136例听神经瘤性别差异和左右发病情况的中西医结合分析

目的 对听神经瘤的性别差异和左右发病情况进行中西医结合分析。方法 回顾性分析2011年7月至2015年7月收治及手术治疗的听神经瘤患者的临床资料,对比研究男性与女性、男性左右侧、女性左右侧肿瘤性质等相关指标的差异,并基于中医学和西医学理论对听神经瘤发病规律进行分析。结果 男性与女性听神经瘤患者在住院时间、肿瘤大小、肿瘤囊变方面比较,男性左侧与右侧听神经瘤患者在肿瘤囊变、术后感染脑膜炎、术后耳鸣缓解方面比较,以及女性左侧与右侧听神经瘤患者在年龄、住院时间、肿瘤大小、肿瘤囊变、肿瘤全切、术后脑脊液漏、术后面神经完整解剖保留方面比较,差异均具有统计学意义（P＜0.05）。结论 男左侧女右侧听神经瘤性质较良好,这与人体中男女、左右的阴阳气血升降差异有关。     

全病程管理对听神经瘤术后吞咽障碍患者康复的影响

目的 探讨全病程管理促进听神经瘤术后吞咽障碍患者康复的效果。方法组建全病程管理小组,选取56例听神经瘤术后吞咽障碍患者为研究对象,按照住院时间分为对照组28例,实施常规护理;干预组28例,实施个案管理师主导的全病程管理。结果干预1年后,两组服药依从性、康复依从性及吞咽功能的时间效应、交互效应和组间效应差异有统计学意义（均P＜0.05）;两组生存质量的时间效应及组间效应差异有统计学意义（均P<0.05）。结论全病程管理能有效提高听神经瘤术后患者的服药及康复依从性,促进吞咽功能恢复,提高生活质量。     

Imaging of the foot and ankle

The complexity of foot and ankle anatomy and biomechanics gives imaging an essential role in the diagnosis and management of foot and ankle pathology. This article will focus on the common non-traumatic and non-neoplastic conditions routinely encountered in orthopaedics and musculoskeletal radiology practice.     

First webspace Morton's neuroma case report with literature review

Morton's neuromas are benign lesions of the inter-digital nerves within the foot. They are most commonly found in the second and third webspace. Morton's neuroma of the first webspace is very rare. A case of a 42-year-old female who presented complaining of long standing forefoot pain is presented. The patient was diagnosed with a soft tissue tumor in the 1st webspace. An excisional biopsy of the tumour confirmed a Morton's neuroma. Very few cases of Morton's neuroma in the first webspace have been reported in the literature.     

伽玛刀治疗听神经瘤失败后再手术的方法及疗效分析

目的探讨伽玛刀治疗听神经瘤失败后再行手术治疗的方法及其效果。方法 20例听神经瘤患者接受伽玛刀治疗后不同时期复查MRI发现肿瘤继续生长或临床症状加重,采用枕下乙状窦后入路行听神经瘤切除术。结果术中发现肿瘤与面神经及周围结构粘连明显。肿瘤全切及近全切除共18例(占90%),次全切除共2例(占10%)。面神经解剖保留18例(占90%),功能保留16例(占80%)。结论采用枕下乙状窦后入路肿瘤切除术是挽救伽玛刀治疗听神经瘤失败后的有效方法,面神经功能保护满意。     

Preoperative Characteristics of Auditory Brainstem Response in Acoustic Neuroma with Useful Hearing: Importance as a Preliminary Investigation for Intraoperative Monitoring

We classified the results of preoperative auditory brainstem response (ABR) in 121 patients with useful hearing and considered the utility of preoperative ABR as a preliminary assessment for intraoperative monitoring. Wave V was confirmed in 113 patients and was not confirmed in 8 patients. Intraoperative ABR could not detect wave V in these 8 patients. The 8 patients without wave V were classified into two groups (flat and wave I only), and the reason why wave V could not be detected may have differed between the groups. Because high-frequency hearing was impaired in flat patients, an alternative to click stimulation may be more effective. Monitoring cochlear nerve action potential (CNAP) may be useful because CNAP could be detected in 4 of 5 wave I only patients. Useful hearing was preserved after surgery in 1 patient in the flat group and 2 patients in wave I only group. Among patients with wave V, the mean interaural latency difference of wave V was 0.88 ms in Class A (n = 57) and 1.26 ms in Class B (n = 56). Because the latency of wave V is already prolonged before surgery, to estimate delay in wave V latency during surgery probably underestimates cochlear nerve damage. Recording intraoperative ABR is indispensable to avoid cochlear nerve damage and to provide information for surgical decisions. Confirming the condition of ABR before surgery helps to solve certain problems, such as choosing to monitor the interaural latency difference of wave V, CNAP, or alternative sound-evoked ABR.     

