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1.
Acta Otolaryngol ; 141(9): 835-840, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34406114

RESUMO

BACKGROUND: High-resolution MR imaging enables the visualization of individual nerves in the internal auditory canal (IAC). Cochlear nerve deficiency (CND) is recognized as one of the major causes of sensory neural hearing loss (SNHL), especially in cases of unilateral hearing loss in childhood. Some patients with CND are thought to have accompanying vestibular nerve deficiency (VND). However, there have been few reports focusing on VND and vestibular function in these children. AIMS: The aim of this study was to evaluate the frequency of VND and vestibular dysfunction in children with unilateral SNHL caused by CND. MATERIAL AND METHODS: Thirty-eight children with unilateral SNHL, who were diagnosed with CND by 3 T-MRI, were evaluated for VND and underwent caloric testing and cervical vestibular evoked potential (cVEMP). RESULTS: Fourteen of 38 patients (37%) had VND, and eleven (29%) of the patients [ten of the patients (71%) with VND] had at least one vestibular dysfunction. The patients with VND had significantly worse hearing and an IAC of smaller diameter than did patients without VND. CONCLUSIONS AND SIGNIFICANCE: We should pay attention to VND as well as vestibular dysfunction in hearing loss patients with CND.


Assuntos
Nervo Coclear/fisiopatologia , Perda Auditiva Unilateral/fisiopatologia , Nervo Vestibular/fisiopatologia , Doenças do Nervo Vestibulococlear/complicações , Adolescente , Criança , Nervo Coclear/diagnóstico por imagem , Feminino , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Unilateral/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Nervo Vestibular/diagnóstico por imagem
2.
Laryngoscope ; 131(10): 2323-2331, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34152614

RESUMO

OBJECTIVES/HYPOTHESIS: To investigate prevalence, radiological characteristics, and functional correlates of arachnoid cysts (AC) of the internal auditory canal (IAC) region, including associations of nerve compression with auditory/vestibular symptoms and asymmetrical audiogram or vestibular testing. STUDY DESIGN: Retrospective study. METHODS: T2-weighted magnetic resonance imaging (MRI) studies of IACs were retrospectively analyzed from 1247 patients with asymmetric auditory or vestibular symptoms. Patients with radiological findings of AC of the IAC were identified. Multiplanar analysis was used to analyze cyst position in the IAC and assess nerve displacement or compression. Size, position, and presence of nerve compression were correlated with symptoms. RESULTS: Twenty-four patients had a cyst in the middle or fundus in the IAC. Diameter (P = .04) and position (P = .002) of AC were associated with symptoms. Sagittal analyses identified displacement versus compression (P = .003) more reliably than axial imaging. Symptom laterality was associated with the site of radiological abnormality. Vestibular nerve compression was associated with vertigo (P = .0001), and cochlear nerve compression was associated with auditory symptoms (P < .0001). CONCLUSIONS: In a retrospective series of patients undergoing MRI of IACs for asymmetric auditory or vestibular impairment, clinical symptom profile correlated with blinded assessment of IAC lesions. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2323-2331, 2021.


Assuntos
Cistos Aracnóideos/complicações , Nervo Coclear/patologia , Imageamento por Ressonância Magnética/métodos , Síndromes de Compressão Nervosa/diagnóstico , Nervo Vestibular/patologia , Adulto , Cistos Aracnóideos/diagnóstico , Nervo Coclear/diagnóstico por imagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Osso Petroso/diagnóstico por imagem , Osso Petroso/inervação , Estudos Retrospectivos , Nervo Vestibular/diagnóstico por imagem , Vestíbulo do Labirinto/diagnóstico por imagem , Vestíbulo do Labirinto/inervação
3.
Auris Nasus Larynx ; 48(3): 347-352, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32928603

