胸腰段髓内神经鞘瘤继发出血1例报告

神经鞘瘤是椎管内常见肿瘤之一,其好发部位是髓外硬膜下或硬膜内外[1],脊髓髓内神经鞘瘤临床十分少见,髓内神经鞘瘤继发出血更为罕见。我院骨科2009年3月~2012年2月共收治脊髓髓内神经鞘瘤3例,其中1例继发髓内出血,报告如下。     

Trochlear neurinoma: case report

A case of solitary neurinoma of the trochlear nerve was reported. The patient was a 37-year-old female, who had a sudden attack of right-sided temporal headache with nausea and vomiting on August 1, 1982. Headache was subsided in a few days but she had complained of diplopia since the episode. Ophthalmological examination revealed right superior oblique muscle palsy. She was neurologically free otherwise. CT scan, taken about three weeks after the onset, showed a solitary enhancing mass in the region of tentorial incisura on the right side. She was admitted to our clinic on August 24, 1982. Extensive work-up including polytomography, cerebral angiography, lumbar puncture, and so forth, revealed no abnormality. There were no cutaneous manifestations of von Recklinghausen's disease. Craniotomy was performed on October 28, 1982 and the tumor was totally removed by way of right subtemporal-transtentorial route. The tumor, size of which was 1.0 X 0.9 X 0.7 cm, was located just underneath the tentorial edge, and was adherent to it. The trochlear nerve was found incorporated in the tumor. Histological diagnosis was neurinoma of Antoni A type. Postoperatively, she was well and fully active, except for diplopia due to the sacrificed trochlear nerve.     

Massive hemorrhage within an acoustic neurinoma. Case report

A 39-year-old male experienced unilateral right hearing loss and tinnitus for 7 years and was hospitalized after he suddenly developed severe headache, vertigo, and right facial paralysis. Computed tomography (CT) showed a round, high-density are in the right cerebellopontine angle. Magnetic resonance (MR) imaging demonstrated a crescent-shaped region of high signal intensity, representing hemorrhage, in the superior aspect of the tumor, surrounded by edema. The right internal auditory canal was enlarged. Four-vessel angiography disclosed neither an aneurysm nor an arteriovenous malformation. A right suboccipital craniectomy revealed an encapsulated mass 3 cm in diameter in the right cerebellopontine angle. The tumor was totally removed. Histological examination revealed a typical neurinoma composed of Antoni type A and B cells. After undergoing anastomosis of the right hypoglossal and facial nerves, the patient was discharged in good condition. In this case MR imaging demonstrated intratumoral hemorrhage (which is rare in cases of acoustic neurinoma) and the surrounding tissue more clearly than did CT scanning.     

Large dumbbell neurinoma of hypoglossal nerve: case report

Hypoglossal neurinomas are rare. Only 46 cases have been reported. We report a case of dump-bell neurinoma with a large multilobulated intracranial component. The relevant literature is reviewed.     

Multiple neurinoma of the spinal cord: case report

The patient, a 72-year-old female, was admitted with an 11-year history of progressive dysesthesia in the left leg. Neurological findings on admission revealed weakness in the bilateral legs, hyperreflexia of left leg, hypalgesia and hypesthesia under the Th 8 level, and urinary incontinence. Plain lumber X-ray showed enlargement of the intervertebral foramen of L 1/2. Myelography disclosed block age at the level of Th 9 and filling defect at the level of Th 10/11 and L1/2. CT myelography revealed a cord swelling and partially exophytic tumor from Th 8 to Th 9, another tumor located posterior-laterally at the level of Th 11, and another tumor located extra and intradural at the level of L1/2. Laminectomy was performed from Th 8 to L 3. A tumor of the Th 9 was located intramedullary, another tumor of the Th 11 was located intradural extramedullary, and another tumor of the L1/2 was located in the epidural space (so-called dumb-bell type tumor). These tumors were removed completely except the extra-canal part of L1/2 tumor. Histopathological examination revealed typical Antoni type A schwannoma in all tumors. This case was considered multiple neurinomas of the spine in which tumors were located in three separate anatomical sites, intramedullary, intradural extramedullary, and epidural sites. This patient did not show café-au-lait spot, and neurofibroma in her body. The authors considered the patient might be a case of central neurofibromatosis. The authors stressed that multiple neurinomas of the spine is not rare, so careful study of the whole spine is necessary including its intramedullar space.     

