; 94:165-173. [PMID: 37523519 DOI: 10.1227/neu.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma. METHODS Patient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years). Sixty patients (19%) had prior resections. Abnormal facial sensation was the commonest complaint (49%). The anatomic locations were root (N = 40), ganglion (N = 141), or dumbbell type (N = 128). The median tumor volume was 4 cc (range, 0.2-30.1 cc), and median margin dose was 13 Gy (range, 10-20 Gy). Factors associated with tumor control, symptom improvement, and adverse radiation events were assessed. RESULTS The median and mean time to last follow-up was 49 and 65 months (range 6-242 months). Greater than 5-year follow-up was available for 139 patients (45%), and 50 patients (16%) had longer than 10-year follow-up. The overall tumor control rate was 94.5%. Tumors regressed in 146 patients (47.2%), remained unchanged in 128 patients (41.4%), and stabilized after initial expansion in 20 patients (6.5%). Progression-free survival rates at 3 years, 5 years, and 10 years were 91%, 86%, and 80 %. Smaller tumor volume (less than 8 cc) was associated with significantly better progression-free survival ( P = .02). Seventeen patients with sustained growth underwent further intervention at a median of 27 months (3-144 months). Symptom improvement was noted in 140 patients (45%) at a median of 7 months. In multivariate analysis primary, SRS ( P = .003) and smaller tumor volume ( P = .01) were associated with better symptom improvement. Adverse radiation events were documented in 29 patients (9%). CONCLUSION SRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.
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Affiliation(s)
- Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Andrew Faramand
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Sudesh S Raju
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya , Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Cairo , Egypt
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Cairo , Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo , Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | | | | | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Québec , Canada
| | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Québec , Canada
| | - M Harrison Snyder
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh , Pennsylvania , USA
| | - Jason Sheehan
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Baha'eddin A Muhsen
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Hamid Borghei-Razavi
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Gene Barnett
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Douglas Kondziolka
- Departments of Neurosurgery and Medical Physics, NYU Langone Health System, New York , New York , USA
| | - John G Golfinos
- Departments of Neurosurgery and Medical Physics, NYU Langone Health System, New York , New York , USA
| | - Luca Attuati
- Department of Neurosurgery, Gamma Knife Humanitas Research Hospital, Milan , Italy
| | - Piero Picozzi
- Department of Neurosurgery, Gamma Knife Humanitas Research Hospital, Milan , Italy
| | - James McInerney
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey , Pennsylvania , USA
| | - Lekhaj Chand Daggubati
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey , Pennsylvania , USA
| | - Ronald E Warnick
- Department of Neurosurgery, Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati , Ohio , USA
| | - Caleb E Feliciano
- Department of Neurosurgery, Gamma Knife Center of Puerto Rico, San Juan , Puerto Rico
| | - Eric Carro
- Department of Neurosurgery, Gamma Knife Center of Puerto Rico, San Juan , Puerto Rico
| | - David McCarthy
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Robert M Starke
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Howard J Landy
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Christopher P Cifarelli
- Department of Neurologic Surgery, West Virginia University, Morgantown , West Virginia , USA
| | - John A Vargo
- Department of Neurologic Surgery, West Virginia University, Morgantown , West Virginia , USA
| | - John Flickinger
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
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Ren J, Yuan Y, Qi M, Tao X. MRI-based radiomics nomogram for distinguishing solitary fibrous tumor from schwannoma in the orbit: a two-center study. Eur Radiol 2024; 34:560-568. [PMID: 37532903 DOI: 10.1007/s00330-023-10031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES To investigate the value of magnetic resonance imaging (MRI) radiomics for distinguishing solitary fibrous tumor (SFT) from schwannoma in the orbit. MATERIALS AND METHODS A total of 140 patients from two institutions were retrospectively included. All patients from institution 1 were randomized into a training cohort (n = 69) and a validation cohort (n = 35), and patients from institution 2 were used as an external testing cohort (n = 36). One hundred and six features were extracted from T2-weighted imaging (T2WI) and contrast-enhanced T1-weighted imaging (CET1WI). A radiomics model was built for each sequence using least absolute shrinkage and selection operator logistic regression, and radiomics scores were calculated. A combined model was constructed and displayed as a radiomics nomogram. Two radiologists jointly assessed tumor category based on MRI findings. The performances of the radiomics models and visual assessment were compared via area under the curve (AUC). RESULTS The performances of the radiomics nomogram combining T2WI and CET1WI radiomics scores were superior to those of the pooled readers in the training (AUC 0.986 vs. 0.807, p < 0.001), validation (AUC 0.989 vs. 0.788, p = 0.009), and the testing (AUC 0.903 vs. 0.792, p = 0.093), although significant difference was not found in the testing cohort. Decision curve analysis demonstrated that the radiomics nomogram had better clinical utility than visual assessment. CONCLUSION MRI radiomics nomogram can be used for distinguishing between orbital SFT and schwannoma, which may help tumor management by clinicians. CLINICAL RELEVANCE STATEMENT It is of great importance and challenging for distinguishing solitary fibrous tumor from schwannoma in the orbit. In the present study, an MRI-based radiomics nomogram were developed and independently validated, which could help the discrimination of the two entities. KEY POINTS • It is challenging to differentiate solitary fibrous tumor from schwannoma in the orbit due to similar clinical and image features. • A radiomics nomogram based on T2-weighted imaging and contrast-enhanced T1-weighted imaging has advantages over radiologists. • Radiomics can provide a non-invasive diagnostic tool for differentiating between the two entities.
