Headaches after acoustic neuroma surgery

Headache and depression were studied in patients who had undergone operation for acoustic neuroma. A questionnaire with headache and Beck Depression Inventory scale were sent to 228 patients, of whom 192 (84%) responded. Preoperative headache was reported by 61 (32%) of the respondents (47 migraine and nine tension-type headache) and 122 (64%) respondents had postoperative headache (15 new migraine and four new tension-type headache). The new postoperative headache was chronic (≥3 months) in 86% and continued at the time of the survey in 55% and presented typically as severe short-lasting attacks provoked by physical stress, bending or coughing. Non-steroidal anti-inflammatory drugs were effective in most cases. Depression (usually mild) occurred in 24% of the respondents, being significantly more common in prolonged postoperative headache patients. The operation doubled the prevalence of headache (from 32% to 64%). Headache after acoustic neuroma operation appears to be a specific subgroup of postcraniotomy headache.     

Pulsed Radiofrequency Under Ultrasound Guidance for Persistent Stump‐Neuroma Pain

Limb amputation is a leading cause of pain and disability. Limb amputation can be associated with a myriad of symptoms, including phantom limb sensation, phantom limb pain, and stump pain. Treatment of phantom limb pain and stump pain, remains difficult, therefore optimal management must include a multidisciplinary approach. This case report describes the use of ultrasound for diagnosis and successful management, of persistent stump‐neuroma pain, using pulsed radiofrequency ablation.     

Noise exposure as a risk factor for acoustic neuroma: a systematic review and meta-analysis

Objective: To investigate whether acoustic neuroma is associated with noise.

Design: PubMed, Cochrane, Embase and CINAHL databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) using quality-effect models.

Study sample: A total of eight studies with moderate or high quality involving 75,571 participants met the inclusion criteria.

Results: There was no significant relationship between overall noise exposure and acoustic neuroma (OR:1.02, 95% CI: 0.64–1.63). However, further subgroup analysis showed that leisure noise exposure (OR: 1.73, 95% CI: 1.10–2.73), above five years’ exposure (OR: 1.81, 95% CI: 1.14–2.85) and continuous exposure (OR:2.77, 95% CI: 1.70–4.49) were associated with an increased risk of acoustic neuroma.

Conclusions: These results suggest an elevated risk of acoustic neuroma among individuals who have been exposed to occupational noise when some subgroup analysis are conducted. Leisure noise in particular seems to play a significant role in the development of acoustic neuroma. However, due to the heterogeneity among the included studies, this conclusion should be interpreted with cautions, even though the continuous long-term consequences should not be ignored.     

神经内窥镜下桥脑小脑角病变的解剖与治疗

目的探索神经内窥镜下桥脑小脑角区的局部应用解剖及神经内窥镜辅助显微手术的实用性。方法对2具尸头及38例桥脑小脑角病变患者的桥脑小脑角区进行神经内窥镜观察与治疗。结果在神经内窥镜下几乎能观察到桥脑小脑角区全部血管神经结构。38例桥脑小脑角病变患者无术后并发症及死亡。结论桥脑小脑角内窥镜下可分为头、中、尾侧三个层面,每个层面内含知名血管和神经。经乙状窦后人路神经内窥镜辅助显微手术治疗桥脑小脑角病变,可提高手术疗效,降低手术危险性。     

Headache after resection of acoustic neuroma

Long-lasting severe headaches are reported to occur in up to 83% of patients who have undergone resection of acoustic neuroma, especially through a suboccipital approach. These headaches, however, are not well defined. The objective of this study was to assess the frequency and character of new-onset headaches after resection of acoustic neuroma by a suboccipital approach with cranioplasty. Review of the medical record was followed by a telephone interview with 48 patients (67% female; mean age, 52 years) who had undergone resection of an acoustic neuroma through a suboccipital craniotomy during the 2 years before the study. Of the 48 patients, 58% had post-operative head pain that lasted more than 7 days and could be categorized into two types. A moderate to severe, short-term head pain with gradual resolution occurred in 35% of the patients, and a mild, unremitting pain was reported by 23%. Both types of pain had a dull ache or pressure quality and were adjacent to or confined to the incisional area. Overall, 77% of the patients were pain-free within 4 months after operation. Age, sex, tumor size, or preoperative history of headache did not influence development of the postoperative pain.
We found that new-onset headache after resection of acoustic neuroma by a suboccipital approach with cranioplasty is much less common than previously reported and is best described as mild incisional pain rather than a severe headache. The literature regarding headaches after different surgica1 approaches for acoustic neuroma resection is reviewed, and possible explanations for development of the pain are discussed.     