A case of acoustic neurinoma presenting as subarachnoid hemorrhage

A case of acoustic neurinoma presenting with subarachnoid hemorrhage is reported. The patient, a 33-year-old female, had suffered from left hearing disturbance and tinnitus for several years prior to admission. She had sudden onset of severe headache in the left posterior auricular region, nausea and vomiting while watching a play-going. Immediately she was brought to a neighboring hospital by ambulance. Lumbar puncture demonstrated xanthochromic cerebrospinal fluid with high opening pressure of 380 mmH2O or more and she was diagnosed as having subarachnoid hemorrhage (SAH). As her level of consciousness was progressively lowered, she was transferred and admitted to our hospital. Findings of plain CT scan on admission suggested that she had a brainstem hemorrhage with acute obstructive hydrocephalus. After the immediate operation of ventricle drainage, she became alert. Two weeks after admission, contrast-enhanced CT scan, internal meatus tomography and vertebral angiography were performed because she complained of tinnitus and hearing loss of her left ear. A huge lt. C-P angle tumor was revealed and its total removal was carried out successfully after V-P shunt operation for her hydrocephalic condition. Histological examination showed a typical acoustic neurinoma. The postoperative course was uneventful only with a moderate facial paresis on her left side. Acute and severe subarachnoid hemorrhage of the posterior fossa in cases of acoustic neurinoma has been reported very sporadically. However, CT examination revealed such a rare case of acoustic neurinoma and lead us to a successful surgical treatment for the patient.     

Extracranial posterior inferior cerebellar artery aneurysm causing isolated intraventricular hemorrhage: a case report

The authors report the unusual case of an aneurysm arising on an extracranial loop of the left posterior inferior cerebellar artery (PICA). The computed tomographic scan showed an isolated hemorrhage in the lateral ventricles, and the lesion was recognized 1.5 cm below the foramen magnum at the level of the atlas. The literature concerning peripheral PICA aneurysms is reviewed and the clinical and radiological features of these lesions are discussed. A tendency for subarachnoid bleeding from distal PICA aneurysm ruptures to spread into the ventricular system is suggested. The diagnosis of distal PICA aneurysm should also be considered in cases of isolated intraventricular hemorrhage without obvious parenchymal or subarachnoid hemorrhage. The need for four-vessel angiography when studying patients suffering from a subarachnoid hemorrhage is stressed.     

Trigeminal neurinoma associated with suprasellar arachnoid cyst: case report

The first case of trigeminal neurinoma associated with suprasellar arachnoid cyst is presented. Coexistence of these two lesions may be accidental, but it is also possible that the arachnoid cyst was secondary to the neurinoma.     

Transsacral rectocele following combined neurinoma resection: A case report

IntroductionThis report describes for the first time a case of a transsacral rectocele after combined abdominotranssacral tumour resection. Furthermore, we demonstrate a method for laparoscopic defect repair.Presentation of caseA 44-year-old Caucasian female presented to our hospital with strange gurgling sounds and a painless subdermal swelling in her lower back after resection of a presacral neurinoma two years earlier. Magnetic resonance imaging (MRI) showed a huge rectocele through a sacral defect extending into the subcutaneous tissue. We performed a laparoscopic defect repair with the implantation of a self-fixating mesh graft. Five days after surgery, the patient was discharged in a good general condition. Five months after the operation, a follow-up MRI showed a good postoperative result with the correct position of the rectum.DiscussionThe repair of transsacral prolapses with attachment of a mesh is complicated by the high rigidity of the pelvis and its surrounding structures. The key criteria in choosing the method of operative approach are the size and content of the prolapse. Huge sacral defects with bowel prolapses require a transabdominal approach to enable repositioning the bowel into the abdomen and excluding bowel injuries and inner hernias.ConclusionA laparoscopic approach provides a good intraoperative visibility for a safe retrorectal preparation and mesh graft repair of sacral defects.     

Acoustic neurinoma presenting with repeated intratumoral hemorrhage. Case report

A case of acoustic neurinoma with multiple intratumoral hemorrhages is reported. A 56-year-old male noted sudden hearing reduction in his left ear in October of 1985. The diagnosis of a local physician was sudden deafness. About 10 months later, he had two episodes of severe headache without nausea or vomiting. The patient was hospitalized in October of 1986. Neurological examination cerebellar ataxia. cerebellar ataxia. Plain and enhanced computed tomography revealed only an unremarkable low-density area at the left cerebellopontine angle. In contrast, magnetic resonance imaging (MRI) clearly demonstrated a large (3 x 4 x 5 cm), multicystic tumor in the site. On exposure of the tumor at surgery, most of the cysts were found to be filled with a dark red or xanthochromic fluid. The tumor was completely removed following numerous cyst punctures to decrease its volume. There was no evidence of subarachnoid hemorrhage. Histological examination showed a typical acoustic neurinoma. The cyst wall contained numerous telangiectasia-like lesions. The initial symptom of this patient was sudden hearing loss, which is an atypical manifestation of acoustic neurinoma. The massive intratumoral hemorrhage was thought to be caused by telangiectatic lesions in the cyst wall. MRI clearly demonstrated the hemorrhagic cysts within the tumor, especially in the posterior fossa.     