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Affiliation(s)
- Jiliang Ren
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200010, China
| | - Ying Yuan
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200010, China
| | - Meng Qi
- Department of Radiology, Eye & ENT Hospital, Fudan University, No. 83 Fenyang Road, Shanghai, 200030, China.
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200010, China.
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27
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Müller M, Kaiser R, Özçakar L, Mezian K. Sonographic Diagnosis of a Radial Nerve Schwannoma: Reflex Hammer "Showing Inside". Am J Phys Med Rehabil 2024; 103:e6-e7. [PMID: 37205738 DOI: 10.1097/phm.0000000000002294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Martin Müller
- From the Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic (MM, KM); Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic (RK); and Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (LÖ)
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28
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Guo W, Liu Z, Wang Z, Tian H, Zi X. Olfactory Groove Schwannoma or Olfactory Ensheathing cell Tumor? J Craniofac Surg 2024; 35:e21-e23. [PMID: 37643126 DOI: 10.1097/scs.0000000000009705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Schwannomas are benign tumors that arise from Schwann cells. Rare cases are shown to arise from the olfactory nerve. The genesis of Olfactory groove schwannoma (OGSs) is still puzzling. Yusda et al hypothesized that olfactory ensheathing cell tumors (OECTs) might be the origin of OGSs. CLINICAL PRESENTATION Here, the authors report the case of a 59-year-old woman who presented with a paroxysmal headache for 1 year. The tumor appeared as hypointensity on T1-weighted images, hyperintensity on T2-weighted, and exhibited strong, heterogeneous enhancement. The tumor was removed through a lateral supraorbital approach. The final pathologic diagnosis was schwannoma. The postoperative period was uneventful after 4 months, and the headache disappeared. DISSCUSSION AND CONCLUSION OGSs and OECTs are extremely rare. There are many similarities in clinical manifestations, images, and pathologic findings. OGSs are difficult to distinguish from OECTs.
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Affiliation(s)
| | - Zhirui Liu
- Department of Outpatient Service, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | | | | | - Xicun Zi
- Department of Outpatient Service, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
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29
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Sun Z, Wang X, Pang X. Malignant melanotic schwannoma: A case report and literature review. Asian J Surg 2024; 47:640-641. [PMID: 37805316 DOI: 10.1016/j.asjsur.2023.09.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Zhicheng Sun
- Department of Spinal Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China.
| | - Xiyang Wang
- Department of Spinal Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China.
| | - Xiaoyang Pang
- Department of Spinal Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China.
