neurinoma

神经鞘瘤
  • 文章类型: Case Reports
    胃神经鞘瘤(GS)是胃肠道(GI)中来自雪旺氏细胞的罕见间质肿瘤,占此类肿瘤的2-6%。我们报道了一名52岁的女性,她经历了腹痛,呕血,还有Melena,最初通过超声和计算机断层扫描腹部怀疑患有胃肠道间质瘤。尽管在上内窥镜检查期间没有发现活动性出血,她接受了一次成功的开腹胃大部切除术,组织病理学证实GS.GS的诊断,可以模仿其他胃肠道条件,由于其非特异性症状在很大程度上依赖于影像学和组织病理学分析,包括上消化道和下消化道出血的可能性。该病例强调了GS的诊断挑战,并强调了手术切除是首选治疗方法。通常导致良好的预后。
    Gastric schwannomas (GS) are rare mesenchymal tumors from Schwann cells in the gastrointestinal (GI) tract, representing 2-6% of such tumors. We report a 52-year-old woman who experienced abdominal pain, hematemesis, and melena, initially suspected of having a GI stromal tumor through ultrasound and computed tomography abdomen. Despite no active bleeding found during an upper endoscopy, she underwent a successful open subtotal gastrectomy, with histopathology confirming GS. The diagnosis of GS, which may mimic other GI conditions, relies heavily on imaging and histopathological analysis due to its nonspecific symptomatology, including the potential for both upper and lower GI bleeding. This case underscores the diagnostic challenges of GS and highlights surgical resection as the preferred treatment, generally leading to a favorable prognosis.
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  • 文章类型: Case Reports
    神经鞘瘤或神经鞘瘤是一种生长缓慢的肿瘤,由神经鞘发展而来。它主要是良性的,很少转化为恶性肿瘤。下肢神经鞘瘤的发病率非常低。神经鞘瘤不太可能从腓总神经发展。一名中年男性主诉左膝疼痛,辐射到左脚,膝盖后部疼痛肿胀。做了病灶内切除,患者完全康复,无术后并发症。发现切除的标本是左腿腓总神经的神经鞘瘤。在一个月的时间里,三个月,术后1年随访,患者在足部被动和主动背屈时没有疼痛的抱怨。感觉异常完全恢复,感觉完整。该报告显示,无症状的神经鞘瘤有时会出现疼痛症状。在这种情况下,仔细和彻底切除神经鞘瘤可以导致完全康复。
    Schwannoma or neurilemmoma is a slow-growing tumor that develops from nerve sheaths. It is mostly benign and only rarely transforms into malignancy. The incidence of schwannoma is very low in the lower limbs. Schwannomas developing from the common peroneal nerve is unlikely. A middle-aged male presented with complaints of left knee pain, which was radiating to the left foot, and a painful swelling at the back of the knee. An intralesional excision was done, and the patient made a full recovery with no postoperative complications. The excised specimen was found to be a schwannoma of the common peroneal nerve of the left leg. At the one-month, three-month, and one-year postoperative follow-ups, the patient had no complaints of pain on passive and active dorsiflexion of the foot. There was complete recovery from paresthesia and intact sensation was present. This report shows that asymptomatic schwannomas can sometimes present with symptoms of pain. In such cases, careful and complete excision of the schwannoma can lead to full recovery.
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  • 文章类型: Case Reports
    背景:神经鞘瘤是一组分化良好的良性肿瘤,起源于周围神经系统的雪旺氏细胞。它们在骨盆中的定位非常罕见。具有扩张性生长的神经鞘瘤可引起广泛的神经系统症状或对盆腔器官的压迫。
    方法:作者介绍了一个60岁女性的案例研究,有症状的深盆腔神经鞘瘤。患者接受了机器人辅助手术,导致肿瘤完全摘除。患者术后病程顺利,共住院2天。通过组织病理学分析证实了神经鞘瘤的诊断。在11个月的随访监测中,患者没有出现任何神经功能缺损或其他症状。
    结论:机器人辅助手术可以在难以接近的解剖区域进行安全有效的手术治疗。神经源性肿瘤的术前成像需要磁共振成像。在发现神经鞘瘤证据的情况下,不建议进行组织学验证。在微创骨盆手术方面经验丰富的专业团队的多学科合作是必要的。
    Schwannomas are a group of well differentiated benign tumors originating from the Schwann cells of the peripheral nervous system. Their localization in the pelvis is very rare. Schwannomas with expansive growth can cause wide neurologic symptoms or oppression of pelvic organs.
