Ultrasonographic manifestations of traumatic neuromas after neck dissection in papillary thyroid carcinoma / 中国医学影像技术

Objective To investigate the ultrasonographic manifestations of traumatic neuroma after neck dissection in papillary thyroid carcinoma (PTC).Methods A retrospective analysis was performed in 21 patients with 26 lesions who underwent neck dissection.The ultrasonographic characteristics were reviewed,including numbers,location,size,shape,margin,echogenicity,with or without direct continuity to the nerve fiber,the presence of internal hyperechogenicity and blood supply.Results Among the 26 lesions of 21 patients,25 lesions were in the lateral cervical area while the other one was in the central cervical area.The mean shortest diameter of the lesions was (3.5±1.0)mm and that of longest diameter was (9.1±2.9)mm.Totally 13 lesions were oval in shape and the other 13 were round.The clear margin was found in 13 lesions and fuzzy margin was observed in another 13 lesions.All the lesions were heterogeneously hypoechoic.The presence of internal hyperechoic areas were found in 16 lesions.The direct continuity with the nerve fiber was found in 20 lesions,while the other 6 lesions were not continued to the nerve directly.Color Doppler flow imaging showed that 20 of the 26 lesions existed a little blood flow signal and the other 6 lesions showed no flow signal.During the ultrasound-guided fine-needle aspiration biopsy (US-FNAB),21 patients complained about the intolerable serious pain and the pain relieved when the needle removed.Conclusion Traumatic neuromas are hypoecho lesions located in the operation area after neck dissection in PTC with distinctive ultrasonographic features,especially the direct continuity with the nerve fiber,as well as the clinical histories and sharp pain during US-FNAB,which can help to diagnose.

Scar neuromas as triggers for headache after craniotomy: clinical evidence / Neuromas de cicatriz como gatilhos para cefaleia pós-craniotomia: evidência clínica

We present four cases of headache with variable intensity, located in close proximity to a craniotomy incision which was performed for non-traumatic reasons. Since manual palpation of the scar often triggers pain, and infiltration with local anesthetics reduce or abolish the pain in some patients, we suggest that neuromas or nerve entrapment in the scars, as a result of the surgery, are responsible for headaches. Although local infiltrations or nerve blocks are often used for diagnostic reasons, herein we consider that they are also of therapeutic value. We review the current known pathophysiology of post-craniotomy headaches and present a hypothesis suggesting a greater recognition of the potential contribution of neuroma formation in areas of scars tissue to contribute to this kind of headache.

Apresentamos quatro casos de cefaleia de variada intensidade, localizada junto à incisão de craniotomia, realizada por causas não traumáticas. Como a palpação manual da cicatriz desencadeava a dor e a infiltração local com anestésicos a reduzia ou abolia, apresentamos uma hipótese sugerindo a formação de neuromas de cicatriz na etiologia da dor. Sugerimos bloqueios anestésicos como ferramenta diagnóstica e terapêutica. Revisamos a fisiopatologia da cefaleia pós-craniotomia e apresentamos uma hipótese sugerindo a potencial contribuição da formação de neuromas de cicatriz na etiologia deste tipo de dor.

Cirurgia da base do crânio: uma desafiadora especialidade da medicina moderna / Skull base surgery: a challenging speciality of modern medicine

A cirurgia da base do crânio emerge como uma especialidade da medicina moderna. Seu principal objetivo é tratar lesões, principalmente tumores, situados em complexa topografia anatômica e que, há duas décadas, eram considerados inoperáveis. O objetivo desta revisão é fornecer ao médicos generalistas uma visão dos aspectos conceituais, históricos, patológicos, epidemiológicos, clínicos e terapêuticos em cirurgia da base do crânio.

Skull base surgery has emerged as a specialty in modern medicine. Its main objective is to treat injuries, especially tumors located in anatomically complex sites that two decades ago were considered inoperable. The aim of this review is to provide general practitioners with a view of conceptual, historical, pathological, epidemiological, clinical and therapeutic aspects of skull base surgery.

Cefaleia pós-traumática crônica: relato de caso / Post-traumatic chronic headache: case report

JUSTIFICATIVA E OBJETIVOS: De acordo com a Classificação Internacional das Cefaleias, a cefaleia pós-traumática é caracterizada por dor de intensidade variável, máxima na área do trauma, que se inicia em até sete dias após a lesão. O objetivo deste estudo foi relatar o caso de cefaleia pós-traumática crônica, secundária à lesão por arma de fogo. A dor era desencadeada pela palpação de pontos de gatilho em cicatriz.RELATO DO CASO: Paciente do sexo masculino, 31anos, sofreu lesão por arma de fogo na região cervical esquerda,desenvolvendo cefaleia refratária, com área máxima em região de cicatriz. Observou-se ponto de gatilho nessa região. Foi proposto tratamento com bloqueio periférico com excelente resposta.CONCLUSÃO: Sugere-se que a formação de neuromas em áreas de cicatriz possa estar envolvida com a fisiopatologia da cefaleia pós-traumática.