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30
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Meling TR. Commentary: Endoscopic Transorbital Surgery for Trigeminal Schwannoma: Introduction of a Novel Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:98-99. [PMID: 37831984 DOI: 10.1227/ons.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- Torstein R Meling
- Department of Neurosurgery, The National Hospital of Denmark, Rigshospitalet, Copenhagen, Denmark
- Department of Neurological Surgery, Besta NeuroSim Center, Istituto Nazionale Neurologico "C.Besta", Milano, Italy
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31
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Byvaltsev VA, Kalinin AA. [Minimally invasive removal of dumbbell shaped schwannomas with transforaminal lumbar fusion: a retrospective study with a minimum 3-year follow-up]. Zh Vopr Neirokhir Im N N Burdenko 2024; 88:47-53. [PMID: 38549410 DOI: 10.17116/neiro20248802147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Currently, there are no standards in surgical treatment of dumbbell-shaped tumors of lumbo-foraminal region. OBJECTIVE To evaluate the effectiveness and long-term results of minimally invasive resection of dumbbell-shaped lumbar schwannomas Eden type 2 and 3 combined with transforaminal lumbar interbody fusion and transpedicular stabilization. MATERIAL AND METHODS A retrospective study included 13 patients (8 men and 5 women) with lumbar dumbbell tumors Eden type 2 and 3 who underwent minimally invasive facetectomy through posterolateral anatomical corridor, microsurgical tumor resection and MI TLIF. We analyzed intraoperative parameters, neurological functions (ASIA scale), clinical characteristics (ODI, SF-36), and complications. Resection quality and area of the multifidus muscle were assessed according to MRI data. All patients were followed-up throughout at least 3-year. RESULTS Surgery time was 147 min, blood loss - 118 ml, hospital-stay - 7 days. Clinical parameters significantly improved in the follow-up period: ODI score decreased from 72 to 12 (p=0.004), SF-36 PCS increased from 26.24 to 48.51 (p=0.006) and MCS score increased from 29.13 to 53.68 (p=0.002). According to MRI data, no tumor recurrences and severe muscle atrophy (>30%) were observed after 3 years in all cases. Superficial wound infection occurred in 1 (7.7%) case. There were normal neurological functions (ASIA type E) in all patients. CONCLUSION Minimally invasive facetectomy through posterolateral approach with MI TLIF technology can be used for safe and effective resection of dumbbell-shaped schwannomas Eden type 2 and 3.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia
- Russian Railways-Medicine Clinical Hospital, Irkutsk, Russia
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia
- Russian Railways-Medicine Clinical Hospital, Irkutsk, Russia
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32
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Dong QJ, Chen C, Wang Y. A case of colonic schwannoma causing ileocolonic intussusception. J Gastrointest Surg 2024; 28:93-95. [PMID: 38353083 DOI: 10.1016/j.gassur.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Qiu-Jie Dong
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China; Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Cheng Chen
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Wang
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China.
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Murin M, Rousek M, Schütz ŠO, Husárová T, Vaněk P, Pohnán R. Robotic-assisted resection of deep pelvic schwannoma. Rozhl Chir 2024; 102:437-440. [PMID: 38290821 DOI: 10.33699/pis.2023.102.11.437-440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Schwannomas are a group of well differentiated benign tumors originating from the Schwann cells of the peripheral nervous system. Their localization in the pelvis is very rare. Schwannomas with expansive growth can cause wide neurologic symptoms or oppression of pelvic organs. CASE REPORT The authors present a case study of a 60-year-old woman with a large, symptomatic deep pelvic schwannoma. The patient underwent robotic-assisted surgery resulting in complete tumor extirpation. The patient's postoperative course was uneventful with a total of two hospitalization days. The diagnosis of a schwannoma was confirmed by histopathologic analysis. At 11-month follow-up surveillance the patient did not present any neurological deficit or other symptoms. CONCLUSION Robotic-assisted surgery allows safe and effective surgical treatment in difficult-to-access anatomical areas. Magnetic resonance imaging is required for preoperative imaging of neurogenic tumors. Histological verification is not recommended in cases where evidence of a schwannoma is found. Multidisciplinary cooperation of a dedicated team experienced in minimally invasive pelvic surgery is necessary.
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Kong D, Yu Z, Mu X. A case report of low-grade malignant schwannoma-occupying lesions. Asian J Surg 2024; 47:569-570. [PMID: 37833223 DOI: 10.1016/j.asjsur.2023.09.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- Defu Kong
- Xinxiang Medical University, Xinxiang, China
| | - Zhenghong Yu
- Department of Spinal Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xinling Mu
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
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35
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Kong DS, Shin HJ. Endoscopic Transorbital Surgery for Trigeminal Schwannoma: Introduction of a Novel Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:96-97. [PMID: 37819070 DOI: 10.1227/ons.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/14/2023] [Indexed: 10/13/2023] Open
Abstract
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE The major indications of endoscopic transorbital approach include spheno-orbital meningiomas, cavernous sinus lesions, and Meckel cave lesion such as trigeminal schwannomas. It can avoid excessive brain retraction and allows for a fast recovery to the normal daily living activity. ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT To access the cavernous sinus, the sagittal crest and meningo-orbital band should be identified and cut. ESSENTIAL STEPS OF THE PROCEDURE 1. Skin incision along the superior eyelid is performed. 2. Careful dissection of the soft tissue under the orbicularis is required not to injure the orbital septum. 3. After the lateral orbital rim is exposed, the periosteum and periorbita are elevated from the lateral orbital wall. 4. Drilling of the zygomatic bone within the orbit exposes the temporalis muscle first followed by the exposure of the temporal dura. It is essential to obtain adequate working room when the base of the greater sphenoidal wing is drilled. The sagittal crest should be removed, and the meningo-orbital band should be cut to expose the lateral cavernous sinus wall. PITFALLS/AVOIDANCE OF COMPLICATIONS For successful access through the orbit, endoscopic transorbital approach needs to minimize the retraction of the orbit. To achieve this goal, retraction of the orbit should be limited to a maximum of 10 minutes. VARIANTS AND INDICATIONS OF THEIR USE This approach can be combined with lateral orbitotomy. It provides a wider working room and makes surgery easier to access the lateral temporal lobe.The patient consented to the procedure, and the participants and any identifiable individuals consented to publication of his/her image. Images at 1:29 reproduced from Corrivetti F, de Notaris M, Di Somma A, et al, "Sagittal crest": definition, stepwise dissection, and clinical implications from a transorbital perspective, Operative Neurosurgery , 22(5), p e206-e212, ©2022, by permission from the Congress of Neurological Surgeons. Video screen capture from The Neurosurgical Atlas at 1:06 used with permission from Aaron Cohen-Gadol; ©The Neurosurgical Atlas, all rights reserved.
