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1.
BMJ Case Rep ; 12(5)2019 May 13.
Article in English | MEDLINE | ID: mdl-31088815

ABSTRACT

Schwannomas are benign tumours arising from Schwann cells in the peripheral nerve. The schwannoma of the accessory nerve is a very rare entity. We report a case of Schwannoma of the extracranial accessory nerve. A 22-year-old man presented with a slow-growing mass, located on the right upper neck. The patient did not have any neurological deficit. CT scan showed a hypodense mass behind sternocleidomastoid muscle. The suspected diagnosis was an adenopathy of the accessory spinal chain. Surgery was done via transcervical approach. The histopathological analysis concluded with a diagnosis of schwannoma. No recurrence was noted at the follow-up examination 29 months after surgery.


Subject(s)
Accessory Nerve Diseases/pathology , Cranial Nerve Neoplasms/pathology , Neurilemmoma/pathology , Accessory Nerve Diseases/diagnostic imaging , Accessory Nerve Diseases/surgery , Cranial Nerve Neoplasms/diagnostic imaging , Diagnosis, Differential , Humans , Lymphadenopathy/diagnosis , Male , Neck/pathology , Neurilemmoma/diagnostic imaging , Neurilemmoma/surgery , Young Adult
2.
World Neurosurg ; 128: 158-161, 2019 Aug.
Article in English | MEDLINE | ID: mdl-31082561

ABSTRACT

BACKGROUND: Meningiomas that arise from the cranial nerve are rare. We present a case with an intradural extramedullary tumor at the foramen magnum originating from the spinal accessory nerve. CASE DESCRIPTION: The patient was a 69-year-old woman with dizziness and pain in the bilateral shoulder for 2 years. Neurologic examination revealed spinal accessory nerve palsy (difficult in raising the shoulder, deficit of 3/5) on the left side without further deficits. Magnetic resonance imaging showed medullar compression because of a left intradural extramedullary foramen magnum lesion dorsolateral to the medulla. Surgical exposure via a midline suboccipital approach with C1 laminectomy revealed that the lesion arises from the left accessory nerve without dural attachment. The tumor was resected without injury to the spinal accessory nerve, and histologic examination revealed that it was a meningothelial meningioma. The spinal accessory nerve palsy improved to 4 of 5 after 3 months after surgery. CONCLUSIONS: To our knowledge, this is the first report of an accessory nerve meningioma at the foramen magnum in which the spinal accessory nerve palsy appeared before operation and improved after tumor resection.


Subject(s)
Accessory Nerve Diseases/diagnostic imaging , Meningeal Neoplasms/diagnostic imaging , Meningioma/diagnostic imaging , Accessory Nerve Diseases/physiopathology , Accessory Nerve Diseases/surgery , Aged , Female , Humans , Magnetic Resonance Imaging , Meningeal Neoplasms/physiopathology , Meningeal Neoplasms/surgery , Meningioma/physiopathology , Meningioma/surgery
3.
JBJS Case Connect ; 7(2): e23, 2017.
Article in English | MEDLINE | ID: mdl-29244663

ABSTRACT

CASE: A 37-year-old man with scapular winging, caused by combined palsy of the spinal accessory nerve and the long thoracic nerve, was successfully treated with a pectoralis major transfer to substitute for the serratus anterior muscle, and with levator scapulae and rhomboid muscle transfers to substitute for the trapezius muscle. CONCLUSION: The serratus anterior paralysis was thought to have occurred secondary to traction of the long thoracic nerve by the unsupported scapula following the spinal accessory nerve palsy. Even with combined paralyses of the serratus anterior and trapezius muscles, combined muscle transfers that substitute for the paralyzed muscles can improve shoulder function.