听神经瘤术后患者家属心理状态的质性研究

目的了解听神经瘤术后患者家属的心理状态,为提高家属的生活质量提供依据。方法采用深度访谈法收集9例神经功能损害中重度的听神经瘤患者家属的个案资料,并用现象学分析法进行分析。结果 9例家属在照顾患者时出现了以下的心理状态:焦虑,怀疑与担心,压力与支持,情绪消极。结论听神经瘤术后患者家属需要真切的人文关怀、情感和社会保障制度的支持,以减轻其出院后的照顾压力,提高家属及患者的生活质量。     

听神经瘤的低场MRI及Gd—DTPA诊断

目的：探讨听神经瘤的低场MRI及国产Gd-DTPA增强表现及诊断价值。材料和方法：搜集经手术病理证实的27例（29个病灶）听神经瘤患者的低场MRI及国产Gd-DTPA增强资料。对其主要影像学改变进行观察分析。结果：听神经瘤的低场MRI主要表现为：（1）肿瘤以内听道口为中心,多与岩骨呈锐角并向中线或桥脑小脑角方向生长;（2）T1加权肿瘤呈低或等信号,T2加权呈均匀性高信号或混杂信号;（3）病灶边界较清楚,外周常有水肿带环绕;（4）内听道口扩大及第Ⅶ、Ⅷ对颅神经增粗;（5）国产Gd-DTPA的增强效果十分显著,尤其对内听道内型微小听神经瘤更具诊断价值。结论：低场MRI可作为诊断听神经瘤的敏感检查方法,采用国产Gd-DTPA增强不但能提高肿瘤的诊断率,并可为制定手术方案和判断有无术后残留,复发提供参考依据。     

上肢周围神经损伤后的痛性神经瘤及其治疗

 外周神经损伤后,受损神经局部往往会出现神经纤维的异常生长增生,于损伤局部形成迂曲、错长,最终形成局部肿块,即所谓创伤性神经瘤,而其中约10％的创伤性神经瘤出现顽固的病理性疼痛。在手外科,创伤后痛性神经瘤是上肢外周神经损伤后常见的严重并发症之一,疗效尚不理想。经典手术治疗方法如神经残端转位至肌肉、残端缝合至小静脉及神经残端骨内包埋等往往疗效有限。近年来已尝试将自体脂肪移植、组织移植、电刺激及神经导管等新技术应用于创伤后痛性神经瘤的治疗。本文就上肢常见的痛性神经瘤的原因、诊断及治疗进展进行综述,为将来该领域的进一步研究提供参考。     

眼动功能定量分析在前庭疾病中鉴别诊断的意义

目的探讨眼动功能定量分析检查在鉴别不同类型前庭疾病中的作用.方法本文收集181例眼动功能定量分析资料,其中正常组40例,突发性聋组46例,药物中毒性眩晕组26例,梅尼埃病组48例,听神经瘤组21例,分别进行扫视、跟随及视动试验定量分析检查.结果周围性前庭病变各项检查与正常组比较无统计学差异;听神经瘤组扫视试验潜伏期延长,达246ms+66ms,较正常组190ms+25ms明显延长,跟随试验各项指标均示异常,视动性检查最大慢相速度及平均慢相速度减慢,分别为18.4°/s±6.4°/s和16.0°/s±6.0°/s,较正常组22.6°/s±8.8°/s和20.3°/s±8.7°/s减慢.结论提示眼动功能定量分析检查对鉴别前庭周围性和中枢性病变有一定参考价值.