RESUMO

OBJECTIVE: The correlation between enhancement of the vestibulocochlear nerves on gadolinium-enhanced magnetic resonance imaging (MRI) and vestibulocochlear functional deficits was examined in patients with Ramsay Hunt syndrome (RHS). METHODS: Nineteen patients with RHS who showed herpes zoster oticus, peripheral facial palsy, and vertigo were enrolled. Canal paresis (CP) in the caloric test, abnormal response to ocular and cervical vestibular myogenic potentials (oVEMP and cVEMP), and refractory sensorineural hearing loss were evaluated. MRI images perpendicular to the internal auditory canal were reconstructed to identify the superior (SVN) and inferior vestibular nerves (IVN) and the cochlear nerve (CV). The signal intensity increase (SIinc) of the four-nerve enhancement was calculated as an index. RESULTS: Among RHS patients, 79%, 53%, 17% and 26% showed CP in the caloric test, abnormal responses to oVEMP and cVEMP, and refractory sensorineural hearing loss, respectively. SIinc rates of the SVN were significantly increased in RHS patients with CP in the caloric test, and with abnormal responses to oVEMP and cVEMP. SIinc rates of the SVN tended to increase in RHS patients with refractory sensorineural hearing loss (p = 0.052). SIinc rates of the IVN were significantly increased in RHS patients with abnormal responses to oVEMP and cVEMP, and refractory sensorineural hearing loss, but not in those with CP in the caloric test. SIinc rates of the CN were significantly increased in RHS patients with CP in the caloric test, abnormal response to oVEMP and refractory sensorineural hearing loss, but not in those with abnormal response to cVEMP. CONCLUSION: In patients with RHS, the origin of vertigo may be superior vestibular neuritis, which is affected by reactive varicella-zoster virus from the geniculate ganglion of the facial nerve through the faciovestibular anastomosis. The results also suggested that in some RHS patients, inferior vestibular neuritis contributes to the development of vertigo and that the origin of refractory sensorineural hearing loss is cochlear neuritis.


Assuntos
Nervo Coclear/diagnóstico por imagem , Herpes Zoster da Orelha Externa/complicações , Imageamento por Ressonância Magnética , Nervo Vestibular/diagnóstico por imagem , Adolescente , Adulto , Idoso , Testes Calóricos , Meios de Contraste , Feminino , Gadolínio , Perda Auditiva Neurossensorial/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/fisiopatologia , Canais Semicirculares/fisiopatologia , Potenciais Evocados Miogênicos Vestibulares , Neuronite Vestibular/virologia , Adulto Jovem
4.
Int J Comput Assist Radiol Surg ; 15(11): 1859-1867, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32964338

RESUMO

PURPOSE: Artificial intelligence (AI) in medical imaging is a burgeoning topic that involves the interpretation of complex image structures. The recent advancements in deep learning techniques increase the computational powers to extract vital features without human intervention. The automatic detection and segmentation of subtle tissue such as the internal auditory canal (IAC) and its nerves is a challenging task, and it can be improved using deep learning techniques. METHODS: The main scope of this research is to present an automatic method to detect and segment the IAC and its nerves like the facial nerve, cochlear nerve, inferior vestibular nerve, and superior vestibular nerve. To address this issue, we propose a Mask R-CNN approach driven with U-net to detect and segment the IAC and its nerves. The Mask R-CNN with its backbone network of the RESNET50 model learns a background-based localization policy to produce an actual bounding box of the IAC. Furthermore, the U-net segments the structure related information of IAC and its nerves by learning its features. RESULTS: The proposed method was experimented on clinical datasets of 50 different patients including adults and children. The localization of IAC using Mask R-CNN was evaluated using Intersection of Union (IoU), and segmentation of IAC and its nerves was evaluated using Dice similarity coefficient. CONCLUSIONS: The localization result shows that mean IoU of RESNET50, RESNET101 are 0.79 and 0.74, respectively. The Dice similarity coefficient of IAC and its nerves using region growing, PSO and U-net method scored 92%, 94%, and 96%, respectively. The result shows that the proposed method outperform better in localization and segmentation of IAC and its nerves. Thus, AI aids the radiologists in making the right decisions as the localization and segmentation of IAC is accurate.


Assuntos
Inteligência Artificial , Aprendizado Profundo , Orelha Interna/diagnóstico por imagem , Adulto , Criança , Nervo Coclear/diagnóstico por imagem , Nervo Facial/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Redes Neurais de Computação , Nervo Vestibular/diagnóstico por imagem
5.
Rofo ; 192(9): 854-861, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32079028

