RESUMEN
Two case reports of patients operated for posterior fossa tumors complicated by postoperative hematoma are presented. In both cases patients underwent tracheostomy and were on ventilator for more than three weeks. Postoperative course was complicated by pneumonia and bronchitis. Fiberoptic bronchoscopy was performed to rule out lung complications. Fiberoptic laryngotracheoscopy was done for dynamic control of vocal cords paralysis and helped to make a decision regarding the time of the safe extubation.
Asunto(s)
Astrocitoma/complicaciones , Broncoscopía/métodos , Parálisis Bulbar Progresiva/diagnóstico , Neoplasias del Ventrículo Cerebral/complicaciones , Ependimoma/complicaciones , Complicaciones Posoperatorias/diagnóstico , Parálisis de los Pliegues Vocales/diagnóstico , Adulto , Astrocitoma/diagnóstico , Astrocitoma/cirugía , Parálisis Bulbar Progresiva/etiología , Parálisis Bulbar Progresiva/terapia , Neoplasias del Ventrículo Cerebral/diagnóstico , Neoplasias del Ventrículo Cerebral/cirugía , Terapia Combinada , Fosa Craneal Posterior , Ependimoma/diagnóstico , Ependimoma/cirugía , Femenino , Tecnología de Fibra Óptica , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Fibras Ópticas , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Reoperación , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/terapiaRESUMEN
Tumors extending into the nasal cavity, cranium, and paranasal sinuses have a number of distinctive features to take into consideration. Among them are the communication with an open air, high incidence of associated intracranial infections, specific complications (i.e. suppurative sinusitis, polyps, mucocele, pneumocephalus, nasal CSF leak). The features mentioned make these lesions unique. 50 consecutive patients underwent treatment in Burdenko Neurosurgical Institute. The diagnosis was confirmed either by CT, MRI, or at operation. Rhinological and otoneurological signs were also subjected to analysis. Most frequently these tumors (the majority of which were meningiomas (n = 34) extended into the nasal cavity (40 patients) and paranasal sinuses (n = 50). It was noted that the clinical signs vary depending on the histological type of tumor, its location and direction of growth (i.e. medial or lateral). Medially growing tumors usually involved 2-4 sinuses, while laterally growing tumors involved only one sinus. Among the symptoms, disturbances of smell, conductive hearing impairment, deformation of both the soft and hard palate, slowing of the experimental nystagmus due to disturbed extraocular movements. Some light is shed on the differential diagnosis, indications for various surgical approaches (transcranial, transnasal, and facial). The results of surgical treatment and postoperative complications are presented in the paper. The diagnosis and treatment of such patients require an interdisciplinary approach while would involve a team of a neurosurgeon, neuroradiologist, otoneurologist, and a neuro-ophthalmologist.
Asunto(s)
Neoplasias Nasales/diagnóstico , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias Craneales/diagnóstico , Adolescente , Adulto , Niño , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cavidad Nasal , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Nasales/complicaciones , Neoplasias Nasales/cirugía , Enfermedades Otorrinolaringológicas/etiología , Neoplasias de los Senos Paranasales/complicaciones , Neoplasias de los Senos Paranasales/cirugía , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/etiología , Neoplasias Craneales/complicaciones , Neoplasias Craneales/cirugíaRESUMEN
The authors analyse rhinological and otoneurological symptoms in 50 patients with benign craniofacial tumors verified at surgical interventions, computed tomography, NMR-tomography. The tumors involved anterior parts of the brain stem, nasal cavity and paranasal sinuses, 34 tumors were diagnosed as meningiomas. Clinical correlations with tumor histology and topography were noted. Specific ENT preoperative, postoperative and long-term complications are described. The diagnosis and treatment of the above patients need cooperation with specialists of the allied fields: neurosurgeons, neuroroentgenologists, otoneurologists, neuro-ophthalmologists.
Asunto(s)
Angiofibroma , Neoplasias Encefálicas , Tronco Encefálico , Neoplasias Meníngeas , Meningioma , Neoplasias Nasales , Neoplasias de los Senos Paranasales , Adolescente , Adulto , Angiofibroma/diagnóstico , Angiofibroma/terapia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Niño , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/terapia , Meningioma/diagnóstico , Meningioma/terapia , Persona de Mediana Edad , Neoplasias Nasales/diagnóstico , Neoplasias Nasales/terapia , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias de los Senos Paranasales/terapia , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
The papers covers the specific features of manifestations of the Gasserian ganglion and its root with emphasis on the otoneurological findings of 70 patients with the diagnosis verified during surgery. According to the predominant extent of tumor growth, three groups of patients are identified: 1) those with a tumor located only in the middle cranial fossa (n = 23); 2) those with that in the cerebellopontine angle (n = 22); 3) those with its bulk in the middle cranial fossa, which extended to the posterior cranial fossa medially along the cranial clivus (n = 25). In addition to the local symptoms common to all three groups, otoneurological data typical of each group identified are analyzed thoroughly. The differential diagnostic criteria of neurinomas of the trigeminal nerve are presented.