Subject(s)
Accessory Nerve Diseases/surgery , Pectoralis Muscles/transplantation , Peripheral Nervous System Diseases/surgery , Scapula/physiopathology , Superficial Back Muscles/transplantation , Accessory Nerve Diseases/physiopathology , Adult , Humans , Male , Peripheral Nervous System Diseases/physiopathology , Thoracic Nerves/injuries
4.
Neurochirurgie ; 58(4): 258-62, 2012 Aug.
Article in French | MEDLINE | ID: mdl-22622236

ABSTRACT

BACKGROUND: The accessory nerve schwannoma localized in spinal canal is extremely rare; only nine cases have been reported in the literature until now. We report a new case of schwannoma at the spinal root of accessory nerve. OBSERVATION: A young woman aged 30 had a high cervical spinal cord compression with respiratory problems. At admission, magnetic resonance imaging (MRI) showed a tumor compressing the spinal cord at C2 to the foramen magnum. The tumor was removed successfully and its origin from the left accessory nerve was confirmed peroperatively. CONCLUSION: Although schwannoma of the accessory nerve is exceptional, this entity should be considered as a differential diagnosis with the other tumors of the foramen magnum.


Subject(s)
Accessory Nerve Diseases/pathology , Cranial Nerve Neoplasms/pathology , Neurilemmoma/pathology , Spinal Neoplasms/pathology , Spinal Nerve Roots/pathology , Accessory Nerve Diseases/surgery , Adult , Cranial Nerve Neoplasms/surgery , Female , Foramen Magnum/surgery , Humans , Magnetic Resonance Imaging , Neurilemmoma/surgery , Neurologic Examination , Neurosurgical Procedures , Spinal Neoplasms/surgery , Spinal Nerve Roots/surgery
5.
Neurosurgery ; 68(2): 390-5; discussion 396, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21135731

ABSTRACT

BACKGROUND: Stretch-induced spinal accessory nerve palsy has been considered extremely rare, with only a few cases reported. OBJECTIVE: In 357 patients with stretch lesions of the brachial plexus, we investigated the prevalence, course, and surgical treatment of accessory nerve palsy. METHODS: Accessory nerve palsy was ascertained when the patient was unable to shrug the ipsilateral shoulder. Patients underwent brachial plexus reconstruction between 6 and 8 months after trauma. To confirm paralysis, during surgery, the accessory nerve was stimulated electrically. RESULTS: Accessory nerve palsy occurred in 19 of the 327 patients (6%) with upper type or complete palsy of the brachial plexus. Proximal injuries of the accessory nerve accompanied by voice alteration and complete palsy of the sternocleidomastoid and trapezius muscle occurred in 2 patients. Proximal palsy without vocal alterations was observed in 6 patients. Palsy of the trapezius muscle with preservation of the sternocleidomastoid muscle occurred in 11 patients. All 7 patients who demonstrated muscle contractions upon electrical stimulation of the accessory nerve during surgery recovered completely. Patients with surgical reconstruction of the accessory nerve through grafting (n = 2) or repair by platysma motor nerve transfer (n = 2) recovered active shoulder shrugging within 36 months of surgery. Seven of the 8 patients without accessory nerve reconstruction recovered from their drop shoulder and head tilt, but remained unable to shrug. CONCLUSION: If intraoperative electrical stimulation produces contraction of the upper trapezius muscle, no repair is needed. In proximal injuries, the platysma motor branch should be transferred to the accessory nerve; whereas in paralysis distal to the sternocleidomastoid muscle, the accessory nerve should be explored and grafted.


Subject(s)
Accessory Nerve Diseases/epidemiology , Accessory Nerve Diseases/etiology , Accessory Nerve Injuries , Brachial Plexus Neuropathies/complications , Brachial Plexus/injuries , Accessory Nerve/surgery , Accessory Nerve Diseases/surgery , Adult , Brachial Plexus/surgery , Brachial Plexus Neuropathies/surgery , Humans , Paralysis/etiology , Prevalence , Retrospective Studies
6.
Pract Neurol ; 10(4): 191-4, 2010 Aug.
Article in English | MEDLINE | ID: mdl-20647524

ABSTRACT

Accessory nerve palsies may cause considerable functional disability and they unfortunately continue to occur as a complication of surgery in and, around the posterior triangle of the neck. Here the causes of accessory nerve palsies are reviewed and the symptoms and signs arising as a consequence are summarised. In addition, the various treatments and their indications are highlighted and discussed.