    The authors present a case study of a 60-year-old woman with a large, symptomatic deep pelvic schwannoma. The patient underwent robotic-assisted surgery resulting in complete tumor extirpation. The patient\'s postoperative course was uneventful with a total of two hospitalization days. The diagnosis of a schwannoma was confirmed by histopathologic analysis. At 11-month follow-up surveillance the patient did not present any neurological deficit or other symptoms.
    Robotic-assisted surgery allows safe and effective surgical treatment in difficult-to-access anatomical areas. Magnetic resonance imaging is required for preoperative imaging of neurogenic tumors. Histological verification is not recommended in cases where evidence of a schwannoma is found. Multidisciplinary cooperation of a dedicated team experienced in minimally invasive pelvic surgery is necessary.
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  • 文章类型: Systematic Review
    背景:外展神经(AN)神经鞘瘤是极其罕见的肿瘤。影响术后结局的临床特征和因素尚不明确。
    目的:为了表征神经鞘瘤的临床特征和手术结果的预测因素方法和材料:对神经鞘瘤的文献进行PRISMA指导的系统综述。随后,我们进行了单因素和多因素回归分析,以确定影响术后结局的变量的预测值.
    结果:共评估了42项包含55名患者的研究。演示时的平均年龄为43.9±14.6岁。最常见的症状是CNVI麻痹(69.1%)。海绵窦(49.1%)和脑前池(36.3%)是最常见的受累部位。在中位随访时间为28.4±25.8个月时,手术后完全恢复为36.3%。术前神经麻痹(P<0.001),枕下入路(P=0.007)和肿瘤次全切除术(P=0.044)是术后并发症的重要保护因素。前桥位置和术后并发症是AN恢复的不良预后指标(分别为OR0.10,P=0.030,OR0.10,P=0.028)。次全切除与较高的AN恢复几率显着相关(OR,6.06,P=0.040)。
    结论:神经鞘瘤是罕见但严重的肿瘤,可引起显著的发病率,只有大约三分之一的患者在手术后显示完全康复。枕下入路是术后并发症的保护因素,尤其是与次全切除结合时。了解这些因素以及肿瘤特征有助于优化手术计划和术前咨询。
    Abducens nerve (AN) schwannomas are extremely rare tumors. Clinical characteristics and factors that influence postoperative outcomes are not well defined.
    To characterize clinical features of AN schwannomas and predictors of surgical outcomes.
    PRISMA-guided systematic review of the literature on AN schwannomas was performed. Subsequently, univariate and multivariate regression analyses were performed to identify the predictive value of variables that influence postoperative outcomes.
    A total of 42 studies with 55 patients were evaluated. The mean age at presentation was 43.9 ± 14.6 years. The most common presenting symptom was cranial nerve VI palsy (69.1%). Cavernous sinus (49.1%) and prepontine cistern (36.3%) were the most commonly involved locations. Complete recovery after surgery was seen in 36.3% at a median follow-up of 28.4 ± 25.8 months. Preoperative AN palsy (P < 0.001), suboccipital approach (P = 0.007), and subtotal resection of tumor (P = 0.044) were significant protective factors for postoperative complications. Prepontine location and postoperative complications were poor prognostic indicators of AN recovery (odds ratio [OR], 0.10, P = 0.030 and OR, 0.10, P = 0.028, respectively). Subtotal resection was significantly correlated with higher odds of AN recovery (OR, 6.06; P = 0.040).
    AN schwannomas are rare but serious tumors that can cause significant morbidity, with only approximately one third of patients showing complete recovery after surgery. The suboccipital approach was a protective factor for postoperative complications, especially when combined with subtotal resection. Knowledge of these factors along with tumor characteristics helps optimize surgical planning and preoperative counseling.