伽玛刀治疗听神经瘤疗效观察

目的探讨伽玛刀治疗听神经瘤的疗效。方法应用玛西普伽玛刀治疗听神经瘤152例,其中84例获得完整随访资料,随访时间为12～89个月。结果肿瘤体积缩小57例（67．9％）、不变23例（27．3％）、增大4例。听力保留率为70．6％（36／51）,出现患侧面神经一过性受损4例（5．3％）,出现三叉神经功能受损症状3例（2例为一过性,1例经治疗后缓解）。结论伽玛刀治疗听神经瘤有较高的肿瘤生长控制率,对相关颅神经损伤小,并发症少,是一种安全有效的治疗方法。     

听神经瘤枕下乙状窦后入路显微切除术后面神经功能损伤的危险因素分析

目的研究听神经瘤（AN）显微镜外科切除后面神经功能损伤的危险因素。 方法回顾性分析绵阳市中心医院神经外科自2017年1月至2020年1月行枕下乙状窦后入路显微切除术治疗的140例AN患者的临床资料,随访6个月,采用H-B面神经功能受损量表（HBFGS）评估患者术后6个月的面神经受损程度,并将年龄、性别、肿瘤直径、肿瘤切除范围、手术时间、术中是否行面神经监测、面神经位置、面神经与肿瘤的黏连严重程度等作为分析因素,分析影响患者术后面神经功能受损的独立危险因素。 结果按照术后6个月面神经HBFGS分级结果将患者分为2组,HBFGS分级Ⅰ~Ⅲ级为轻中度障碍组（78例）,Ⅳ~Ⅵ级为重度障碍组（62例）。轻中度障碍组患者的肿瘤最大直径显著小于重度障碍组,手术时间显著短于重度障碍组,差异均具有统计学意义（P<0.05）;肿瘤切除程度、术中行面神经监测情况以及面神经与肿瘤的黏连程度与重度障碍组比较,差异均具有统计学意义（P<0.05）。多因素Logistic回归分析结果提示,肿瘤最大直径>3.13 cm、肿瘤部分切除与次全切除、面神经与肿瘤中、重度黏连均是导致术后面神经功能严重障碍的独立危险因素（OR>1,P<0.05）,而术中行面神经监测是术后面神经严重障碍的保护因素（OR<1,P<0.05）。 结论AN瘤体大小、肿瘤切除程度、术中是否行面神经监测以及面神经与肿瘤的黏连程度是影响患者乙状窦后入路显微切除AN术后面神经功能受损程度的独立因素。     

Post-surgical vestibular schwannoma remnant tumors: What to do?

BackgroundVestibular schwannomas (VS) are benign tumors of the vestibular nerve's myelin sheath. The current trend in VS surgery is to preserve at the facial function, even if it means leaving a small vestibular schwannoma tumor remnant (VSTR) after the surgery. There is no defined therapeutic management VSTR. The aim of this study was to assess the evolution of the VSTR to define the best therapeutic management and identify predictive factors of VSTR progression.MethodsAmong the 256 patients treated surgically for VS in the Department of Neurosurgery at Angers University Hospital, 33 patients with a post-surgical VSTR were included in this retrospective study. For all surgical patients, the data collected were age at diagnosis, the Koos classification, the surgical access, the existence of a type 2 neurofibromatosis (NF2), the TR location and size on control MRI-scans. Patients had a bi-annual follow-up with clinical status and VSTR size assessment with MRI-scan. Survival analyzes were performed to determine the time and rate of VSTR progression, and identify factors of progression.ResultsThe mean follow-up of the population was 51 months. All VS remnant progression occurred between 38 and 58 months after surgery. In non-NF2 patients with first follow-up MRI-scan three months after surgery, 43% presented a spontaneous regression, 50% a stability and 7% a progression of the VSTR. In the same population with the 1-year MR-scan after surgery as baseline, 25% presented a spontaneous regression, 62.5% a stability and 12.5% a VSTR progression. These data are consistent with the data reported in the literature. The post-operative facial function impairment and an initial remnant ≥ 1.5 cm³ were found to be significant risk factors of VS remnant progression in non-NF2 population in univariate analysis (P = 0.048 and 0.031) but not in multivariate analysis.ConclusionIn our experience, the best therapeutic management of the post-surgical VSTP in non-NF2 patients with no risk factor of progression is a simple clinical radiological follow-up otherwise complementary radiosurgery should be considered.     

Toothache Caused by Trigeminal Neuralgia Secondary to Vestibular Schwannoma: A Case Report

Introduction

Vestibular schwannoma, also called acoustic neuroma, is a tumor composed of Schwann cells that most commonly involves the vestibular division of the 8th cranial nerve. A thorough medical and dental history and properly conducted diagnostic testing and radiographic evaluation are essential in differentiating odontogenic tooth pain from tooth pain of a nonodontogenic origin.

Methods

This report discusses a case of acoustic neuroma mimicking odontogenic pain. A 61-year-old man presented with pain in the lower left quadrant. Medical history revealed peripheral neuropathy and prior exposure to Agent Orange. Diagnostic testing on teeth #19, #20, and #21 ruled out an odontogenic cause for the pain. Brushing of a specific region of the face elicited pain that resembled the patient's chief concern. The patient was referred to a craniofacial pain center with the tentative diagnosis of trigeminal neuralgia. Treatment for trigeminal neuralgia was not successful, prompting referral to the neurosurgery department where magnetic resonance imaging was performed.

Results

Magnetic resonance imaging revealed a moderate-size, lobular, left cerebellopontine angle mass lesion consistent with acoustic neuroma with compression of the left trigeminal nerve secondary to the lesion.

Conclusions

Acoustic neuroma can cause tooth pain secondary to compression of the trigeminal nerve.