RESUMO

PURPOSE: Sudden unilateral peripheral vestibular deficit is mostly termed vestibular neuritis (VN), even if its cause or the exact location of the lesion remains unclear. Thus, therapy is mostly symptomatic. We aimed to prove if there is peripheral atrophy after VN with persistent canal paresis. METHODS: After approval by the ethics committee and according to the declaration of Helsinki and with informed consent, ten patients with persistent canal paresis after VN and ten age-matched healthy controls were included. High-resolution measurement (in-plane resolution 0.2 mm) of the internal auditory canal (IAC) using a 3 D CISS sequence at 3 Tesla was performed. The course of the pertaining nerves was reconstructed in the 3 D dataset and the measurement was performed at 60 % of the length of the IAC. The cross-sectional areas of the superior (SVN) and inferior vestibular nerve (IVN) were taken independently by two blinded readers. RESULTS: The interrater difference regarding the area was 22 %. We found significant atrophy of the SVN with a 24 % smaller area (p = 0.026) and found a smaller ratio of SVN/IVN on the symptomatic side (p = 0.017). Concerning single subject data, only 5 patients showed extensive atrophy of the NVS, while 5 patients did not. The time since symptom onset did not significantly influence the atrophy. CONCLUSION: MRI measuring of the area of the NVS after VN could detect atrophy after VN. However, only 5 patients exhibited marked atrophy, while the other 5 patients did not. With the background of stringent inclusion criteria (more than 6 months of symptom duration and proven persistent canal paresis), one has to wonder if there might be different etiologies behind the apparently identical symptoms. KEY POINTS: · MRI measuring of the area of the NVS after VN could detect atrophy after VN. · Only half of the 10 researched patients showed atrophy, while the other patients did not. · There are different etiologies to be suspected for VN. CITATION FORMAT: · Freund W, Weber F, Schneider D et al. Vestibular Nerve Atrophy After Vestibular Neuritis - Results from a Prospective High-Resolution MRI Study. Fortschr Röntgenstr 2020; 192: 854 - 861.


Assuntos
Inteligência Artificial , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética/métodos , Nervo Vestibular/diagnóstico por imagem , Neuronite Vestibular/diagnóstico por imagem , Algoritmos , Atrofia , Meato Acústico Externo/diagnóstico por imagem , Meato Acústico Externo/patologia , Humanos , Estudos Prospectivos , Nervo Vestibular/patologia
6.
Eur Arch Otorhinolaryngol ; 276(12): 3309-3316, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31531775

RESUMO

INTRODUCTION: Vestibular neuritis is the second cause of vertigo and new imaging protocols using delayed FLAIR with double-dose of gadolinium are proposed for its diagnosis. Our aim is to demonstrate that a single dose of gadolinium is sufficient. METHODS: Thirty-three patients with a unilateral vestibular neuritis are compared to a control group. All patients underwent a FLAIR sequence, 1 hour after intravenous injection of a single dose of gadolinium, on a 1.5 Tesla MRI. Two radiologists analyzed the enhancement intensity of the superior (sup VN) and inferior vestibular nerve (inf VN) and ratios to the signal of the cerebellum were calculated (supVN/C). The statistics were performed using Bayesian analysis. RESULTS: A strong enhancement of the sup VN was observed on the pathological side in 85% of patients with vestibular neuritis. The average signal intensity of the pathological sup VN (139 units ± 44) was more than two times the average intensity in the control group (58.5 units ± 5). The average ratios supVN/C were significantly different between the pathological side in vestibular neuritis (2.43 units ± 0.63) and the control group [1.16 ± 0.14 (Pr(diff > 0) = 1)]. A delayed enhancement > 71.5 units had a sensitivity of 96% and a specificity of 100% for the diagnosis of superior vestibular neuritis. CONCLUSION: A delayed FLAIR sequence, acquired 1 hour after a single dose of gadolinium injection, is a useful method for the diagnosis of vestibular neuritis. An enhancement of the sup VN > 71.5 units was in favor of the diagnosis.


Assuntos
Gadolínio DTPA/administração & dosagem , Imageamento por Ressonância Magnética/métodos , Nervo Vestibular/diagnóstico por imagem , Neuronite Vestibular/diagnóstico , Adulto , Idoso , Teorema de Bayes , Estudos de Casos e Controles , Meios de Contraste , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Vertigem/etiologia , Testes de Função Vestibular , Nervo Vestibular/patologia , Neuronite Vestibular/diagnóstico por imagem
7.
Bull Exp Biol Med ; 164(6): 707-711, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29658089

RESUMO

We propose a new approach to optimization of electrical stimulation of the vestibular nerve and improving the transfer function of vestibular implant. A mathematical model of the vestibular organ is developed based on its anatomy, the model premises, 3D-analysis of MRI and CT images, and mathematical description of physical processes underlying propagation of alternating electric current across the tissues of vestibular labyrinth. This approach was tested in vitro on the rat vestibular apparatus and had been examined anatomically prior to the development of its mathematical model and equivalent electrical circuit. The experimental and theoretical values of changes of the gain-phase characteristics of vestibular tissues in relation to location of the reference electrode obtained in this study can be used to optimize the electrical stimulation of vestibular nerve.