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  • 文章类型: Case Reports
    神经鞘瘤是周围神经鞘的施万细胞的肿瘤。很少报道骶骨位置,尤其是在脊柱关节炎患者中。在这里,我们报告了一例25岁的男性罕见的变痛症,该男性患有非放射学的轴性脊柱关节炎病史,并确定了骶骨神经鞘瘤的诊断。
    Schwannoma are tumors of Schwann cells of the peripheral nerve sheath. Sacral location is rarely reported especially in spondyloarthritis patients. Herein, we report a case of uncommon pygalgia in a 25-year-old man with history of a non-radiographic axial spondyloarthritis and in whom the diagnosis of sacral Schwannoma was established.
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  • 文章类型: Journal Article
    为了评估临床流行病学方面,病理特征,诊断方法,腮腺内面神经神经鞘瘤(IFNS)的治疗方案和功能结局,并提供有关腮腺内面神经鞘瘤的病例报告。PubMed,ProQuest,谷歌学者,筛选了科学直接和Scopus进行研究。文章选择和数据提取由一名研究者完成,另一名研究者证实了其准确性。经过摘要和文本筛选,根据PRISMA指南,以系统评价的纳入和排除标准,最终选择了69篇文章进行研究。还有一个病例报告给我们部门。诊断的平均年龄为43±16岁,女性占主导地位。肿瘤的平均持续时间为29.5个月,初始诊断时肿瘤的平均大小为3.6±1.67cm。44例以多形性腺瘤为主要诊断。行浅表腮腺切除术64例,切除47例。3例患者通过端到端吻合术和16例患者通过面部舌下管吻合术进行重建治疗。5例患者的GAN电缆移植,18例患者进行了大耳神经移植,8例患者进行了端到侧的腓肠神经移植。D型肿瘤通过扩大面神经切除治疗,这很难重建,并且还采用了神经移植物,该神经移植物通常不能提供可接受的面部功能恢复。面神经神经鞘瘤是一种罕见的实体,在诊断和治疗方面存在困境。管理病变也很困难,因为术中对神经的粘附使肿瘤无边缘难以在不牺牲神经的情况下进行。目前,对于各种类型的腮腺内面神经鞘瘤的治疗尚无共识。
    To evaluate the clinico-epidemiological aspects, pathological features, diagnostic methods, management protocol and functional outcome of the intra-parotid facial nerve schwannoma (IFNS) and to present a case report on intra parotid facial nerve schwannoma. PubMed, ProQuest, Google scholar, Science direct and Scopus were screened for studies. Article selection and data extraction was done by one investigator and other investigator confirmed its accuracy. After abstract and text screening a total of 69 articles were finally selected for the study with the inclusion and exclusion criteria of the systematic review as per PRISMA guidelines. With addition of one case reported to our department. The mean age of diagnosis was 43 ± 16 years with a slight female predominance. The mean duration of the tumour was 29.5 months and the mean size of the tumour on initial diagnosis was 3.6 ± 1.67 cm. Pleomorphic adenoma was the primary diagnosis in 44 cases. Superficial parotidectomy was done in 64 cases followed by resection in 47 cases. Reconstructive treatment was carried out by an end-to-end anastomosis in 3 patients and by facial-hypoglossal anastomosis in 16 patients, GAN cable grafting in 5 patients, a greater auricular nerve graft was done in18 patients and end-to-side interposed sural nerve graft in 8 patients. The type D tumours are treated by extended resection of the facial nerve, which is difficult to reconstruct and also employs a nerve graft that does not often give acceptable recovery of facial function. Facial nerve schwannomas being a rare entity poses a dilemma in diagnosis and management. Managing the lesions is also difficult as intraoperative adherence to the nerve makes a tumour free margin difficult without sacrificing the nerve. At present there is no consensus regarding the management of various types of intra-parotid facial nerve shwannoma.
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  • 文章类型: Journal Article
    BACKGROUND: Advanced intercellular communication is a known oncogenic factor. In the central nervous system, Connexin-43 (Cx43) forms this junctional networking. Moreover, it correlates with the proliferation rate, and thus behavior, of gliomas. We assessed the expression of Cx43 and its relationship to Ki67 in other common central nervous system tumors.