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Affiliation(s)
- Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Capital Armed Forces Hospital, Seungnam, Gyeonggido, Korea
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Abbas M, Fatimi AS, Hassan SI, Aamir FB, Arshad S, Fatimi SH. Intrapulmonary schwannoma presenting as an asymptomatic lung mass: a case report. J Med Case Rep 2023; 17:538. [PMID: 38082359 PMCID: PMC10714630 DOI: 10.1186/s13256-023-04234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Schwannomas are solitary well-circumscribed encapsulated benign tumors that exhibit Schwann cell differentiation, and arise directly from myelinated peripheral or central nerves. Although they are usually asymptomatic and found incidentally, schwannomas can cause symptoms due to compression of nearby structures which, depending on the location, can make clinical presentations widely variable. Despite their rarity, schwannomas have been documented in a number of locations including the limbs, cerebellopontine angle, posterior mediastinum, and, far more infrequently, the lungs. CASE PRESENTATION In this article, we report an incidental finding of an intrapulmonary schwannoma in a 59-year-old Pakistani woman who was grossly asymptomatic upon presentation to the cardiothoracic surgery clinic. An [18F]fluorodeoxyglucose positron emission tomography/computed tomography scan revealed a lobulated soft-tissue lesion measuring 23 mm × 23 mm in the lower lobe of the right lung. A computed tomography-guided core biopsy of the mass was performed, which revealed a benign spindle cell lesion based on histopathological examination and immunohistochemical staining. The mass was surgically resected via a right lower lobectomy, and subsequently confirmed to be an encapsulated neoplastic lesion composed of well-differentiated Schwann cells. There were no short- or long-term complications, morbidities, or recurrences based on 1-year follow-up. CONCLUSION This report underscores the predominantly asymptomatic nature of schwannomas and reemphasizes the efficacy of surgical resection as a safe and curative procedure for a tumor of this nature. Albeit very rare, intrapulmonary schwannomas can be considered a differential diagnosis when encountering solitary asymptomatic pulmonary nodules or masses.
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Affiliation(s)
- Manzar Abbas
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Sidra Arshad
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Saulat Hasnain Fatimi
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan.
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Kawasaki T, Ichikawa J, Imada H, Kanno S, Onohara K, Yazawa Y, Tatsuno R, Jyubashi T, Torigoe T. Indolent Multinodular Synovial Sarcoma of Peripheral Nerves Mimicking Schwannoma: A Case Report and Literature Review. Anticancer Res 2023; 43:5729-5736. [PMID: 38030190 DOI: 10.21873/anticanres.16779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND/AIM Most cases of synovial sarcoma (SS) are aggressive and large-sized; only few show indolent behavior, having a small size. Nerves are rare sites of SS occurrence. An atypical case of SS can lead to its misdiagnosis as a benign tumor and delay its treatment. CASE REPORT Here, we report a case of primary SS of indolent multinodular synovial sarcoma of peripheral nerves. Considering the clinical and imaging findings at the first visit, we suspected a benign tumor and continued careful follow-up. Three years later, marginal resection was performed and SS was suspected. We then performed an additional wide resection using a free flap. Histopathologically, the proximal tumor showed a diffuse proliferation of spindle cells without pleomorphism, whereas the distal tumor showed a similar histology with more hypercellularity. Additional wide-resection specimens showed remnant tumors derived from the peripheral nerve. Immunohistochemistry (IHC) showed positive staining for SS18:SSX and SSX in both tumors and fluorescence in situ hybridization showed positive staining for the SS18 split in both tumors. Finally, SS of the peripheral nerve was diagnosed. Owing to FNCLCC grade 2 tumor and tumor size, adjuvant chemotherapy was not performed. CONCLUSION In cases of SS or other sarcomas with atypical clinical courses, with imaging findings mimicking benign tumors, we recommend marginal resection along with pathological examination for correct diagnosis.