Assuntos
Modelos Anatômicos , Transmissão Sináptica/fisiologia , Nervo Vestibular/fisiologia , Vestíbulo do Labirinto/fisiologia , Animais , Simulação por Computador , Condutividade Elétrica , Estimulação Elétrica , Eletrodos , Imageamento por Ressonância Magnética , Masculino , Ratos , Ratos Wistar , Técnicas de Cultura de Tecidos , Tomografia Computadorizada por Raios X , Nervo Vestibular/anatomia & histologia , Nervo Vestibular/diagnóstico por imagem , Vestíbulo do Labirinto/anatomia & histologia , Vestíbulo do Labirinto/diagnóstico por imagem , Vestíbulo do Labirinto/inervação
8.
HNO ; 65(12): 966-972, 2017 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-28948300

RESUMO

BACKGROUND: Vestibular schwannoma (VS) is a benign tumor that develops in the internal auditory canal and the cerebellopontine angle, potentially diminishing hearing or balance. Most VS tumors arise from one of two vestibular branches: the superior or inferior vestibular nerve. Determining the specific nerve of origin could improve patient management in terms of preoperative counseling, treatment selection, and surgical decision-making and planning. The aim of this study was to introduce a novel scoring system that was designed to determine the nerve of origin. METHODS: The nerve of origin was predicted based on video head impulse assessments of all semicircular channels, together with cervical/ocular vestibular-evoked myogenic potential tests. The acquired data were entered into a scoring system developed to allocate the tumor origin. Finally, the nerve of origin was definitively determined intraoperatively. RESULTS: The novel scoring system was applied to 5 consecutive patients undergoing surgical VS treatment. In one case, no determination was possible. In all other cases, the preoperatively predicted tumor origin was the same as the origin determined during surgery. CONCLUSION: The scoring system predicts the nerve of origin and will be evaluated in a larger prospective cohort study of VS patients in the near future.


Assuntos
Neuroma Acústico , Ângulo Cerebelopontino/diagnóstico por imagem , Ângulo Cerebelopontino/patologia , Audição , Humanos , Neuroma Acústico/diagnóstico por imagem , Estudos Prospectivos , Nervo Vestibular/diagnóstico por imagem , Nervo Vestibular/patologia
9.
J Clin Neurosci ; 17(2): 214-8, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20056421

RESUMO

We conducted a prospective study to identify prognostic factors of hearing preservation after gamma knife radiosurgery (GKRS) for vestibular schwannoma (VS). Twenty-seven patients with unilateral VS and serviceable hearing underwent GKRS. The mean lesion diameter was 17.3mm (range 6.1-30.0mm), the median marginal dose was 12 Gy (11-15 Gy), and the mean follow-up duration was 35.7 months (9-81 months). The probabilities of hearing preservation after GKRS were calculated using the Kaplan-Meier method. Tumor growth was controlled in 26 of the 27 patients (96.3%), and rates of hearing preservation were 85.1% and 68.1% at 2 and 3 years, respectively. A normal auditory brainstem response (ABR) (p = 0.008) and Gardner-Robertson class I hearing (p = 0.012) before GKRS were found to be significant prognostic factors of a favorable outcome. Our findings suggest that a normal pre GKRS ABR strongly predicts hearing preservation after GKRS. Accordingly, we advise that ABR should be considered with other prognostic factors when GKRS is considered in patients with VS.