    METHODS: The expression of Cx43 and Ki67 were assessed in formalin-fixed paraffin embedded samples of human brain metastases, meningiomas, and neurinomas using immunohistochemistry. Neurinomas and meningiomas were jointly evaluated due to similar non-malignant behavior.
    RESULTS: A total of 14 metastases of different extracerebral carcinomas, 6 meningiomas, and 10 neurinomas were evaluated. Five (36%) metastases and 5 (31%) meningiomas/neurinomas showed minor expression, whereas 6 (43%) metastases and 2 (13%) meningiomas/neurinomas showed no Cx43 expression at all. In 3 (21%) metastases and 9 (56%) meningiomas/neurinomas, moderate or strong expression of Cx43 was identified. The higher expression of Cx43 in meningiomas and neurinomas directly correlated with Ki67, r = 0.53 (P = 0.034). For metastases no significant correlation was found. Mitotic index in meningiomas/neurinomas correlated with Ki67 expression, r = 0.74 (P < 0.001), but did not show statistically significant correlation with Cx43 expression in these tumors.
    CONCLUSIONS: The expression of Cx43 as a marker of cell-to-cell networking exposed a significant correlation with the Ki67-defined proliferation index in case of primary central nervous system neuroectodermal neoplasms. However, it does not seem to play a comparable role in metastases with extracerebral origin.
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  • 文章类型: Journal Article
    颅神经鞘瘤几乎总是由感觉神经或混合神经引起。运动神经,比如滑车神经,很少与神经鞘瘤有关。由于滑车神经神经鞘瘤的报道数量很少,因此尚未就手术干预达成共识。这项研究包括对文献和我们手术治疗滑车神经神经鞘瘤的经验的系统回顾。
    三个数据库(WebofScience,PubMed,和Cochrane图书馆)进行了搜索,没有日期限制。如果研究发表在英语文献中,并介绍了接受滑车神经鞘瘤手术治疗的任何年龄的患者,则将其包括在内。从纳入的研究中提取的数据与我们的经验相结合。
    41项研究,介绍43名患者,符合纳入标准。添加我们的经验后,患者总数为45。最常见的症状是复视(62.2%),头痛(46.7%),和运动无力(37.8%)。诊断期间的平均年龄为45.1岁。尽管亚时态跨月方法(n=14)是最优选的方法,近年来,其应用有所减少。在过去的十年里,枕下侧入路(n=11)已普及。81%的患者发现术后滑车神经缺损残留。神经功能缺损的概率与肿瘤体积无统计学相关性(P=0.914),位置(P=0.669),或切除率(P=0.554)。
    虽然滑车神经鞘瘤是罕见的,而且它们的治疗涉及到挑战,完全切除与适当的方法提供了最理想的结果。
    Cranial nerve schwannomas almost always arise from sensory or mixed nerves. Motor cranial nerves, such as the trochlear nerve, are rarely associated with schwannomas. No consensus has yet been made for surgical intervention because of the low number of reported cases of trochlear nerve schwannomas. This study comprises a systematic review of the literature and our experience for surgically treated trochlear nerve schwannomas.
    Three databases (Web of Science, PubMed, and Cochrane Library) were searched without date restrictions. Studies were included if they were published in the English literature and presented patients of any age who underwent surgical treatment for trochlear schwannoma. Data extracted from the included studies were combined with our experience.
    Forty-one studies, presenting 43 patients, met the inclusion criteria. The total number of patients was 45 after our experience was added. The most common symptoms were diplopia (62.2%), headache (46.7%), and motor weakness (37.8%). Mean age during the diagnosis was 45.1 years. Although the subtemporal transtentorial approach (n = 14) is the most preferred method, its application has decreased in recent years. In the last decade, the lateral suboccipital approach (n = 11) has gained popularity. Residual postoperative trochlear nerve deficit was detected in 81% of patients. The probability of neurologic deficit was not statistically associated with tumor volume (P = 0.914), location (P = 0.669), or resection rate (P = 0.554).
    Although trochlear schwannomas are rare and their treatment involves challenges, total resection with the proper approach provides the most desirable results.