Asunto(s)
Neoplasias de los Nervios Craneales/diagnóstico , Neurilemoma/diagnóstico , Ganglio del Trigémino , Nervio Trigémino , Neuralgia del Trigémino/diagnóstico , Enfermedades Vestibulares/diagnóstico , Adulto , Neoplasias Cerebelosas/complicaciones , Neoplasias Cerebelosas/diagnóstico , Ángulo Pontocerebeloso , Fosa Craneal Posterior , Neoplasias de los Nervios Craneales/complicaciones , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neurilemoma/complicaciones , Neuralgia del Trigémino/etiología , Enfermedades Vestibulares/etiologíaRESUMEN
Eleven patients were admitted to the hospital with the diagnosis of unilateral tumor of the vestibulocochlear nerve at the stage of clinical manifestations or at a well advanced stage. Their otoneurological examinations revealed a microtumor at the side opposite to the major tumor node. Of great diagnostic importance were vestibulometric data which showed lack of vestibular excitation on both sides: in some cases it was not recorded during caloric tests while in other cases it was not recorded during caloric or rotation tests. In view of the lack of the vestibular response on the "healthy" side, it was supposed that there was a microtumor there. In all cases this diagnosis was confirmed either by computer tomography or by CT and surgery. This symptom can be very helpful for an early detection of a microtumor or the vestibulocochlear nerve on the side opposite to the major tumor node. It is emphasized that special attention should be given to arm displacement, during caloric tests.
Asunto(s)
Neoplasias Primarias Múltiples/diagnóstico , Neuroma Acústico/diagnóstico , Nistagmo Fisiológico/fisiología , Reflejo Vestibuloocular/fisiología , Pruebas Calóricas/métodos , Lateralidad Funcional , Humanos , Neoplasias Primarias Múltiples/fisiopatología , Neuroma Acústico/fisiopatología , Factores de TiempoRESUMEN
The work analyses the results of complex examination (by an otoneurologist and neuroroentgenologist) of 34 patients with neurinoma of the 8th cranial nerve measuring from 13 to 25 mm. It is difficult to establish the diagnosis of neurinoma of the 8th nerve in the early stage; its recognition is based on the combination of otoneurological findings and the results of computed tomography, particularly computed cisternography with Amipaque. Despite the small size of the tumor, all patients had local symptomatology in the form of unilateral neurosensory deficiency or deficiency of hearing, vestibular excitability, and taste (on the anterior two thirds of the tongue). Three variants of tumor localization were distinguished by computed tomography: inside the canal, lateral, and medial. Computed cisternography with Amipaque yielded additional information on the size of the tumors and showed more exactly their relation to the brain stem. The results of computed tomography and cisternography corresponded completely to the otoneurological data which reflected the degree of the tumors' effect on the brain stem structures adequately and subtly.
Asunto(s)
Neuroma Acústico/diagnóstico , Audiometría , Cisterna Magna/diagnóstico por imagen , Diatrizoato de Meglumina , Electronistagmografía , Humanos , Metrizamida , Neuroma Acústico/complicaciones , Cráneo/diagnóstico por imagen , Trastornos del Gusto/diagnóstico , Trastornos del Gusto/etiología , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
The results of otoneurological and clinical examination were compared with the operative findings in 100 patients with neurinomas of the acoustic nerve. A regularity was found in the frequency of development and the degree of manifestation of some otoneurological and clinical signs depending on the size of the tumor. In 88% of cases the idea of the size of the tumor gained from the results of otoneurological and clinical examination corresponded to the actual size of the new growth determined during the operation.
Asunto(s)
Neuroma Acústico/diagnóstico , Diagnóstico Diferencial , Humanos , Estadificación de Neoplasias , Examen Neurológico , Neuroma Acústico/fisiopatología , Neuroma Acústico/cirugía , Factores de TiempoAsunto(s)
Condrosarcoma/cirugía , Cordoma/cirugía , Fosa Craneal Posterior/patología , Neoplasias Orofaríngeas/cirugía , Neoplasias Faríngeas/cirugía , Neoplasias Craneales/cirugía , Cráneo/patología , Adulto , Condrosarcoma/patología , Cordoma/patología , Fosa Craneal Posterior/cirugía , Femenino , Humanos , Masculino , Métodos , Neoplasias Orofaríngeas/patología , Neoplasias Craneales/patologíaRESUMEN
The peculiarities of the dynamics of the entire complex of otoneurologic symptoms were studied in 60 patients with a tumor of the acoustic nerve in stages II and III of the disease after total (in 38) and partial (in 22) resection of the neoplasm. The data obtained bore evidence that the dynamics of the otoneurologic symptoms depended on the developmental stage of the tumor, its relation to the brain stem, and the character of the operation (total or partial removal of the tumor). Total resection of the tumor in stage II proved most effective: in the residual period both stem vestibular disorders and statokinetic and coordination disturbances were minimum or absent. In total removal of the tumor in stage III of the disease the regression of the symptoms was delayed and much less apparent. In subtotal removal of the tumor during stage II the symptoms regressed slightly or not at all. Symptomatology remained gross, irreversible or even frequently became more severe after subtotal removal of the tumor in stage III of the disease.
Asunto(s)
Neoplasias del Sistema Nervioso Periférico/cirugía , Nervio Vestibulococlear , Audiometría , Tronco Encefálico/fisiopatología , Electronistagmografía , Humanos , Neurilemoma/fisiopatología , Neurilemoma/cirugía , Neoplasias del Sistema Nervioso Periférico/fisiopatología , Vestíbulo del Laberinto/fisiopatologíaRESUMEN
The author describes the otoneurological symptomatology of 213 patients with glial tumours of the hemispheres which were verified during surgical operations. The use of modern methods in studying the audition permitted to give a differentiated characteristics of vestibular and acoustic disorders. Vestibular disturbances irrespective of the tumor localization were more frequently seen. In moderately expressed general cerebral symptoms vestibular symptoms of the subcortical and diencephalic level prevailed. The authors mark their early appearance and especially their crude expressiveness in lesions of the posterior areas of the hemispheres. There were frequent combinations of vestibular disorders of a subcortical diencephalic level with cerebral posterior. The focal symptomatology depends upon the localization of the tumour.