Assuntos
Neoplasias dos Nervos Cranianos/patologia , Perda Auditiva Neurossensorial/patologia , Neuroma Acústico/patologia , Complicações Pós-Operatórias/patologia , Radiocirurgia/efeitos adversos , Doenças do Nervo Vestibulococlear/patologia , Adulto , Idoso , Nervo Coclear/patologia , Nervo Coclear/efeitos da radiação , Nervo Coclear/cirurgia , Neoplasias dos Nervos Cranianos/fisiopatologia , Neoplasias dos Nervos Cranianos/cirurgia , Eletroencefalografia , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Feminino , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/fisiopatologia , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Prognóstico , Estudos Prospectivos , Doses de Radiação , Radiografia , Radiocirurgia/estatística & dados numéricos , Nervo Vestibular/diagnóstico por imagem , Nervo Vestibular/patologia , Nervo Vestibular/cirurgia , Doenças do Nervo Vestibulococlear/fisiopatologia , Doenças do Nervo Vestibulococlear/cirurgia , Adulto Jovem
10.
Neurosurgery ; 65(2): 294-300; discussion 300-1, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19625908

RESUMO

OBJECTIVE: Management options for patients with vestibular schwannoma include observation, surgical resection, stereotactic radiosurgery (SRS), and stereotactic radiation therapy. In younger patients, resection is often advocated because of concern regarding the long-term effects of radiation. We studied tumor response and clinical outcomes after SRS in such patients. METHODS: We reviewed long-term outcomes in 55 patients with vestibular schwannomas. Patients were 40 years of age or younger, underwent gamma knife (GK) SRS between 1987 and 2003, and were followed up for a minimum of 4 years. The median patient age was 35 years (range, 13-40 years). Forty-one patients had Gardner-Robertson class 1 to 4 hearing. Thirteen patients (24%) had undergone surgical removal. The median tumor volume was 1.7 mm. The median tumor margin dose was 13.0 Gy (range, 11-20 Gy). RESULTS: At a median of 5.3 years, (range, 4-20 years), 2 of 55 patients underwent GK SRS for a second time; 1 of these patients had had a recurrence after initial resection. The 5-year rate of freedom from additional management was 96%. Hearing preservation rates (i.e., remaining within the same Gardner-Robertson hearing class) were 93%, 87%, and 87% at 3, 5, and 10 years, respectively. In patients with serviceable hearing before SRS, it was maintained in 100%, 93%, and 93% of patients at 3, 5, and 10 years, respectively. Hearing preservation was related to a margin dose lower than 13 Gy (P = 0.017). At the last assessment, facial and trigeminal nerve function was preserved in 98.2% and 96.4% of patients, respectively; the only facial deficit (House-Brackmann grade III) occurred in a patient who received a tumor dose of 20 Gy early in our experience (1988). None of the patients treated with doses lower than 13 Gy experienced facial or trigeminal neuropathy. All patients continued their previous level of activity or employment after GK SRS. No patient developed a secondary radiation-related tumor. CONCLUSION: Our experience indicates that GK SRS is an effective management strategy for younger patients with vestibular schwannoma, most of whom have no additional cranial nerve dysfunction.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Radiocirurgia/estatística & dados numéricos , Nervo Vestibular/cirurgia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Nervo Coclear/fisiopatologia , Nervo Coclear/efeitos da radiação , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/patologia , Nervo Facial/fisiopatologia , Nervo Facial/efeitos da radiação , Traumatismos do Nervo Facial/epidemiologia , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Neurossensorial/prevenção & controle , Humanos , Masculino , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Recidiva Local de Neoplasia/cirurgia , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Avaliação de Resultados em Cuidados de Saúde , Doses de Radiação , Radiografia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Nervo Trigêmeo/fisiopatologia , Nervo Trigêmeo/efeitos da radiação , Doenças do Nervo Trigêmeo/epidemiologia , Doenças do Nervo Trigêmeo/prevenção & controle , Nervo Vestibular/diagnóstico por imagem , Nervo Vestibular/patologia , Adulto Jovem
11.
J Laryngol Otol ; 123(5): 572-4, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-18501037

RESUMO

OBJECTIVE: We report a new temporal bone anomaly - an enlarged superior vestibular nerve canal - associated with sensorineural hearing loss. CASE REPORT: A 10-month-old male infant presented with sensorineural hearing loss together with bilaterally enlarged superior vestibular nerve canals. Compared with published temporal bone computed tomography measurements, our patient's canals were normal in length but approximately double the normal width. In addition, careful review of the imaging did not clearly identify a bony wedge between the superior and inferior vestibular nerve canals. CONCLUSION: Enlarged superior vestibular nerve canal malformation may be a marker for sensorineural hearing loss. Increased vigilance amongst otologists may establish the prevalence of this anomaly and its possible effects on hearing.