BACKGROUND AND OBJECTIVES: According to the International Classification of Headache Disorders,post-traumatic headache is characterized by pain of variable intensity, maximum in the trauma area, which starts up to seven days after the injury. This study aimed at reporting a case of post-traumatic chronic headache, secondary to firearm injury. Pain was triggered by palpation of triggering points at the scar.CASE REPORT: Male patient, 31 years old, suffered afirearm injury at the left cervical region, developing refractory headache with maximum area at the scar region.Triggering points at the scar region were observed. A treatment with peripheral block was proposed with excellent response.CONCLUSION: It is suggested that the formation of neuromas in scar areas may be involved with the pathophysiology of post-traumatic headache.

Avaliação macroscópica, microscópica e histomorfométrica do tecido cicatricial pós-cirúrgico de eqüinos submetidos a duas técnicas de neurectomia digital / Macroscopic, microscopic, and histomorphometric evaluation of post-operative scar tissue in horses submitted to two techniques for digital neurectomy

Avaliou-se macro e microscopicamente o tecido cicatricial pós-operatório de eqüinos submetidos a duas técnicas de neurectomia digital: guilhotina (TG) e stripping (TS). Decorridos 14 meses das cirurgias, foram colhidas 32 amostras de tecido cicatricial em quatro éguas, que tiveram os membros submetidos a ambas as técnicas. À macroscopia, verificaram-se as dimensões da cicatriz do coto proximal e a distância entre os cotos proximal e distal. À microscopia, foi quantificada a proporção de tecido nervoso regenerado por meio de histomorfometria. Não houve diferença nas dimensões do tecido cicatricial, contudo a distância entre cotos foi 5,6 vezes maior na TS (P<0,001). Histologicamente, observou-se a presença de tecido conjuntivo frouxo e denso, macrófagos e fibras nervosas delgadas em ambas as técnicas cirúrgicas. Estruturas nodulares, compostas por fascículos nervosos, foram visualizadas em 56,2 por cento (9/16) das amostras colhidas em nervos submetidos à TS. As porcentagens médias de tecido nervoso no tecido cicatricial foram de 0,31 por cento na TG e 2,6 por cento na TS (P<0,001). Concluiu-se que o retorno à sensibilidade nervosa deve demorar mais a ocorrer após a TS, devido à maior distância entre cotos. A maior proporção de tecido nervoso sugere que essa técnica favorece a regeneração nervosa.

The post-operative healed tissues in horses submitted to two digital neurectomy techniques, the guilhotine (GT) and the stripping (ST), were evaluated by macroscopy and microscopy. Fourteen months after surgery, 32 samples of scar tissue were collected from four mares that had the members experimentally submitted to both surgical techniques. By macroscopy, the dimensions of the scar tissue of the proximal stump and the distance between nerve stumps were taken. By microscopy, the proportion of nervous tissues in the scar tissue was quantified by histomorphometry. There were no differences between the scar tissue dimensions, but the distance between stumps was 5.6-fold greater in ST subjects. Histologically, connective tissue, macrophages, and thin nervous fibers were observed in scar tissue present in animals of both groups. Nodular structures composed by nervous fascicules were visualized in 56.2 percent (9/16) of the samples collected from the ST group. The mean percentage of the nervous tissue in scar tissue was 0.31 percent in GT samples and 2.6 percent in ST samples (P<0.001). After ST, a longer time to the return of the sensibility may occur due to the greater distance between stumps. However, greater proportion of nervous tissue in the scar tissue suggests that the use of this technique favors nervous regeneration.