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Affiliation(s)
- Tomonori Kawasaki
- Department of Pathology, Saitama Medical University International Medical Centre, Saitama, Japan
| | - Jiro Ichikawa
- Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan;
| | - Hiroki Imada
- Department of Pathology, Saitama Medical Centre, Saitama Medical University, Saitama, Japan
| | - Satoshi Kanno
- Department of Pathology, Saitama Medical University International Medical Centre, Saitama, Japan
| | - Kojiro Onohara
- Radiology, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yasuo Yazawa
- Orthopaedic Oncology & Surgery, Saitama Medical University International Medical Centre, Saitama, Japan
| | - Rikito Tatsuno
- Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takahiro Jyubashi
- Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tomoaki Torigoe
- Orthopaedic Oncology & Surgery, Saitama Medical University International Medical Centre, Saitama, Japan
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Calvanese F, Boari N, Spina A, Gagliardi F, Bailo M, Mortini P. MIS removal of extraforaminal lumbar spine schwannoma using MAS-TLIF retractor: technical note. Br J Neurosurg 2023; 37:1901-1903. [PMID: 33612022 DOI: 10.1080/02688697.2021.1888872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND To report the use of Nuvasive MAS-TLIF retractor for the removal of lumbar spine schwannomas. METHODS A 47-year-old man with 1-year history of back pain with progressive left sciatica underwent surgical resection of a left extraforaminal lumbar schwannoma (type IV according to Eden's classification) using the MAS-TLIF retractor. RESULTS The patient completely recovered from the preoperative symptoms and was discharged three days after surgery. The MRI acquired 6 months postoperatively showed complete tumour removal, with no signs of instability. The MAS-TLIF retractor allows for an optimal paraspinal tissues retraction, improving the area of exposure and the manoeuverability angle. Moreover, the stability of the retraction is guaranteed by the positioning of the two transpedicular screws. Spinal fusion is not necessary because the posterior tension band is not jeopardised. CONCLUSIONS MAS-TLIF retractor allows for a minimally invasive and safe surgical removal of LSS maximising surgical exposure and avoiding spinal fusion.
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Affiliation(s)
- Francesco Calvanese
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Lin Z, Feng Z. Preoperative differentiation of mediastinum and retroperitoneum ganglioneuroma from schwannoma with clinical data and enhanced CT: developing a multivariable prediction model. Clin Radiol 2023; 78:e925-e933. [PMID: 37833142 DOI: 10.1016/j.crad.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 10/15/2023]
Abstract
AIM To develop a multivariable prediction model for preoperative differentiation of ganglioneuroma (GN) from schwannoma in mediastinum and retroperitoneum based on clinical data and enhanced computed tomography (CT). MATERIALS AND METHODS This was a retrospective diagnostic study. Patients diagnosed with mediastinum or retroperitoneal GN or schwannoma at Zhongshan Hospital between July 2006 and March 2022 were divided into a training cohort and a validation cohort at a ratio of 7:3. Clinical information and CT features were collected. Histopathology was the reference standard for diagnosis. The model was developed using binary logistic regression. The predictive performance of the model was assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS A total of 105 patients (47 men and 58 women; mean age of 41 ± 15 years) were enrolled. There were significant differences in symptoms (p=0.006), location (p=0.008), ratio of the craniocaudal diameter (CC) to the major axis on axial images (CC/M; p=0.025), ratio of the CC to the diameter on axial images (CC/D; p<0.001), density homogeneity (p=0.001), enhancement homogeneity (p<0.001), enhancement degree (p<0.001), venous phase CT attenuation value (V; p=0.011), and blood vessels changes (p=0.045) between GN and schwannoma. The area under the ROC curve (AUC) and accuracy in the validation cohort were 0.841 (95% confidence interval [CI] 0.672, 1.000) and 0.839 (95% CI: 0.674, 0.929), respectively. Calibration curves and DCA showed that the model was beneficial for patients. CONCLUSION The multivariable prediction model exhibited good predictive performance and may facilitate preoperative planning.
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Affiliation(s)
- Z Lin
- Department of Radiology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province 361004, China
| | - Z Feng
- Department of Radiology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province 361004, China.