Assuntos
Perda Auditiva Neurossensorial/diagnóstico por imagem , Osso Temporal/anormalidades , Doenças Vestibulares/diagnóstico por imagem , Nervo Vestibular/diagnóstico por imagem , Humanos , Lactente , Masculino , Radiografia , Osso Temporal/diagnóstico por imagem
12.
Brain ; 131(Pt 10): 2538-52, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18515323

RESUMO

This review summarizes our current knowledge of multisensory vestibular structures and their functions in humans. Most of it derives from brain activation studies with PET and fMRI conducted over the last decade. The patterns of activations and deactivations during caloric and galvanic vestibular stimulations in healthy subjects have been compared with those in patients with acute and chronic peripheral and central vestibular disorders. Major findings are the following: (1) In patients with vestibular neuritis the central vestibular system exhibits a spontaneous visual-vestibular activation-deactivation pattern similar to that described in healthy volunteers during unilateral vestibular stimulation. In the acute stage of the disease regional cerebral glucose metabolism (rCGM) increases in the multisensory vestibular cortical and subcortical areas, but simultaneously it significantly decreases in the visual and somatosensory cortex areas. (2) In patients with bilateral vestibular failure the activation-deactivation pattern during vestibular caloric stimulation shows a decrease of activations and deactivations. (3) Patients with lesions of the vestibular nuclei due to Wallenberg's syndrome show no activation or significantly reduced activation in the contralateral hemisphere during caloric irrigation of the ear ipsilateral to the lesioned side, but the activation pattern in the ipsilateral hemisphere appears 'normal'. These findings indicate that there are bilateral ascending vestibular pathways from the vestibular nuclei to the vestibular cortex areas, and the contralateral tract crossing them is predominantly affected. (4) Patients with posterolateral thalamic infarctions exhibit significantly reduced activation of the multisensory vestibular cortex in the ipsilateral hemisphere, if the ear ipsilateral to the thalamic lesion is stimulated. Activation of similar areas in the contralateral hemisphere is also diminished but to a lesser extent. These data demonstrate the functional importance of the posterolateral thalamus as a vestibular gatekeeper. (5) In patients with vestibulocerebellar lesions due to a bilateral floccular deficiency, which causes downbeat nystagmus (DBN), PET scans reveal that rCGM is reduced in the region of the cerebellar tonsil and flocculus/paraflocculus bilaterally. Treatment with 4-aminopyridine lessens this hypometabolism and significantly improves DBN. These findings support the hypothesis that the (para-) flocculus and tonsil play a crucial role in DBN. Although we can now for the first time attribute particular activations and deactivations to functional deficits in distinct vestibular disorders, the complex puzzle of the various multisensory and sensorimotor functions of the phylogenetically ancient vestibular system is only slowly being unraveled.


Assuntos
Encéfalo/fisiopatologia , Nervo Vestibular/fisiopatologia , Neuronite Vestibular/diagnóstico , Animais , Encéfalo/diagnóstico por imagem , Estimulação Elétrica , Humanos , Imageamento por Ressonância Magnética , Rede Nervosa/fisiologia , Tomografia por Emissão de Pósitrons , Temperatura , Nervo Vestibular/diagnóstico por imagem , Neuronite Vestibular/fisiopatologia
13.
Otolaryngol Clin North Am ; 35(2): 393-404, viii, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12391625

RESUMO

Acoustic neuroma results from abnormal proliferation of Schwann cells. These tumors originate in the region of Scarpa's ganglion at the junction of peripheral and central myelin of the vestibular nerve located in the internal auditory canal (IAC). The bony confine of the IAC houses the VII and the VIII cranial nerves. The presence of tumor mass compresses these structures. The growing tumor mass may also prolapses into the cerebellopontine angle (CPA). With continued growth, the tumor eventually compresses on the brain stem and cerebellum. Despite the benign nature of these tumors, the clinical course of this disease may be fraught with complications.


