三叉神经鞘瘤的MRI 诊断

分析三叉神经鞘瘤的ＭＲＩ表现。方法搜集病理证实的三叉神经鞘瘤６例,其中并发神经纤维瘤病２例,均行ＭＲ平扫及增强检查。结果肿瘤ＭＲ表现以哑铃状骑跨征为主,肿瘤大多为实性,边界清楚,有完整的包膜肿瘤呈等。混杂或长Ｔ１、长Ｔ２信号,注射Ｇｄ－ＤＴＰＡ后性病灶呈均匀强化,整性病灶呈环状强化。结论ＭＲＩ以其特有的多方位断层,多参数成像对三叉神经鞘瘤的定位,定性诊断具有很高的准确性。     

后纵隔巨大神经鞘瘤1例并文献复习

神经鞘瘤又称施万细胞瘤,为常见的后纵隔神经源性肿瘤,绝大多数为良性肿瘤,但存在恶变可能。临床表现可因瘤体大小及生长位置不同而不同,常通过相关影像学检查发现。本文报道1例巨大神经鞘瘤手术切除病例,结合相关文献资料对神经鞘瘤的病理特点、影像学特点、临床诊治方法等作一归纳总结。     

民航飞行员三叉神经鞘瘤术后放飞一例

一、临床资料患者男性,55岁,13737 300/800型机长教员,飞行时间11 000 h.因间断性头痛,右侧面部皮肤麻痹9月余,加重两月,于2004年6月收住北京天坛医院,入院诊断:桥小脑角占位病变.同月在该院于8倍显微镜下行右侧桥小脑角肿瘤切除术(瘤体4.0 cm×3.5 cm).术后病理检查:三叉神经鞘瘤.术后恢复良好,无不适症状,24 h脑电图、电测听、听觉诱发电位、前庭功能检查及颅脑MRI均未见异常.2005年9月天坛医院专家会诊意见如下:①手术成功,属良性肿瘤.     

下颌骨神经鞘瘤一例报告

女性,22岁,住院号:85056,右下颌肿胀不适二月余并逐渐增大,于1978年7月21日来院就诊。查体:右下颌有4×3厘米大小肿块,表皮不红,触诊肿块质硬并有轻度压痛,口内右下第6、7牙齿松动Ⅱ度。化验检查:白细胞6800,中性72%,淋巴25%,单核2%,伊红1%。X线检查:右侧下颌骨体部有4.2×3.2厘米大小呈囊状膨胀性骨质破坏区,边界清晰周边有线状硬化影,右下第5、6、7牙槽骨质有吸收。X线印象:考虑为颌骨牙源性囊肿。     

气管神经鞘瘤一例

患者　男 ,48岁。 1年前无明显诱因出现劳累后呼吸困难、气促、紫绀 ,呼吸困难进行性加重 ,咯白痰。胸片 :气管内结节影 ,直径约 2 .3ｃｍ ,密度均匀 ,边缘清晰锐利 ,与右侧气管壁呈锐角相接 ,几乎堵塞全部气道。ＣＴ横断面扫描 :气管右侧壁见一肿块影 ,直径为 4 1ｃｍ ,大部分位于气管外 ,并向气管内突入 ,阻塞约 3/ 4气腔 ,病灶内缘规则 ,密度均匀 ,ＣＴ值 42ＨＵ ,与周围血管关系密切 ,但能分清 (图 1)。利用螺旋ＣＴ 3ｍｍ薄层扫描后重叠5 0 %重建 ,传送到独立工作站上进行多平面重组、最小密度重建、表面覆盖显示、四维血管造影法 (图 …     

右腓骨神经鞘瘤一例报告

患者，男，33岁，因右外踝部肿胀疼痛15年，近日加重收入我院骨科。体检：右外踝处高起，肿胀，触受4．0cm×3．0cm肿物，质韧，局部轻压疼，边界清楚。局部皮肤无红热。表面皮肤无静脉怒张，无色素沉着。实验室检查无特殊。     