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Cao X, Wan X, Dai N, Guo C. A rare case of gastric schwannoma resection complicating by multiorgan high-frequency electrical burns. Asian J Surg 2023; 46:5705-5706. [PMID: 37625966 DOI: 10.1016/j.asjsur.2023.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Affiliation(s)
- Xinguang Cao
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyu Wan
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nan Dai
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changqing Guo
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Stenman A, Falhammar H, Zedenius J, Juhlin CC. Adrenal and periadrenal schwannoma: histological, molecular and clinical characterization of an institutional case series. Endocrine 2023; 82:631-637. [PMID: 37535242 PMCID: PMC10618319 DOI: 10.1007/s12020-023-03463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Adrenal schwannoma (AS) and periadrenal schwannoma (PAS) are exceedingly rare Schwann cell tumors that develop from the adrenal medulla and periadrenal peripheral nerves respectively. The underlying genetic events are elusive. METHODS We searched our institutional database for AS/PAS cases and reviewed the histology and clinical outcome. Comprehensive molecular work-up was performed. RESULTS We found reports of 4 AS/PAS cases diagnosed between 1992 and 2022 among the 1248 adrenal lesions submitted for histopathology during the same time period (0.32%). Two patients were male, two were female, and the age span was 59-80 years. Median size was 70 mm (range 50-100 mm), and from a radiology perspective, the lesions were initially suspected of malignant lesions originating from either adrenals or kidneys. Hormonal analyses were normal in all cases. Histologically, three cases were annotated as cellular AS or PAS, and one case was annotated as microcystic AS. Molecular characterization using focused next-generation sequencing did not identify SMARCB1 or NF2 mutations, alterations previously associated to schwannoma at other anatomical sites. The postoperative period was without complications for all patients, and follow-up did not show any signs of relapse or metastatic disease. CONCLUSION AS/PAS are rare neoplasms that are most often benign, and the molecular etiology is most likely not related to mutations in established schwannoma-related genes. Since these tumors may be misinterpreted as malignant, knowledge of this entity is essential for radiologists, endocrinologists, surgeons and pathologists.
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Affiliation(s)
- Adam Stenman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Jan Zedenius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Solna, Stockholm, Sweden
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital Solna, Stockholm, Sweden.
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Ligresti D, Quintini D, Tarantino I, Bertani A, Jukna A, Rizzo GEM, Traina M. Contrast-enhanced endoscopic ultrasound and fine-needle biopsy of a rare mediastinal mass: a mediastinal schwannoma. Endoscopy 2023; 55:E1071-E1072. [PMID: 37734416 PMCID: PMC10513774 DOI: 10.1055/a-2163-1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS – ISMETT, Palermo, Italy
| | - Dario Quintini
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS – ISMETT, Palermo, Italy
- Department of Surgical Oncological and Gastroenterology Sciences, University of Padua, Padua, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS – ISMETT, Palermo, Italy
| | - Alessandro Bertani
- Unit of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS – ISMETT, Palermo, Italy
| | - Agita Jukna
- Pathology Unit, Department of Diagnostic and Therapeutic Services, IRCCS – ISMETT, Palermo, Italy
| | - Giacomo Emanuele Maria Rizzo
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS – ISMETT, Palermo, Italy
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Mario Traina
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS – ISMETT, Palermo, Italy
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Lv ML, Zhong JQ, Feng H. Schwannomatosis manifesting as multiple schwannomas in a single intercostal nerve. Asian J Surg 2023; 46:5928-5929. [PMID: 37690891 DOI: 10.1016/j.asjsur.2023.08.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Min-Li Lv
- Department of Radiology, Zigong First People's Hospital, 643000, Zigong, PR China.
| | - Jian-Quan Zhong
- Department of Radiology, Zigong First People's Hospital, 643000, Zigong, PR China
| | - Hao Feng
- Department of Radiology, Zigong First People's Hospital, 643000, Zigong, PR China
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Zhu P, Li XY. Rare Case of a Schwannoma of the Posterior Pharyngeal Wall in a Child. Ear Nose Throat J 2023; 102:759-761. [PMID: 34281403 DOI: 10.1177/01455613211031027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a rare case of a schwannoma which is localized on the posterior pharyngeal wall. It caused severe difficulty in swallowing and breathing in a 3-year-old child. Schwannomas of the posterior pharyngeal wall have been rarely reported in children. To our knowledge, only 7 cases of posterior pharyngeal wall schwannoma have been previously reported in the literature, but none of them is associated with a child. The tumor was removed with plasma radiofrequency excision via a transoral route. Computed tomography or magnetic resonance imaging examination showed no recurrence of the tumor up to 2 years. To our knowledge, for the first time, a case of posterior pharyngeal wall schwannoma has been reported in a 3-year-old child, and the schwannoma was removed via plasma radiofrequency transoral excision. This case study illustrates that schwannoma may occur in children, and it is safe to treat this disease through plasma radiofrequency transoral excision route.