Assuntos
Neuroma Acústico/diagnóstico , Neuroma Acústico/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Nervo Facial/diagnóstico por imagem , Nervo Facial/patologia , Nervo Facial/cirurgia , Humanos , Imageamento por Ressonância Magnética , Técnicas Estereotáxicas/instrumentação , Tomografia Computadorizada por Raios X , Nervo Vestibular/diagnóstico por imagem , Nervo Vestibular/patologia , Nervo Vestibular/cirurgia
14.
Vestn Otorinolaringol ; (2): 14-7, 2002.
Artigo em Russo | MEDLINE | ID: mdl-12056152

RESUMO

The authors present pilot experience with transcranial duplex scanning (TCDS) of the cerebral vessels in 17 patients with secondary cochleovestibular neuritis combined with chronic leptomeningitis (primarily of the posterior cranial fossa). This method has determined extra- and intracranial hemodynamics, characterized arterial and venous blood flow qualitatively and quantitatively, outlined possible genetically determined factors in development of dyscirculatory disorders. Finally, hemodynamic defects of two types were revealed in 12 patients. Type 1 (3 patients) was characterized by asymmetric circulation in the territory of the middle, anterior and posterior cerebral arteries, by the absence of venous congestion. Type 2 (9 patients) was characterized by impaired venous outflow manifesting as higher speed of the blood flow and its phase response along the intracranial veins and sinuses. In 7 patients these defects combined with asymmetric circulation along brain stem arteries. These patients were diagnosed to have perilymphatic labyrinthine hydrops.


Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Nervo Coclear , Meningite/complicações , Neurite (Inflamação) , Tomografia Computadorizada de Emissão/métodos , Adulto , Doença Crônica , Nervo Coclear/irrigação sanguínea , Nervo Coclear/diagnóstico por imagem , Nervo Coclear/fisiopatologia , Hidropisia Endolinfática/diagnóstico , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurite (Inflamação)/diagnóstico , Neurite (Inflamação)/etiologia , Neurite (Inflamação)/fisiopatologia , Projetos Piloto , Nervo Vestibular/irrigação sanguínea , Nervo Vestibular/diagnóstico por imagem , Nervo Vestibular/fisiopatologia
15.
Acta Otorhinolaryngol Belg ; 53(1): 67-71, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10102042

RESUMO

A case of unilateral congenital deafness revealing a narrow vacant internal auditory canal and a more anterior and superior second canal where the facial and vestibulocochlear nerves are well visualised is presented. Having reviewed the scientific and embryological data, the authors consider the mechanism of this malformation.


Assuntos
Surdez/congênito , Orelha Interna/anormalidades , Adolescente , Nervo Coclear/diagnóstico por imagem , Surdez/diagnóstico , Orelha Interna/diagnóstico por imagem , Eletronistagmografia , Potenciais Evocados Auditivos do Tronco Encefálico , Nervo Facial/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X , Nervo Vestibular/diagnóstico por imagem
16.
Acta Otolaryngol ; 117(1): 35-40, 1997 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9039478

RESUMO

Thallium chloride 201Tl combined with SPECT was performed in a series of 29 patients with neuroradiological evidence of vestibular schwannoma (VS). The relative tumor uptake (U) and relative tumor concentration (C) of the radiotracer 201Tl was determined, and the cerebellum served as a reference. The relative tracer concentration and uptake were correlated to tumor volume determined by gadolinium DTPA enhanced MR, to prediagnostic duration of symptoms, to tumor vascularity expressed by the average number of intratumoral vessels using the endothelial marker CD31, and to the proliferative activity in the tumors expressed by positive staining with the monoclonal antibody MIB-1 for Ki-67. A positive 201TI enhancement was detected in 17 tumors (n = 17). Tumors U and C were statistically unrelated to tumor volume (p = 0.236 and p = 0.439). SPECT demonstrated all tumors > 0.8 cm3, but it had its limitation as a diagnostic modality of small intracanalicular tumors, when compared with gadolinium DTPA enhanced MR. Relating U and C in all tumors (n = 29) and the prospectively registered data on the prediagnostic duration of symptoms, a statistical significance was found (p = 0.012 and p = 0.015). No statistically significant correlation was observed between U and C and the proliferative activity of the tumors expressed by positive staining with the monoclonal antibody MIB-1 for Ki-67 (p = 0.063 and p = 0.086). A statistically significant correlation was noted between C and U in the operated group (n = 12) and tumor vascularity expressed by the average number of the intratumoral vessels (p = 0.003 and p = 0.014). SPECT was found to be superior to MR in determining VS growth potentials as it expresses tumor vascularity, which is essential for tumor growth. It seems that we now have an in vivo functional radiological modality capable of providing data on VS vascularity and determination of growth potential in the individual tumor. A high radioactive tracer uptake in the tumor corresponded to high tumor vascularity, indicating a high growth rate and vice versa.