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  • DOI:
    文章类型: Journal Article
    腓骨神经鞘瘤是罕见的良性肿瘤。关于手术治疗后临床和功能结果的研究文献仍然很少。我们评估了该疾病的术前表现,并评估了手术后的临床和功能结果。
    我们收集了2016年6月至2020年6月手术治疗的腓骨神经瘤的所有病例。我们分析了每个患者的个人数据,并在手术前后进行了准确的临床检查。术前和术后均进行MRI检查。
    我们报告了9例腓骨神经鞘瘤:5例起源于腓总神经,4例仅起源于深或浅分支。它们的平均尺寸为22.6mm。每位患者在手术前都表现出感觉障碍;术前MRC评分为4.2。术前MSTS和LEFS评分分别为23.6和64.4。在每种情况下手术都是成功的。无局部复发或重大并发症发生。肿瘤大小与诊断延迟和术前缺陷的发展显着相关。手术在全球范围内被证明是成功的:术后评估强调了神经系统症状和整体功能限制的显着减少。
    疾病早期的手术治疗是一种可靠且相对安全的治疗选择。
    Peroneal nerves Schwannomas are rare benign tumors. Literature is still poor of studies about clinical and functional outcomes after surgical treatment. We evaluated the pre-operative presentation of the disease and assessed clinical and functional outcomes after surgery.
    We collected all the cases of peroneal nerves\' neurinoma treated surgically between June 2016 and June 2020. We analyzed each patients\' personal data and carried out accurate clinical examinations before and after surgery. MRI was performed both pre-operatively and post-operatively.
    We reported 9 cases of peroneal nerves schwannomas: five arising from the common peroneal nerve and four arising from the deep or superficial branches alone. Their mean size was 22.6 mm. Each patient showed sensation deficits before surgery; pre-operative MRC score was 4.2. Pre-Operative MSTS and LEFS scores were 23.6 and 64.4. Surgery was successful in each case. No local recurrence nor major complication occurred. Tumor size was significantly associated with both diagnostic delay and development of pre-operative deficits. Surgery was proven to be globally successful: post-operative evaluations highlighted a marked reduction of neurological signs and overall functional limitations.
    Surgical treatment at early stages of the disease represents a reliable and relatively safe therapeutic option.
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  • 文章类型: Case Reports
    桥小脑角(CPA)和内听道(IAC)的脂肪瘤是相对罕见的肿瘤。听神经瘤是该部位最常见的肿瘤,这通常会导致听力损失,眩晕,还有耳鸣.偶尔,这个肿瘤压迫脑干,提示手术切除。该区域的脂肪瘤可能引起类似于神经瘤的症状。然而,他们不考虑手术治疗,因为他们的移除可能会导致几个额外的缺陷。CPA/IAC脂肪瘤的保守治疗和重复磁共振成像检查是保留颅神经功能的标准措施。在这里,我们报告了一个听神经瘤和CPA脂肪瘤同侧相互靠近的病例。主要症状为听力损失,无面神经麻痹。因此,必须避免面部神经损伤。考虑到肿瘤之间的解剖关系,颅神经,和CPA/IAC脂肪瘤,我们对听神经瘤进行了全手术切除.我们故意不治疗脂肪瘤,能保护面神经.该报告可能为今后类似病例的鉴别诊断提供有益参考。
    Lipomas of the cerebellopontine angle (CPA) and internal auditory canal (IAC) are relatively rare tumors. Acoustic neurinoma is the most common tumor in this location, which often causes hearing loss, vertigo, and tinnitus. Occasionally, this tumor compresses the brainstem, prompting surgical resection. Lipomas in this area may cause symptoms similar to neurinoma. However, they are not considered for surgical treatment because their removal may result in several additional deficits. Conservative therapy and repeated magnetic resonance imaging examinations for CPA/IAC lipomas are standard measures for preserving cranial nerve function. Herein, we report a case of acoustic neurinoma and CPA lipoma occurring in close proximity to each other ipsilaterally. The main symptom was hearing loss without facial nerve paralysis. Therefore, facial nerve injury had to be avoided. Considering the anatomical relationships among the tumors, cranial nerves, and CPA/IAC lipoma, we performed total surgical removal of the acoustic neurinoma. We intentionally left the lipoma untreated, which enabled facial nerve preservation. This report may be a useful reference for the differential diagnosis of similar cases in the future.
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