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Affiliation(s)
- Peng Zhu
- Department of Otorhinolaryngology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao Yan Li
- Department of Otorhinolaryngology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Alexander AY, Plou P, Plitt AR, Driscoll CLW, Peris-Celda M. Resection of a Trigeminal Schwannoma Using a Retrosigmoid Approach With Suprameatal Extension: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e371. [PMID: 37966255 DOI: 10.1227/ons.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/12/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- A Yohan Alexander
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pedro Plou
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Aaron R Plitt
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin L W Driscoll
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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Roy S, Mehta A, Muraleedharan M, Virk RS. Sinonasal schwannoma masquerading as an IgG4-related nasal mass. BMJ Case Rep 2023; 16:e255135. [PMID: 37973538 PMCID: PMC10660653 DOI: 10.1136/bcr-2023-255135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
An elderly (8th decade) diabetic patient presented with insidious, painless protrusion of the right eye for 1 month, associated with nasal congestion. Past history included healed serous chorioretinopathy in the right eye (>30 years back) and recently diagnosed (1 year prior) autoimmune IgG4-related pancreatitis for which he was on long-term corticosteroids. On nasal endoscopic examination, a well circumscribed mass was found in the right nasal cavity.Keeping in mind the systemic diagnosis, the sinonasal mass was suspected to be a IgG4-related disease. An endoscopic biopsy was performed and revealed a surprise diagnosis of grade 1 nasal schwannoma.
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Affiliation(s)
- Shrimoyee Roy
- Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Mehta
- Grewal Eye Institute, Chandigarh, Chandigarh, India
| | - Manjul Muraleedharan
- Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh Virk
- Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Luzzi S, Giotta Lucifero A, Baldoncini M, Nuñez M, Villalonga JF, Galzio R, Campero A. Comparative Analysis of Surgical Working Corridors for Meckel Cave Trigeminal Schwannomas: A Quantitative Anatomic Study. Oper Neurosurg (Hagerstown) 2023; 25:e251-e266. [PMID: 37589470 DOI: 10.1227/ons.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Volumetric analysis of the working corridors of the interdural approach to the Meckel cave may lead to a selection of routes which are anatomically more advantageous for trigeminal schwannoma resection. The herein-reported anatomic study quantitively compares the infratrochlear (IT) transcavernous, anteromedial (AM), and anterolateral (AL) corridors, highlighting their feasibility, indications, advantages, and limitations. METHODS Anatomic boundaries and depth of Meckel cave, porus trigeminus, IT transcavernous, AM, and AL corridors were identified in 20 formalin-fixed latex-injected cadaveric heads and were subsequently measured. The corridor areas and volumes were derived accordingly. Each opening angle was also calculated. Angles and volumes were compared using analysis of variance. Statistical significance was set at a P -value <.05. RESULTS The IT transcavernous corridor volume was greater than that of the AM and AL. The opening angle of the AM middle fossa triangle was wider than the other 2. CONCLUSION The IT corridor can be advantageous for Meckel cave schwannomas invading the cavernous sinus and those with a notable extension into the posterior fossa because the transcavernous approach maximizes the working space into the retrosellar area. The AM middle fossa corridor is strategic in schwannomas confined to the Meckel cave with a minor extension into the posterior fossa. It raises the chance of total resection with a single approach involving the porus trigeminus opening.