左侧膈神经神经鞘瘤一例

患者　男 ,5 7岁。在外院行左侧甲状腺囊肿切除术后7ｄ ,颈胸部ＭＲＩ检查 ,偶然发现左侧中纵隔内肿块 ,而转入我院进一步诊治。患者无明显自觉症状。平片示左侧中纵隔增宽。ＭＲＩ示左肺动脉旁一 3 0ｃｍ× 2 0ｃｍ× 3 5ｃｍ大小肿块影 ,边缘光整规则 ,Ｔ1ＷＩ呈均匀低信号 (图 1) ,Ｔ2 ＷＩ呈中央低信号 ,周围高信号。ＣＴ平扫示肿块呈均匀低密度 ,增强后呈中等度均匀强化 (图 2 )。手术中见左肺动脉旁椭圆形肿瘤 ,约 3 0ｃｍ× 2 0ｃｍ×3 5ｃｍ大小 ,质较硬 ,分界清 ,包膜完整 ,肿瘤将左膈神经完全包绕于其中 ,可见肿瘤上下端处与正…     

颅内三叉神经鞘瘤的MRI诊断及鉴别诊断

目的:分析三叉神经鞘瘤的生长部位、MRI表现及其影像特征,以提高其诊断准确性。方法:回顾性分析经手术病理证实的三叉神经鞘瘤8例,分析MRI平扫及增强扫描结果并与病理作对照分析。结果:8例三叉神经鞘瘤中,左侧3例,右侧5例。3例呈椭圆形生长于中颅窝,5例跨颅窝生长,呈哑铃型。6例突入颞下窝。2例实性病变伴有囊变,6例基本为实性。肿瘤实性部分在T2加权像呈"椒盐"样改变,增强扫描其实性部分明显强化。结论:三叉神经鞘瘤的生长部位、肿瘤的形态及信号特征对于诊断有一定的参考价值。     

腹膜后神经鞘瘤(附1例报告)

腹膜后神经鞘瘤为少见病,2005年4月我院收治1例,现结合文献复习报告如下。1病例病人,男,37岁。间断性右上腹痛10年,无其他伴发症状,可自行缓解。CT扫描提示:胰头后方、腔静脉与腹主动脉间见一类圆形软组织影,直径近3cm,边界清晰,注入造影剂后逐渐强化,延迟后密度仍较高;周围未见肿大淋巴结。入院后经术前准备,在全麻下行腹膜后肿瘤切除术。术中见:肿瘤位于胰头后腹主动脉旁,肠系膜上动脉的右侧,下腔静脉及左肾静脉前方,3cm×4cm大小为类圆形实性肿物,边界清,包膜完整。术后病理:腹膜后神经鞘瘤。术后随访半年,无复发。2讨论2·1概况神经鞘…     

耻骨神经鞘瘤一例

患者　女 ,1 6岁。无意中发现右耻骨包块 4天入院。查体 :右耻骨局部轻度隆起 ,可扪及一 2 .0cm× 3.0cm大小的肿块 ,质硬 ,固定 ,边界清 ,有轻度压痛 ,局部软组织无红肿 ,腹股沟区未扪及肿大淋巴结。实验室检查未见异常。X线平片检查 :右耻骨膨隆 ,其内可见多个不规则形的透亮区及粗网格状结构 ,呈膨胀性改变 ,骨皮质变薄 ,病变累及整个耻骨 ,约 5 .0cm× 1 0 .0cm ,未见骨膜反应及软组织肿块影。X线诊断 :右耻骨骨巨细胞瘤 (图 1 )。CT检查 :平扫示右耻骨约 5 .0cm× 5 .2cm× 1 0 .5cm大小的膨胀性低密度区 ,其内呈软组织密度 ,CT值为…     