Subject(s)
Accessory Nerve Diseases/diagnosis , Accessory Nerve Diseases/etiology , Muscle, Skeletal/innervation , Paralysis/etiology , Paralysis/physiopathology , Shoulder/innervation , Accessory Nerve Diseases/surgery , Diagnosis, Differential , Humans , Middle Aged , Muscle, Skeletal/physiopathology , Paralysis/diagnosis , Shoulder/physiopathology
7.
J Clin Neurosci ; 17(2): 248-50, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19836245

ABSTRACT

We present the first reported case of a spinal accessory nerve cavernous malformation. A 54-year-old Caucasian male presented with a several-year history of progressive, vague bilateral upper and lower extremity paresthesias and pain. MRI of the spine revealed a heterogenously enhancing mass in the dorsal aspect of the spinal canal at the level of the atlas with mild spinal cord compression. The lesion was resected and upon gross and histologic examination it was a cavernous malformation embedded within a branch of the spinal accessory nerve. Post-operatively, the patient had no complications and some improvement in his symptoms. To our knowledge, this is the first report of a patient with a spinal accessory nerve cavernous malformation, and this should be considered in the differential of lesions in the craniocervical region.


Subject(s)
Accessory Nerve Diseases/pathology , Cranial Nerve Neoplasms/pathology , Hemangioma, Cavernous, Central Nervous System/pathology , Spinal Cord Compression/pathology , Accessory Nerve/blood supply , Accessory Nerve/pathology , Accessory Nerve/surgery , Accessory Nerve Diseases/complications , Accessory Nerve Diseases/surgery , Cranial Nerve Neoplasms/complications , Cranial Nerve Neoplasms/surgery , Decompression, Surgical , Diagnosis, Differential , Hemangioma, Cavernous, Central Nervous System/complications , Hemangioma, Cavernous, Central Nervous System/surgery , Humans , Laminectomy , Magnetic Resonance Imaging , Male , Middle Aged , Neurosurgical Procedures , Paresthesia/etiology , Paresthesia/physiopathology , Spinal Canal/blood supply , Spinal Canal/pathology , Spinal Canal/surgery , Spinal Cord/pathology , Spinal Cord/physiopathology , Spinal Cord/surgery , Spinal Cord Compression/etiology , Spinal Cord Compression/physiopathology , Staining and Labeling , Subarachnoid Space/blood supply , Subarachnoid Space/pathology , Subarachnoid Space/surgery , Treatment Outcome
8.
Acta Neurochir (Wien) ; 151(10): 1251-7, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19669691

ABSTRACT

PURPOSE: To describe the early effectiveness of microvascular decompression (MVD) for the treatment of spasmodic torticollis (ST). METHODS: Twelve patients with spasmodic torticollis were treated by microvascular decompression of the accessory nerves using a microscopic neurosurgical technique via the retrosigmoid approach. The most common compressing blood vessels were the ipsilateral posterior inferior cerebral artery (PICA) and/or the vertebral artery. The intraoperative monitor was introduced to detect the accessory nerve and to avoid unnecessary damage to the nerve. RESULTS: Ten patients were cured (83%), and the other two (17%) improved with moderate spasms. In most cases, the improvement was noticed 1 week after the operation. No operation-related complications were observed during the follow-up period, which ranged from 2 months to 3 years. CONCLUSIONS: The early effect of MVD for some patients with spasmodic torticollis was satisfactory, but the long-term results need to be assessed further.


Subject(s)
Accessory Nerve Diseases/physiopathology , Accessory Nerve Diseases/surgery , Decompression, Surgical/methods , Torticollis/physiopathology , Torticollis/surgery , Vascular Surgical Procedures/methods , Accessory Nerve/pathology , Accessory Nerve/physiopathology , Accessory Nerve/surgery , Accessory Nerve Diseases/etiology , Adolescent , Adult , Cranial Fossa, Posterior/anatomy & histology , Cranial Fossa, Posterior/surgery , Decompression, Surgical/mortality , Decompression, Surgical/statistics & numerical data , Female , Humans , Male , Mastoid/anatomy & histology , Mastoid/surgery , Medulla Oblongata/blood supply , Medulla Oblongata/physiopathology , Medulla Oblongata/surgery , Microsurgery/methods , Microsurgery/mortality , Microsurgery/statistics & numerical data , Middle Aged , Neck Muscles/innervation , Neck Muscles/physiopathology , Postoperative Complications/epidemiology , Torticollis/etiology , Treatment Outcome , Vascular Surgical Procedures/mortality , Vascular Surgical Procedures/statistics & numerical data , Vertebral Artery/pathology , Vertebral Artery/physiopathology , Vertebral Artery/surgery , Young Adult
9.
Neurosurg Rev ; 32(2): 151-9; discussion 159, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19189142