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Affiliation(s)
- Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matías Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Nuñez
- Department of Neurosurgery, Hospital El Cruce, Buenos Aires, Argentina
| | - Juan F Villalonga
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
- Hospital Padilla, Department of Neurological Surgery, Tucumán, Argentina
| | - Renato Galzio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alvaro Campero
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
- Hospital Padilla, Department of Neurological Surgery, Tucumán, Argentina
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Landriel F, Padilla Lichtenberg F, Ulloque-Caamaño L, Guerra E, Casto F, Hem S. Carbon-Assisted Minimally Invasive Transtubular Approach for Intercostal Nerve Schwannoma. Oper Neurosurg (Hagerstown) 2023; 25:449-452. [PMID: 37668999 DOI: 10.1227/ons.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/07/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The intraoperative localization of an intercostal nerve schwannoma (INS) is extremely difficult because the lesion is generally not palpable, and the fluoroscopic visualization of anatomic landmarks in the ribs is unsatisfactory. Using activated carbon suspension to mark the soft-tissue approach could improve INS localization. We present a novel, simple, reproducible carbon-assisted minimally invasive transtubular approach for an INS. METHODS The patient was a 57-year-old man with a painful 12th left INS arising below the floating rib. A computed tomography image-guided, tumor-to-skin marking with aqueous carbon suspension was performed 48 hours before surgery. A minimally invasive transtubular approach following the carbon path allowed a precise tumor location. RESULTS The INS was completely removed. The patient's thoracic radicular pain was immediately relieved after surgery. He was discharged the following day with residual numbness on the left thoracic side. At the 5-year follow-up, no tumor recurrence was noted in the control MRI. CONCLUSION This article presents an alternative novel technique for resecting an intercostal schwannoma. Using a transtubular approach with carbon-marking assistance allowed a tumor gross total resection with immediate pain relief and a successful outcome.
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Affiliation(s)
- Federico Landriel
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
| | | | | | - Emily Guerra
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
| | - Florencia Casto
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
| | - Santiago Hem
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jiang M, Chai Y, Xue L, Wang Y, Xia W, Song Y, Yang G, Yuan Y, Tao X, Wu Y, Wu H, Wang Z. Differentiation of geniculate ganglion venous malformation from schwannoma: dynamic T1-weighted imaging provides unique diagnostic value. Eur Radiol 2023; 33:7934-7941. [PMID: 37284867 DOI: 10.1007/s00330-023-09806-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/03/2023] [Accepted: 03/26/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To distinguish geniculate ganglion venous malformation (GGVM) from schwannoma (GGS) by using high-resolution CT (HRCT), routine MRI, and dynamic T1-weighted imaging (T1WI) characteristics. METHODS Surgically confirmed GGVMs and GGSs between 2016 and 2021 were retrospectively included. Preoperative HRCT, routine MR, and dynamic T1WI were performed on all patients. Clinical data, imaging characteristics including lesion size, involvement of facial nerve (FN), signal intensity, enhancement pattern on dynamic T1WI, and bone destruction on HRCT were evaluated. Logistic regression model was developed to identify independent factors for GGVMs, and the diagnostic performance was accessed by receiving operative curve (ROC) analysis. Histological characteristics were explored for both GGVMs and GGSs. RESULTS Twenty GGVMs and 23 GGSs with mean age of 31 were included. On dynamic T1WI, 18 GGVMs (18/20) showed "pattern A" enhancement (a progressive filling enhancement), while all 23 GGSs showed "pattern B" enhancement (a gradual whole-lesion enhancement) (p < 0.001). Thirteen GGVMs (13/20) showed the "honeycomb" sign whereas all GGS (23/23) showed extensive bone changes on HRCT (p < 0.001). Lesion size, involvement of FN segment, signal intensity on non-contrast T1WI and T2-weighted imaging (T2WI), and homogeneity on enhanced T1WI were obviously differed between two lesions (p < 0.001, p = 0.002, p < 0.001, p = 0.01, p = 0.02, respectively). Regression model showed the "honeycomb" sign and "pattern A" enhancement were independent risk factors. Histologically, GGVM was characterized by interwoven dilated and tortuous veins, while GGS was characterized by abundant spindle cells with dense arterioles or capillaries. CONCLUSIONS The "honeycomb" sign on HRCT and "pattern A" enhancement on dynamic T1WI are the most promising imaging characteristics for differentiating GGVM from GGS. CLINICAL RELEVANCE STATEMENT The characteristic sign and enhancement pattern on HRCT and dynamic T1-weighted imaging allow preoperative differentiation of geniculate ganglion venous malformation and schwannoma feasible, which will improve clinical management and benefit patient prognosis. KEY POINTS • The "honeycomb" sign on HRCT is a reliable finding to differentiate GGVM from GGS. • GGVM typically shows "pattern A" enhancement (focal enhancement of the tumor on early dynamic T1WI, followed by progressive contrast filling of the tumor in the delayed phase), while "pattern B" enhancement (gradual heterogeneous or homogeneous enhancement of the whole lesion) is observed in GGS on dynamic T1WI.
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Affiliation(s)
- Mengda Jiang
- Department of Radiology, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongchuan Chai
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Xue
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaoxuan Wang
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenwen Xia
- Department of Pathology, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Song
- Department of MR Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Gongxin Yang
- Department of Radiology, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Yuan
- Department of Radiology, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingwei Wu
- Department of Radiology, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hao Wu
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhaoyan Wang
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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