Intracochlear schwannoma extending to vestibule

Intralabyrinthine schwannomas are benign tumors arising de novo from the perineural Schwann cell sheath of the intralabyrinthine branches of the vestibulocochlear nerve. The development of magnetic resonance imaging (MRI) has significantly increased the diagnosis of these tumors. Intralabyrinthine schwannomas can be sub-classified into seven groups according to the structures of the inner ear that are affected. The management strategy for intralabyrinthine schwannoma is regular monitoring with MRI, as the tumor grows slowly. In cases where the tumor growth is documented on serial MRI or disturbing vestibular symptoms are present, surgical removal can be considered. The surgical approach varies based on tumor location and size. We report a case of intravestibulocochlear schwannoma causing vertigo that developed from an intracochlear tumor during MRI. We successfully removed the tumor via the transotic approach.     

Solitary schwannoma of the cervical vagus nerve.

A case of benign, solitary schwannoma of the cervical vagus nerve with ipsilateral vocal cord paralysis is presented. The differential diagnostic aspects are discussed, with special reference to neurologic deficit in association with this lesion. The possible occurrence of concomitant unrelated malignancy is emphasised.     

保护发音功能的迷走神经鞘瘤切除术

目的　探索在迷走神经鞘瘤切除手术中如何保护发音功能。方法　分析 1997年 1月～ 2 0 0 1年 9月手术治疗并经病理证实的迷走神经鞘瘤 10例。手术中显露肿瘤后探查迷走神经 ,确认肿瘤起源于喉返束还是非喉返束。在肿瘤后外侧非喉返束位置作 1～ 2cm长小切口 ,钝性撕开切口 ,轻柔操作切除肿瘤。结果　起源于迷走神经喉返束的 4例中 ,术后无声嘶 2例 ,另 2例声嘶术后 5～ 12个月消失。起源于非喉返束的 6例术后有 1例声嘶 ,5例无声嘶。结论　正确的手术方法对起源于非喉返束迷走神经鞘瘤行切除术后可完整保护发音功能 ;而对起源于喉返束者需加用神经刺激器与手术显微镜以提高保护发音的成功率     

保护发音功能的迷走神经鞘瘤切除术

目的：探索在迷走神经鞘瘤切除手术中如何保护发音功能。方法：分析1997年1月－2001年9月手术治疗并经病理证实的迷走神经鞘瘤10例。手术中显露肿瘤后探查迷走神经，确认肿瘤起源于喉返束还是非喉返束。在肿瘤外外侧非喉返束位置作1－2cm长小切口，纯性撕开切口，轻柔操作切除肿瘤。结果：起源于迷走神经喉返束的4例中，术后无声嘶2例，另2例声嘶术后5－12个月消失。起源于非喉返束的6例术后有1例声嘶，5例无声嘶。结论：正确的手术方法对起源于非喉返束迷走神经鞘瘤行切除术后可完整保护发音功能；而对起源于喉返束者需加用神经刺激器与手术显微镜以提高保护发音的成功率。     

Cystic schwannoma of the cervical plexus masquerading as a type II second branchial cleft cyst

This case illustrates the rare occurrence of a cystic schwannoma of the neck, presenting clinically and ultrasonographically as a type II second branchial cleft cyst. Histology demonstrated that it was in fact a rare cystic schwannoma, most likely arising from the cervical plexus. This is the first documented case of a cystic schwannoma of the neck being mistaken for a type II second branchial cleft cyst based on clinical and ultrasound findings alone. It suggests that more sophisticated radiological investigations, such as magnetic resonance imaging, may enable accurate diagnosis of a cystic schwannoma of the neck pre-operatively.     

Accessory nerve function in lateral selective neck dissection with undissected level IIb

BACKGROUND: To investigate the accessory nerve function in lateral selective neck dissections (LSND) performed in laryngeal squamous cell carcinoma patients without dissection of level IIB. METHODS: Fifteen LSND were performed in 11 N0 laryngeal carcinoma patients with preservation of level IIB. Distal latencies, compound muscle action potentials (CMAP), and electromyography findings were investigated before surgery, during the 3rd postoperative week, and 3 months thereafter to compare the effects of the procedure on the accessory nerve. RESULTS: Distal latencies and CMAP values were significantly lower in the early and late postoperative periods when compared with preoperative values. In 8 patients, there was no motor unit potential (MUP) in the early postoperative period. However, in the late postoperative period, there was no MUP loss. CONCLUSIONS: Only temporary functional deterioration of the accessory nerve was seen in patients in whom LSND was performed with undissected level IIB.     

Malignant schwannoma of infraorbital nerve

Schwannoma of the head and neck may develop from many nerves, i.e. cranial or spinal. The authors described malignant schwannoma of infraorbital nerve. Patient was treated by combined method: in first step chemotherapy, in second surgical excision with 2 year disease-free survival.     