ABSTRACT

Schwannomas of the lower cranial nerves are very rare and the dumbbell-shaped ones are even rarer. The authors report their experience in managing such lesions, usually presenting either with intra- and/or extra-cranial extension through an enlarged jugular foramen. The juxtacondylar approach without sacrificing the labyrinth was used; clinical, radiological and complication features are discussed and analysed. This is a case series study on 16 consecutive patients with lower cranial nerves schwannomas surgically managed during a 14-year period using the juxtacondylar approach. In 13 cases, a complete resection has been achieved whereas in three, the excision was near total. The tumour nerve origin has been identified only in ten cases (62.5%). No death or additional post-operative cranial nerve deficits occurred. Aspiration pneumonia developed in one patient and cerebrospinal fluid leak in another. Pre-operative lower cranial nerve deficits improved in all patients. At a mean follow-up of 6.6 years (range 2-14 years), no radiological tumour recurrence was recorded amongst the patients having complete resection as well as no tumour progression in the group of near total removal. Jugular foramen schwannomas can be radically and safely resected with no additional neurological deficit if a careful pre-operative evaluation and the appropriate surgical approach is implemented. Finally, full cranial nerve functional recovery may be expected after complete resection.


Subject(s)
Accessory Nerve Diseases/diagnosis , Accessory Nerve Diseases/surgery , Cranial Nerve Neoplasms/diagnosis , Cranial Nerve Neoplasms/surgery , Neurilemmoma/diagnosis , Neurilemmoma/surgery , Neurosurgical Procedures/methods , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurosurgical Procedures/adverse effects , Postoperative Complications , Skull Base/surgery , Tomography, X-Ray Computed , Treatment Outcome , Young Adult
10.
Otolaryngol Head Neck Surg ; 139(6): 854-6, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19041516

ABSTRACT

The standard repair of a nerve gap under tension is to use a sensory autograft, such as the medial antebrachial cutaneous or the sural nerve. The practice of using sensory grafts to repair motor nerve defects is challenged by the discovery of preferential motor reinnervation and modality specific nerve regeneration. In this article, two clinical cases are presented where accessory nerve injuries are repaired with either a motor nerve transfer (a branch of C7) or a motor autograft (obturator nerve), and excellent functional results are reported. These cases provide a stimulus to consider the use of motor nerve grafts or transfers in the repair of motor nerve deficits.


Subject(s)
Accessory Nerve Diseases/surgery , Brachial Plexus Neuropathies/surgery , Nerve Transfer/methods , Shoulder/innervation , Accessory Nerve Diseases/complications , Accessory Nerve Diseases/physiopathology , Adult , Brachial Plexus Neuropathies/complications , Brachial Plexus Neuropathies/physiopathology , Humans , Iatrogenic Disease , Male , Middle Aged , Muscle, Skeletal/innervation , Muscular Atrophy/etiology , Muscular Atrophy/physiopathology
11.
Acta Orthop Traumatol Turc ; 41(2): 159-62, 2007.
Article in Turkish | MEDLINE | ID: mdl-17483655

ABSTRACT

Trapezius muscle paralysis results from injury to the spinal accessory nerve. Impairment in the trapezius muscle function may destabilize the muscle resulting in winged scapula. A 25-year-old university student who was active in sports had complaints of shoulder drop and pain on abduction. He had a three-year history of fall resulting in a scapular fracture for which he received conservative treatment. Physical examination showed asymmetry and drop of the right shoulder. Lateral scapular winging was apparent particularly above 90 degrees of abduction. Electromyography revealed isolated paralysis of the trapezius muscle. The patient underwent reconstruction with the modified Eden-Lange procedure. After a two-year follow-up, asymmetry in the shoulder decreased, there was no pain on active abduction, and the patient returned to active sports and was fully satisfied with the outcome.