Assuntos
Neuroma Acústico/diagnóstico por imagem , Radioisótopos de Tálio , Tálio , Tomografia Computadorizada de Emissão de Fóton Único , Nervo Vestibular/diagnóstico por imagem , Adulto , Idoso , Anticorpos Monoclonais , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neuroma Acústico/diagnóstico , Neuroma Acústico/patologia , Nervo Vestibular/patologia
18.
Acta Otolaryngol Suppl ; 518: 3-12, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-7856448

RESUMO

Morphologic changes in ipsilateral superior vestibulo-ocular neurons (SVON) and the vestibular nerve were measured in 4 cats 8 weeks after labyrinthectomy and 4 cats 1 year after labyrinthectomy. There is a 20% decrease in SVON size and 30% decrease in rough endoplasmic reticulum and ribosomes with no change in the volume fractions of Golgi apparatus or mitochondria. In the central nervous system degeneration of the vestibular nerve terminals ipsilateral to the labyrinthectomy was represented by a 25% loss of synaptic profiles (SP) on SVON at 8 weeks and 57% loss of SP at 1 year after labyrinthectomy. There was no significant loss of fiber number in the vestibular nerve at 8 weeks post lesion but a 35% loss of fibers primarily of the large size at 1 year post lesion.


Assuntos
Orelha Interna/cirurgia , Neurônios/diagnóstico por imagem , Nervo Vestibular/diagnóstico por imagem , Núcleos Vestibulares/diagnóstico por imagem , Animais , Axônios/diagnóstico por imagem , Gatos , Retículo Endoplasmático/ultraestrutura , Microscopia Eletrônica , Degeneração Neural , Ribossomos/ultraestrutura , Sinapses/diagnóstico por imagem , Fatores de Tempo , Ultrassonografia
19.
J Laryngol Otol ; 108(11): 983-5, 1994 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-7829954

RESUMO

A vestibular schwannoma in an only hearing ear is a difficult management problem. A case is presented of a patient who had a Nucleus-22 channel device implanted into a nonfunctioning ear and auditory rehabilitation prior to resection of a large vestibular schwannoma in the contralateral ear.


Assuntos
Implantes Cocleares , Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Nervo Vestibular , Idoso , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Feminino , Testes Auditivos , Humanos , Neurilemoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Nervo Vestibular/diagnóstico por imagem
20.
J Laryngol Otol ; 108(5): 375-9, 1994 May.
Artigo em Inglês | MEDLINE | ID: mdl-8035113

RESUMO

In a series of 571 vestibular schwannomas (VS) operated on in the period 1976-1992, via the translabyrinthine approach, 23 tumours (4 per cent) from 23 patients were radiologically, peroperatively and histologically identified as cystic VS. Neuroimaging examinations (CT and MRI) revealed 15 tumours (2.6 per cent) with extracystic formations and in eight cases (1.4 per cent) intratumoural cysts. In 15 cases (65 per cent), tumours were located extracanalicularly with no involvement of the internal auditory canal (IAC). The extracanalicular tumour extension including the cystic elements ranged between 10 and 60 mm with a mean of 45 mm. In eight cases out of 23 (35 per cent) other diagnostic possibilities such as trigeminal schwannoma, epidermoid cyst and meningioma were proposed at the primary evaluation. Deformation, displacement and/or impression of the fourth ventricle was demonstrated in 17 cases (74 per cent). Three patients (13 per cent) had obstructive hydrocephalus which demanded shunt insertion. Residual tumour was detected in two patients (9 per cent). Growth rate in four cases was more than 10 times higher when compared to the annual growth rate of noncystic VS. The results of this study provide data on cystic VS attenuation demonstrated by CT or MRI which may be valuable in neuroradiological diagnosis of these cystic lesions and emphasizes that the wait-and-see policy should not be applied to the cystic variant of VS.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Nervo Vestibular/diagnóstico por imagem , Adulto , Idoso , Neoplasias dos Nervos Cranianos/patologia , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Neurilemoma/patologia , Estudos Prospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Nervo Trigêmeo
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