Consequences of the bilateral vagus nerve section at a cervical level

We present the consequences corresponding to a bilateral section of the main trunk of vagus nerve at cervical level in a patient with an oropharyngeal carcinoma with bilateral neck nodes. As a consequence of the bilateral resection of both vagus nerves during neck dissections, as well as motor and sensitive damage of the larynx and pharynx, we could observe affection of the normal tone of the oesophagus, stomach and duodenum which forced to enteral nutrition by direct jejunal access, and a disorder of the cardiac rhythm due to loss of the parasympathetic innervation appeared.     

Enucleation of vagal nerve schwannoma using intraoperative nerve monitoring

Vagal nerve schwannomas are rare, benign, neural sheath tumors. The treatment of enlarging or symptomatic vagal nerve schwannomas is surgical resection. Transecting the vagus nerve results in significant morbidity, and attempts at nerve preservation should be made whenever possible. We introduce a nerve-sparing technique using meticulous microsurgical dissection and intraoperative nerve monitoring for vagal schwannomas. A 61-year old patient presented with an enlarging 2-cm right vagal nerve schwannoma. She underwent resection via a transcervical approach. The patient was intubated with an electromyographic (EMG) endotracheal tube that allowed for monitoring of the recurrent laryngeal nerve intraoperatively. A microsurgical subcapsular dissection was performed after branches of the vagus nerve were identified using a nerve probe and preserved. At the conclusion of the resection the nerve was intact and stimulated along its entire course. Postoperatively, the patient had normal vagal nerve function. We introduced the role of intraoperative nerve monitoring using an EMG endotracheal tube for successful enucleation of vagal schwannomas. In conjunction with meticulous microsurgical dissection, nerve monitoring allows for successful preservation of the vagus nerve and decreased postoperative morbidity.     

Intraparotid facial nerve schwannoma. What to do?

• An intraparotid facial nerve schwannoma is often not recognised in pre‐treatment work‐up and frequently results in subsequent significant postoperative morbidity. • We have evaluated the literature regarding pre‐treatment work‐up and facial nerve function outcome. Two of our own cases are presented. • A minority of the intraparotid schwannomas can be removed by resection while preserving facial nerve integrity and function. • In the event of preoperative facial nerve dysfunction, tumour resection and subsequent nerve repair should be considered. • If resection of an intraparotid facial nerve schwannoma cannot be performed with preservation of facial nerve integrity and function, a wait‐and‐see policy seems justified due to the indolent behaviour of the tumour and moderate results of facial nerve reconstruction.     

Benign solitary schwannoma of the cervical vagus nerve. A case report with a review of the literature.

A case of benign solitary schwannoma of the cervical vagus nerve occurring in a 12-year-old girl is reported. Clinical and pathological problems connected with the neoplasm are discussed. From a review of the literature, the lesion seems to be less rare than is commonly believed. Treatment is also discussed, including the possibility of a surgical procedure which allows the restoration of function in the vagus nerve.     

Chondrosarcoma of the cervical vertebra: a case report

A rare case of cervical chondrosarcoma is presented and its clinical behavior and treatment modalities are discussed.     

Chondrosarcoma of the cervical vertebra: a case report

Summary A rare case of cervical chondrosarcoma is presented and its clinical behavior and treatment modalities are discussed.     

Syndromes after resection of a cervical schwannoma

Cervical schwannomas are rare, as fewer than 250 cases have been reported in the literature. The preferred method of removing a schwannoma is enucleation. Complications of schwannoma excision include Horner syndrome, first-bite syndrome, and Pourfour du Petit syndrome. These complications are usually transient and in most cases do not require treatment. Pourfour du Petit syndrome, which is the converse of Horner syndrome, occurs with stimulation of the sympathetic cervical chain. We report a case of cervical schwannoma in a 44-year-old woman who developed signs suggestive of both Horner syndrome and Pourfour du Petit syndrome following excision of the lesion. We discuss the diagnostic workup, surgical treatment, and likely sequelae of this pathology.     

Two cases of intraparotid facial nerve schwannoma

Intraparotid facial nerve schwannomas are rare, their preoperative diagnosis is difficult, and there are controversies about how to proceed when they are suspected intraoperatively. We present two cases of intraparotid facial nerve schwannoma that were diagnosed during parotid surgery, and describe the procedure and follow-up performed.     

Endoscopic surgical management of vidian nerve schwannoma

Vidian nerve schwannomas are highly unusual, with only two reported cases in the world literature, and present with a constellation of symptoms that may be extremely vague. In the reported cases, open techniques have been utilized that required significant dismantling of the midfacial skeleton to access and manage these skull base lesions. Over the last 15 years, a paradigm shift in base of skull surgery has evolved with the advent of transnasal endoscopic techniques and instrumentation, improved surgical access and resectability of most skull-based pathologies, including vidian nerve lesions as reported here. We describe the varied clinical presentation and radiologic findings in two patients with such rare lesions. In addition, in one of these patients, we report on the first use of an expanded endonasal technique to access and remove vidian nerve schwannomas entirely endoscopically.