Subject(s)
Accessory Nerve Diseases/diagnosis , Accessory Nerve Injuries , Paralysis/diagnosis , Accessory Nerve Diseases/surgery , Adult , Diagnosis, Differential , Humans , Male , Neck Muscles , Orthopedic Procedures , Paralysis/surgery
12.
Folia Neuropathol ; 45(1): 23-5, 2007.
Article in English | MEDLINE | ID: mdl-17357007

ABSTRACT

Accessory nerve meningiomas are exceedingly rare. We present a case of a nine-year-old patient with neurofibromatosis type 2 who had radiologic evidence of spinal cord compression from an upper cervical/foramen magnum lesion. He was asymptomatic from this lesion, but it progressed in size. The tumor was resected and histologic investigation revealed frequent tight whorls and psammoma bodies consistent with meningioma. To the authors' knowledge, this is the first reported spinal accessory nerve meningioma in a pediatric patient.


Subject(s)
Accessory Nerve Diseases/pathology , Cranial Nerve Neoplasms/pathology , Meningeal Neoplasms/pathology , Meningioma/pathology , Accessory Nerve Diseases/etiology , Accessory Nerve Diseases/surgery , Child, Preschool , Cranial Nerve Neoplasms/etiology , Cranial Nerve Neoplasms/surgery , Humans , Magnetic Resonance Imaging , Male , Meningeal Neoplasms/etiology , Meningeal Neoplasms/surgery , Meningioma/etiology , Meningioma/surgery , Neurofibromatosis 2/complications , Spinal Cord Compression/etiology , Spinal Cord Compression/surgery
13.
Chir Ital ; 59(6): 877-81, 2007.
Article in Italian | MEDLINE | ID: mdl-18360996

ABSTRACT

We present the case of a male patient who needed surgery for a large undefined submandibular schwannoma and a small contralateral thyroid carcinoma associated with cervical lymph nodes of a dubious nature. During the operative procedure all the pathological conditions were resolved, with some remarkable surprises. A non-functioning parathyroid adenoma was found and removed. A fairly unusual anatomical complication was also detected with regard to the right inferior laryngeal nerve, i.e. an anastomotic branch connecting the main trunk to the vagus nerve.


Subject(s)
Accessory Nerve Diseases , Accessory Nerve , Adenoma , Carcinoma, Papillary/surgery , Cranial Nerve Neoplasms , Neurilemmoma , Parathyroid Neoplasms , Thyroid Neoplasms/surgery , Accessory Nerve Diseases/complications , Accessory Nerve Diseases/pathology , Accessory Nerve Diseases/surgery , Adenoma/complications , Adenoma/diagnosis , Adenoma/pathology , Adenoma/surgery , Carcinoma, Papillary/complications , Cranial Nerve Neoplasms/complications , Cranial Nerve Neoplasms/pathology , Cranial Nerve Neoplasms/surgery , Humans , Laryngeal Nerves/abnormalities , Male , Neurilemmoma/complications , Neurilemmoma/diagnosis , Neurilemmoma/pathology , Neurilemmoma/surgery , Parathyroid Glands/pathology , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/pathology , Parathyroid Neoplasms/surgery , Thyroid Neoplasms/complications , Thyroidectomy , Vagus Nerve/abnormalities
14.
J Bone Joint Surg Am ; 87 Suppl 1(Pt 2): 285-91, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16140801