变异的原始三叉动脉夹层动脉瘤的血管内治疗一例并文献复习

目的探讨夹层动脉瘤的发生机制及变异性原始三叉动脉(primitive trigeminal PTA)动脉瘤的血管内治疗。方法报道并分析我院治疗存在PTA并发夹层动脉瘤的病例;Medline数据库检索PTA动脉瘤及所有关于变异型原始三叉动脉(PTAV)的文献,行文献复习。结果通过闭塞夹层动脉瘤及PTAV本身的术式治愈患者,出院及1年随访的MRS评分均为0分。存在原始三叉动脉者颅内动脉瘤的发病率约为3%,其中动脉瘤发自PTA本身约占2%,见37例报道,其中2例为夹层动脉瘤。PTAV动脉瘤的发生率约为9.8%,其中夹层动脉瘤的发生率在PTAV组及PTA组分别为50%和5.4%。结论血管发育异常是除血流动力学因素以外的动脉瘤,特别是夹层动脉瘤的发病原因之一,在无其他并存血管异常时,闭塞载瘤动脉是对PTAV动脉瘤安全和有效的治疗方法。     

Persistent primitive trigeminal artery associated with aneurysm: report of two cases and review of the literature

We present two cases of persistent primitive trigeminal artery (PPTA) associated with a giant aneurysm originating at the opening of the PPTA on the internal carotid artery (ICA). In one case, opening of the PPTA occurred 4 months after balloon occlusion of the ICA, when a giant aneurysm located at the cavernous segment of the ICA was being treated. The PPTA was occluded successfully using a Guglielmi detachable coil (GDC). A vertebral artery approach was taken. This is the first report of the opening of a PPTA associated with contrast filling of the aneurysm after balloon occlusion of the parent artery. The possibility of contrast filling of the aneurysm via potential PPTA should therefore be considered in the event of an ICA aneurysm with parent artery occlusion.     

Persistent trigeminal artery associated with trigeminal neuralgia: hypothesis of neurovascular compression

Introduction The aim of this study was to determine the prevalence of persistent trigeminal artery (PTA) associated with trigeminal neuralgia (TN). Methods From January 1998 to January 2004, 288 MRI scans of patients examined for trigeminal deficits were retrospectively evaluated. MRI was performed at 1.5 T. Scan protocols included cerebral TSE T2-weighted imaging, contrast enhanced SE T1-weighted imaging and thin-section 3D T2-weighted imaging of the temporal bones, 3D TOF pre- and postcontrast MR angiography. TN was defined as episodes of intense stabbing, electric shock-like pain in areas of the face supplied by the trigeminal branches. Neurovascular compression (NVC) was assumed to be present if the patient showed clinical features of TN, if there was contact between an artery and the trigeminal nerve on the affected side, and if other pathology had been excluded. The prevalence and confidence intervals were calculated (95% CI of the prevalence was based on the exact binomial distribution). Results Of 288 patients, 136 matched the criteria for TN. In this series a PTA was detected in three patients, which in all patients was on the same side as the TN. The prevalence of a PTA in patients presenting with TN was 2.2% (CI 0.005–0.06). Conclusion Previous studies have shown PTA as an incidental finding in 0.1–0.6% of cerebral angiograms. The prevalence of a PTA in patients with TN was 2.2%. With respect to the clinical significance, a PTA has to be considered in TN and the diagnosis of a PTA can easily be made using MR imaging/angiography.     

Intracranial hypoglossal neurinoma: Report of a case

Summary A case of intracranial hypoglossal neurinoma is reported. The diagnostic importance of an enlarged hypoglossal canal with isolated hypoglossal nerve palsy is emphasized. The computed tomography and angiographic findings are described.     

Primitive trigeminal artery associated with an ipsilateral intracavernous giant aneurysm—A case report

Summary A case of primitive trigeminal artery associated with an ipsilateral intracavernous giant aneurysm is reported and the difficulty in treating this aneurysm is discussed.     