Schwannoma vestibular: involução tumoral espontânea / Vestibular Schwannoma: spontaneous tumor involution

A história natural dos schwannomas vestibulares ainda não está totalmente elucidada, mas sua maioria tende a apresentar crescimento lento, muitos permanecendo sem sintomas durante toda a vida do paciente. Cerca de 69 por cento deste tipo de tumor diagnosticados não apresentam crescimento e, destes, 16 por cento chegam a apresentar regressão tumoral. Considerando os tumores que apresentam crescimento, cerca de 70 por cento crescem menos de 2 mm ao ano. O avanço nos métodos de diagnóstico por imagem, particularmente à ressonância magnética com contraste de gadolínio, permite o diagnóstico cada vez mais de lesões com sintomas mínimos e tamanhos menores. O tratamento de escolha para estes tumores ainda é a ressecção completa do tumor. As técnicas cirúrgicas apresentaram grande avanço nas últimas décadas, o que possibilitou diminuição da mortalidade. Assim, a cirurgia, que antes tinha como objetivo apenas a ressecção completa do tumor, agora visa também à preservação da audição e da função do nervo facial. Considerações finais: Considerando-se sua história natural, abre-se a possibilidade de uma conduta conservadora já que o ritmo de crescimento no primeiro ano após o diagnóstico prediz o comportamento do tumor nos próximos anos. A conduta conservadora não implica em repúdio à cirurgia, devendo ser utilizada em casos de aumento tumoral, piora dos sintomas ou desejo do paciente. Além disso, em relatos de literatura não há diferença estatisticamente significante entre os pacientes submetidos à cirurgia logo após o diagnóstico ou após conduta conservadora inicial, no que diz respeito às seqüelas pós-operatórias.

The natural history of Vestibular Schwannomas (VS) is yet not totally known, but most of them have the tendency to slow growth, sometimes without any kind of symptoms during the individual’s entire time. About 69 percent of diagnosed VS do not grow at all and 16 percent of these can even regress. Considering tumors that grow, about 70 percent have grown less than 2mm an year. Advanced radiological diagnosis, especially magnetic resonance imaging with gadolinium helps us diagnose small and less symptomatic tumors. Treatment of choice still is complete tumor resection. Surgical approaches have improved considerably and have helped preserve facial nerve function and hearing. Considering VS’s natural history, there is a possibility for conservative treatment for these tumors, because their growth in the first year after diagnosis predicts tumor growth behavior in the next years. Surgery should be done in cases of tumor growth, patient’s desire or symptoms worsening. Moreover, in terms of postoperative sequelae, there is no difference between patients who underwent surgery immediately after diagnosis and those who underwent initial conservative treatment for these tumors.

Schwannomatosis Involving Peripheral Nerves: A Case Report

Schwannomatosis or neurilemmomatosis has been used to describe patients with multiple nonvestibular schwannomas with no other stigmata of neurofibromatosis type-2 (NF-2). In our case, schwannomatosis, multiple schwannomas were present in a 21-yr-old woman with no stigmata or family history of NF-1 or NF-2. She had no evidence of vestibular schwannoma or other intracranial tumors. Multiple peripheral tumors were found in the carotid space of the neck, and soft tissue of posterior shoulder, lower back, ankle and middle mediastinum. All of those tumors were completely limited to the right side of the body. All surgically removed tumor specimens in this patient proved to be schwannomas.

Treatment of Painful Amputation Neuromas / 대한정형외과학회잡지

During ten years from Mar. 1973 to Feb. 1982, 2410 amputations of limbs have been experienced in Korea Veterans Hospital. 240 painful neuromas, which developed in 203 amputated limbs of 191 patients were treated with four different methods 1) Stretching and simple transection, 2) Transection and ligation, 3) Ligation and absolute alcohol injection and 4) Implantation into bone. After following up for average 5 years and 7 months, the following results were obtained. 1. The painful neuroma occured in 191 (7.9%) out of 2410 amputees. 2. The painful neuroma developed averege 2 years and 9 months after the first amputation. 3. After transection and ligation of the nerves, the painful neuroma recurred in 19.2% of the cases. The average interval taken to recur was 2 years and 6 months. 5. After ligation and absolute alcohol injection into the nerves, the painful neuroma recurred in 14.8% of the cases. The average interval taken to recur was 2 years and 6 months. 6. After implantation of the nerve into the bone, the painful neuroma recurred in 5.7% of the cases. The average interval taken to recur was 2 years and 2 months. 7. The best results were obtained after implantation of the nerves into the bone.

CLINICAL APPLICATION OF MEATOCISTERNOGRAPHY——ANALYSIS OF 25 CASES / 西安交通大学学报(医学版)

This paper reports 25 cases of meatoci-sternography, six cases of acoustic neuromas were diagnosed by it. Among them. 4 cases were of small type and 2 cases, medium Meatocisterncgraphy was compared with CT/ air cisterhography in 8 cases. Our prelimi nary experience shows that meatocisternography is a safe, objective method, with a high distiguishable rate; The diagnosis is trutworthy. The makes small acoustic neuromas and microstructure clearer than CT/ air cisternography in the internal auditory canal. This examination is a very accurate and useful method for detecting small acoustic neuromas and offers more information for other diseases in the internal auditory canal.