ABSTRACT

BACKGROUND: Injury to the spinal accessory nerve in the posterior cervical triangle leads to paralysis of the trapezius muscle. The aim of this study was to determine the indications for nerve repair or reconstructive surgery according to the etiology, the duration of the preoperative delay, and specific patient characteristics. METHODS: Of twenty-seven patients with a trapezius palsy, twenty were treated with neurolysis or surgical repair (direct or with a graft) of the spinal accessory nerve and seven were treated with the Eden-Lange muscle transfer procedure. Lymph node biopsy was the main cause of the nerve injury. The nerve repairs were performed at an average of seven months after the injury, and the reconstructive procedures were done at an average of twenty-eight months. Nerve repair was performed for iatrogenic injuries of the spinal accessory nerve, within twenty months after the onset of symptoms, and in one patient with spontaneous palsy. Reconstructive surgery was performed for cases of trapezius palsy secondary to radical neck dissection, for spontaneous palsies, and after failure of nerve repair or neurolysis. The mean follow-up period was thirty-five months. The functional outcome was assessed clinically on the basis of active shoulder abduction, pain, strength of the trapezius on manual muscle-testing, and level of subjective patient satisfaction. RESULTS: The results were good or excellent in sixteen of the twenty patients treated with nerve repair and in four of the seven patients treated with the Eden-Lange procedure. Poor results were seen in older patients and in patients with a previous radical neck dissection. CONCLUSIONS: Good results can be expected from a repair of the spinal accessory nerve if it is performed within twenty months after the injury, as the nerve is basically a purely motor nerve and the distance from the injury to the motor end plates is short. Muscle transfer should be performed in patients with spontaneous trapezius palsy, when previous nerve surgery has failed, or when the time from the injury to treatment is over twenty months. Treatment is less likely to succeed when the patient is older than fifty years of age or the palsy was due to a radical neck dissection, penetrating injury, or spontaneous palsy.


Subject(s)
Accessory Nerve Diseases/surgery , Muscle, Skeletal/transplantation , Neurosurgical Procedures/methods , Orthopedic Procedures/methods , Accessory Nerve/surgery , Cranial Nerve Diseases/surgery , Humans , Muscle, Skeletal/innervation , Paralysis/surgery
15.
Acta Neurochir (Wien) ; 147(8): 909-10, 2005 Aug.
Article in English | MEDLINE | ID: mdl-15877177

ABSTRACT

A 35-year-old man presented with pain in the right shoulder and neck for 18 months. The neurological examination revealed complete accessory nerve palsy on the right side without further deficits. Magnetic resonance imaging showed a right parapharyngeal tumour expanding into the posterior fossa through the jugular foramen without dural attachment and absence of invasion into the middle ear cavity or internal auditory meatus. Intraoperative inspection disclosed a tumour originating from the accessory nerve. Histological diagnosis revealed a meningothelial meningioma with invasion of the epineural space. To the knowledge of the authors this is the first report of an accessory nerve meningioma in the jugular foramen associated with a posterior fossa component and extension into the parapharyngeal space.


Subject(s)
Accessory Nerve Diseases/pathology , Cranial Nerve Neoplasms/pathology , Meningioma/pathology , Accessory Nerve Diseases/surgery , Adult , Cranial Nerve Neoplasms/surgery , Humans , Male , Meningioma/surgery , Neoplasm Invasiveness
16.
Zhonghua Wai Ke Za Zhi ; 42(13): 773-6, 2004 Jul 07.
Article in Chinese | MEDLINE | ID: mdl-15363292

ABSTRACT

OBJECTIVE: To analysis the clinical presentation, radiological findings, surgical techniques and outcomes of jugular foramen (JF) schwannomas. METHODS: We reviewed our 10-year experience in the surgical treatment of 17 patients suffered from JF schwannomas in Hua Shan Hospital, Shanghai. A total of 8 males and 9 females with a mean age of 42 years underwent surgical procedures. A relative long period of 53-month symptomatic history was shown before surgery. The main clinical presentation are vertigo and hearing difficulty in 10 cases, atrophy of unilateral muscles of tongue in 9 cases, involvement of lower cranial nerve in 8 cases. The classification of tumors was type A (at cerebellopontine angle with minimal enlargement of the JF) in five cases, type B (JF with intracranial extension) in 3 cases, type C (extracranial tumors with JF extension) in 2 cases and type D (dumbbell-shaped with both intra-and extracranial components) in 7 cases. RESULTS: Far lateral approaches were used in 10 cases, retrosigmoid suboccipital approaches were used in 5 cases. Submandibular approaches were selected in other 2 cases. Gross total removal was achieved in 12 cases, and subtotal removal in 5 cases. Follow-up revealed marked improvement from preoperative symptoms in 9 cases and no additional deficits in 3 cases. 5 cases suffered from additional neurological deficits. There were two cases of temporary hoarseness and gradually improved within follow-up. Two patients suffered from swallowing problems as a new deficit. One patient had facial palsy. CONCLUSIONS: JF schwannomas can be surgically treated with relative good outcomes. Surgical approaches should be tailored according to the tumor extension.