Gliosarcoma with direct involvement of the oculomotor nerve: Case report and literature review

Gliosarcoma is a rare malignant brain tumor, characterized by a biphasic tissue pattern with alternating areas displaying glial and mesenchymal differentiation. We first report a case of temporo-mesial gliosarcoma, extended to the crural and ambient cisterns, with direct involvement of the ipsilateral third cranial nerve and encasement of anterior choroidal, posterior communicant and posterior cerebral arteries, presenting without symptoms of peripheral neuropathy. A 61-year-old woman with 1-month history of intense bilateral frontal-temporal headache resistant to pharmacological therapy and paresis of the left lower midface underwent surgical resection, through pterional trans-sylvian approach, of a right temporo-mesial gliosarcoma which directly involved the ipsilateral oculomotor nerve. Reported cases of gliomas with direct involvement of a cranial nerve, from the third to the twelfth, are very rare, whit no cases of gliosarcoma described. Because of its rarity, sometimes this entity is not considered as diagnostic hypothesis and is misdiagnosed, both during preoperative diagnostic evaluation and during the surgery. Gliosarcoma is a strong challenge for neurosurgeons and neurooncologists because of low incidence, poor prognosis and limited reported cases on literature. This case shows unique features for localization, pattern of growth and clinical presentation.     

永存原始三叉动脉供血颈动脉-海绵窦瘘1例北大核心CSCD

1临床资料患者女,51岁。因“左侧头部及面部搏动性疼痛伴头晕、耳鸣2个月”入院。患者既往身体健康,查体可闻及左侧眼球后搏动性血管杂音,左侧眼球突出伴球结膜水肿。患者入院后行全脑血管造影见左侧永存原始三叉动脉供血的颈动脉-海绵窦瘘(carotid-cavernous sinus fistula,CCF),原始三叉动脉两端分别与左侧颈内动脉海绵窦段及左侧小脑上动脉相连,左侧小脑上动脉远端未见显影,主要经眼上静脉、岩上窦、基底窦、直窦引流(图1)。     

Noninvasive mapping of human trigeminal brainstem pathways

The human trigeminal system mediates facial pain and somatosensory processing. The anatomic location of neuronal substrates and axonal pathways of the trigeminal system have previously been characterized with conventional in vitro methods. The present investigation implemented diffusion tensor imaging (DTI) and probabilistic tractography to first segment the peripheral trigeminal circuitry, trigeminal nerve branches (ophthalmic, maxillary, and mandibular nerves), ganglion, and nerve root. Subsequent segmentations involved the spinal trigeminal and trigeminal thalamic tracts, which respectively convey information to the spinal trigeminal nuclei and ventral thalamic regions. This latter procedure also identified 1) spinal thalamic (anterolateral [AL]) system pathways (propagating pain and temperature information from the body), 2) trigeminal lemniscus (TL; touch and face position), and 3) medial lemniscus (ML; touch and limb position). The anatomic location of the identified pain and somatosensory pathways compared well with previous functional findings in the human trigeminal system, as well as the tract position in human histological cross sections. Probabilistic tractography may be a useful method to further comprehend the functional and structural properties of trigeminal and other related systems. Application of DTI to map pain and somatosensory pathways in conjunction with a characterization of function properties of pain and somatosensory processing would further define the systematic changes that occur in trigeminal pathology. Magn Reson Med 60:1037–1046, 2008. © 2008 Wiley‐Liss, Inc.     

Case report: Unilateral masticatory atrophy caused by pure trigeminal motor neuropathy

Pure trigeminal motor neuropathy (PTMN) is characterized by trigeminal motor weakness without signs of trigeminal sensory dysfunction or involvement of other cranial nerves. We describe a rare case of an 83-year-old man with weakness and atrophy of the right masticatory muscle without any sensory disturbance. Brain computed tomography and magnetic resonance imaging revealed atrophy and fatty infiltration of the right masticatory muscle. Electromyography revealed abnormal spontaneous activity, chronic neurogenic motor unit potentials, and reduced interference patterns in the right temporalis and the masseter muscles. The patient was diagnosed with PTMN based on the clinical symptoms and examinations. Our case presents a rare clinical manifestation with unclear etiology.