Choroid plexus metastasis of renal cell carcinoma causing intraventricular hemorrhage: a case report]

We report a rare case of choroid plexus metastasis of renal cell carcinoma causing intraventricular hemorrhage. A 75-year-old female was admitted to our hospital for SAH. Preoperative examination evoked suspicion of an anterior communicating aneurysm as a cause of SAH. Furthermore, there were lesions on the tuberculum sellae and in the left trigone of the lateral ventricle, which were enhanced by Gd-DTPA on MRI. The patient was operated on via the pterional approach on December 3, 1996, but no aneurysm was found. She underwent total removal of the tuberculum sellae mass, which was postoperatively proved to be a meningioma by histological examination. The intraventricular tumor was supposed to be a meningioma, but it was not treated surgically. Two months later, the patient presented hematuria and was diagnosed as having a right renal cancer and underwent right nephrectomy on March 18, 1997. However, postoperatively, disturbance of consciousness continued. A CT scan revealed intraventricular hemorrhage around the tumor in the trigone of the lateral ventricle on March 21. An emergency operation for tumor and clot removal succeeded in improving the patient's condition. Histological examination of the tumor revealed clear-cell type renal cell carcinoma. Solitary choroidal plexus metastasis from renal cell carcinoma is quite rare: only 5 cases have been reported. But only our case was accompanied by intraventricular hemorrhage. Renal cell carcinomas are divided into two types: a slowly progressive type and a rapidly progressive type. Four cases among the reported 5 cases were the slowly progressive type, and our case was regarded as being of the same type.     

Combination of stenting and coil embolization for carotid artery pseudoaneurysm causing symptomatic mass effect: case report

A case of cervical pseudoaneurysm secondary to carotid artery dissection causing symptomatic mass effect was reported. A 60-year-old woman presented with the complaint of right neck swelling and dysphagia that was considered to be the mass effect of a pseudoaneurysm caused by dissection of the right common carotid artery (CCA). Although a self-expanding stent was deployed to cover the orifice of the pseudoaneurysm, the pseudoaneurysm had been enlarged because of thrombus formation on the inner wall. A microcatheter was guided through the stent mesh into the aneurysm, and Guglielmi detachable coils were placed to embolize the orifice. One month later, angiography revealed complete embolization of the aneurysm while preserving flow in the CCA. The mass effect attributable to the pseudoaneurysm was relieved symptomatically as well as radiologically. Carotid artery dissection with symptomatic mass effect can be treated successfully, using a combination of stent and coils. This method may be considered to be an alternative to conventional surgical treatment such as proximal ligation, extracranial-intracranial bypass, or direct surgical repair.     

Intraventricular varix causing hemorrhage. Case report

A case of a cerebrovascular varix located in the right lateral ventricle is reported. The patient suffered intraventricular and subarachnoid hemorrhages. The intraventricular varix was coagulated and excised.     

A trigeminal neurinoma involving the lacrimal nerve: case report.

An isolated neurinoma involving the entire length of the lacrimal nerve is reported. The tumour was large and involved both the intracranial cavernous sinus, as well as the extracranial intraorbital part of the nerve. The patient, a 45-year-old housewife had a painless progressive proptosis associated with marginally decreased lacrimation of the affected eye. There was no evidence of neurofibromatosis.     

Massive hemorrhage in acoustic neurinoma after minor head trauma--case report.

Massive hemorrhage within an intracranial neurinoma occurs rarely. The authors describe a 62-year-old female with intratumoral bleeding which led to the discovery of an acoustic neurinoma. She developed a gait disturbance after a minor head injury. A computed tomographic scan obtained 2 months later demonstrated multiple high-density areas in the anterior portion of the left cerebellopontine angle. Preoperative diagnosis was acoustic neurinoma. The tumor had multiple cysts which contained a mixture of xanthochromic fluid and old, brownish hematomas, and was successfully removed. The intratumoral hemorrhage is thought to have resulted from traumatic rupture of the dilated vessels, although the trauma was slight. This is the first reported case of an acoustic neurinoma discovered through treatment for intratumoral hemorrhage occurring after a minor head injury.     

Intracranial hypoglossal neurinoma with extracranial extension: review and case report

A case of neurinoma affecting the intracranial part of the hypoglossal nerve is reported. Symptoms and signs, radiological findings, and operative results of other cases are reviewed. The value of computerized tomography and magnetic resonance imaging in local diagnosis and the feasibility of a one-stage operation for total removal of tumors with extracranial extension are discussed.     

Primary symptomatic perivesical paraganglioma: a case report

Paraganglioma, extra-adrenal pheochromocytomas, are relatively rare in adults, with most arising from para-aortic sympathetic and visceral organs, such as the bladder. Paraganglioma localized at the extravesical retroperitoneal pelvic cavity is extremely rare. We report a case of symptomatic perivesical pheochromocytoma in a 34-year-old man treated by surgical excision. Symptoms related to cathecolamine secretion ceased after surgery, and the patient has remained disease-free for 24 months.