Subject(s)
Accessory Nerve Diseases , Cranial Nerve Neoplasms , Glossopharyngeal Nerve Diseases , Neurilemmoma , Vagus Nerve Diseases , Accessory Nerve Diseases/diagnosis , Accessory Nerve Diseases/surgery , Adolescent , Adult , Cranial Nerve Neoplasms/diagnosis , Cranial Nerve Neoplasms/surgery , Female , Glossopharyngeal Nerve Diseases/diagnosis , Glossopharyngeal Nerve Diseases/surgery , Humans , Male , Middle Aged , Neurilemmoma/diagnosis , Neurilemmoma/surgery , Retrospective Studies , Vagus Nerve Diseases/diagnosis , Vagus Nerve Diseases/surgery
17.
Neurosurg Focus ; 17(2): E9, 2004 Aug 15.
Article in English | MEDLINE | ID: mdl-15329024

ABSTRACT

OBJECT: Schwannomas of the jugular foramen are rare, comprising between 2 and 4% of intracranial schwannomas. The authors retrospectively analyzed their surgical experience with schwannomas of the lower cranial nerves that presented with intra- and extracranial extensions through an enlarged jugular foramen. The transcondylar suprajugular approach was used without sacrificing the labyrinth or the integrity of the jugular bulb. In this report the clinical and radiological features are discussed and complications are analyzed. METHODS: This retrospective study includes six patients (three women and three men, mean age 31.6 years) with dumbbell-shaped jugular foramen schwannomas that were surgically treated by the senior author during a 5.5-year period. One patient had undergone previous surgery elsewhere. Glossopharyngeal and vagal nerve deficits were the most common signs (appearing in all patients), followed by hypoglossal and accessory nerve deficits (66.6%). Two or more signs or symptoms were present in every patient. Three tumors presented with cystic degeneration. In four patients the jugular bulb was not patent on neuroimaging studies. The suprajugular approach was used in five patients; the origin of the tumor from the 10th cranial nerve could be defined in three of them. All lesions were completely resected. No death or additional postoperative cranial nerve deficits occurred in this series. Aspiration pneumonia developed in one patient. Preoperative deficits of the ninth and 10th cranial nerves improved in one third of the patients and half recovered mobility of the tongue. No recurrence was discovered during the mean follow-up period of 32.8 months. CONCLUSIONS: With careful, extensive preoperative evaluation and appropriate planning of the surgical approach, dumbbell-shaped jugular foramen schwannomas can be radically and safely resected without creating additional neurological deficits. Furthermore, recovery of function in the affected cranial nerves can be expected.


Subject(s)
Accessory Nerve Diseases/surgery , Cranial Nerve Neoplasms/surgery , Glossopharyngeal Nerve Diseases/surgery , Neurilemmoma/surgery , Skull Base Neoplasms/surgery , Vagus Nerve Diseases/surgery , Accessory Nerve Diseases/pathology , Adult , Cranial Nerve Neoplasms/pathology , Female , Glossopharyngeal Nerve Diseases/pathology , Humans , Magnetic Resonance Imaging , Male , Neurilemmoma/pathology , Postoperative Complications/etiology , Pregnancy , Pregnancy Complications, Neoplastic/pathology , Pregnancy Complications, Neoplastic/surgery , Preoperative Care , Retrospective Studies , Skull Base Neoplasms/pathology , Vagus Nerve Diseases/pathology
18.
Neurol Med Chir (Tokyo) ; 43(10): 501-4, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14620203

ABSTRACT

A 60-year-old woman presented with a rare schwannoma arising from a spinal accessory nerve at the C1-2 levels manifesting as cervico-occipital pain. The tumor was removed by surgery with the involved segment of the nerve. She had no postoperative neurological deficit. Histological examination confirmed the diagnosis of schwannoma. Surgical removal is recommended for such cases.


Subject(s)
Accessory Nerve Diseases/surgery , Cranial Nerve Neoplasms/surgery , Neurilemmoma/surgery , Accessory Nerve Diseases/diagnosis , Cranial Nerve Neoplasms/diagnosis , Female , Humans , Middle Aged , Neurilemmoma/diagnosis
19.
Acta Neurochir (Wien) ; 145(4): 309-13; discussion 313, 2003 Apr.
Article in English | MEDLINE | ID: mdl-12748892

ABSTRACT

BACKGROUND: Meningiomas arising from cranial nerves with no dural attachment are exceedingly rare. The authors present a patient with bilateral meningiomatous lesions originating symmetrically from both spinal accessory nerves. CASE REPORT: A 61-year old woman presented with a one-year history of spinal ataxia and minimal left-sided motor impairment. Magnetic resonance imaging demonstrated two extrinsic lesions dorsolaterally of the medulla. Surgical exposure via a midline suboccipital approach with C1 laminectomy revealed the lesions arising from the spinal accessory nerves and in direct contact with the vertebral arteries. Histological investigation showed hypocellular fibrous lesions with proliferating meningothelial cells, psammoma bodies and immunoreactivity for vimentin, S-100 protein and epithelial membrane antigen. INTERPRETATION: To the authors' knowledge this is the first report of intradural tumours of the spinal accessory nerves not derived from Schwann cells and the first report of bilateral intracranial meningiomatous lesions without dural attachment.


Subject(s)
Accessory Nerve Diseases/diagnostic imaging , Accessory Nerve Diseases/pathology , Cranial Nerve Neoplasms/diagnostic imaging , Cranial Nerve Neoplasms/pathology , Meningeal Neoplasms/diagnostic imaging , Meningeal Neoplasms/pathology , Meningioma/diagnostic imaging , Meningioma/pathology , Accessory Nerve Diseases/surgery , Cranial Nerve Neoplasms/surgery , Female , Humans , Magnetic Resonance Imaging , Meningeal Neoplasms/surgery , Meningioma/surgery , Middle Aged , Tomography, X-Ray Computed
20.
Surg Neurol ; 59(3): 217-22; discussion 222, 2003 Mar.
Article in English | MEDLINE | ID: mdl-12681558

ABSTRACT

BACKGROUND: Intracranial schwannoma of the accessory nerve can be divided into two types. One is a jugular foramen type arising from the accessory nerve of the jugular foramen, while the other is an intracisternal type, which arises from the spinal root of the accessory nerve and is separate from the jugular foramen. The latter type is rare, and only 9 cases have been reported previously. CASE DESCRIPTION: A 46-year-old female presented with a large, midline mass lesion in the posterior fossa manifesting as foramen magnum syndrome. Magnetic resonance imaging (MRI) revealed a huge tumor with cystic lesion located in the cisterna magna with extension to the C1 spinal level. The tumor was totally removed by a suboccipital craniectomy and C1 laminectomy. It originated from the spinal root of the right accessory nerve. Temporary slight atrophy of the right sternocleidomastoid muscle was observed, but the patient was free of disease 2 years after treatment. CONCLUSIONS: We report a schwannoma of the spinal accessory nerve in the cisterna magna. The clinical and neuroradiological findings are discussed with a review of the literature. The initial symptoms were variable without loss of function of the cranial nerve, and the tumor tended to grow in the cisterna magna without laterality. Because of the absence of typical neurologic symptoms, early neuroradiological investigation by MRI is recommended for accurate diagnosis of these tumors.


Subject(s)
Accessory Nerve Diseases/diagnostic imaging , Accessory Nerve Diseases/pathology , Cisterna Magna/diagnostic imaging , Cisterna Magna/pathology , Cranial Nerve Neoplasms/diagnostic imaging , Cranial Nerve Neoplasms/pathology , Neurilemmoma/diagnostic imaging , Neurilemmoma/pathology , Accessory Nerve Diseases/surgery , Cisterna Magna/surgery , Cranial Nerve Neoplasms/surgery , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Neurilemmoma/surgery , Tomography, X-Ray Computed
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