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Acta Neurochirurgica Jan 2024To evaluate the most important factors of quality of life in patients after vestibular schwannoma surgery.
AIM
To evaluate the most important factors of quality of life in patients after vestibular schwannoma surgery.
MATERIALS AND METHODS
Patients with unilateral sporadic occurrence of vestibular schwannoma who underwent surgery via suboccipital-retrosigmoid approach were included in the prospective study (2018-2021). Patients after previous Leksell gamma knife irradiation (or other methods of stereotactic radiosurgery) were excluded. Quality of life was assessed using 10 validated questionnaires that were distributed preoperatively, 3 months and 1 year after the surgery.
RESULTS
A total of 76 patients were included in the study, complete data were analysed in 43 of them (response rate 57%). Grade III and IV represented up to 70% of all tumors. Patients with larger tumors had a significantly higher risk of postoperative facial nerve paresis, liquorrhea and lower probability of hearing preservation. Patients with smaller tumors and those, who suffered from headaches before surgery had more frequent and severe headaches after surgery. Postoperative headaches were associated with higher incidence of anxiety and tinnitus. More frequent anxiety was also identified in patients with preoperative serviceable hearing who became deaf after surgery. Nevertheless, tinnitus and hearing impairment appeared to have less impact on overall quality of life compared to headaches and facial nerve function.
CONCLUSION
According to our results, tumor size, postoperative function of the facial nerve and occurrence of postoperative headaches had the greatest influence on the overall postoperative quality of life in patients after vestibular schwannoma surgery.
Topics: Humans; Neuroma, Acoustic; Quality of Life; Prospective Studies; Tinnitus; Headache
PubMed: 38270649
DOI: 10.1007/s00701-024-05936-z -
Frontiers in Veterinary Science 2023The clinical sign of ataxia is related to several neurological diseases and is seen in conjunction with paresis in dogs with spinal cord injury (SCI). Endeavours to...
The clinical sign of ataxia is related to several neurological diseases and is seen in conjunction with paresis in dogs with spinal cord injury (SCI). Endeavours to objectify canine spinal ataxia in SCI remain limited. The aim of this clinical study was to determine and quantify differences between gait characteristics of ataxic dogs with thoracolumbar myelopathy and healthy control dogs using a computer-and treadmill-based gait analysis system. Five dogs with spinal ataxia and six healthy dogs underwent video-and computer-assisted gait analysis while walking on a four-ground reaction force plate treadmill system (maximum speed of 0.7 m/s). Spatio-temporal and kinetic gait characteristics regarding the dogs' locomotion were analysed with a focus on the individual coefficient of variation (CV), as a potential measure for quantification of the level of ataxia. Ataxic dogs with thoracolumbar SCI showed no effect on symmetry indices but higher variability in spatio-temporal and kinetic gait parameters mainly in the pelvic, but also in the thoracic limbs. Double support phase of the individual limb was prolonged in SCI dogs at the cost of the single support and swing phase. Reduced peaks of ground reaction forces (GRF) could potentially be explained by reduction of muscle strength, as a strategy of avoiding falling by taking enthusiastic steps, or by alteration of the rhythmogenic spinal circuits between the pelvic and thoracic limb pattern generators.
PubMed: 37614460
DOI: 10.3389/fvets.2023.1183755 -
Surgical Neurology International 2023The management of vestibular schwannoma has evolved over the past hundred years. In the last decades, surgery has been gradually replaced by radiation therapy as a...
BACKGROUND
The management of vestibular schwannoma has evolved over the past hundred years. In the last decades, surgery has been gradually replaced by radiation therapy as a primary treatment modality, particularly for small tumors, due to the less invasive nature and the compared reported outcomes in tumor control and hearing preservation. However, irradiation sometimes fails to stop tumor growth. In a long-term follow-up after primary fractionated stereotactic radiotherapy, the rate of treatment failure was reported as 3% and needed surgical salvage. For single-fraction modality, Hasegawa . reported salvage treatment after primary Gamma Knife radiosurgery in 8%, where 90% of these underwent surgery and 50% of those who were treated with a second gamma knife surgery required surgical intervention later. An increase in tumor volume by more than 10-20%, tumor growth after three years, and no return to pretreatment volume after transient swelling have been considered as tumor recurrence rather than pseudoprogression, a transient increase in tumor volume after radiotherapy that occurs up to 30% of cases. It has been reported that microsurgery after radiotherapy is more difficult, with most authors reporting a loss of defined arachnoid planes and worse cranial nerve outcomes, especially for hearing and facial nerve function.
CASE DESCRIPTION
A 43-year-old female patient was incidentally (asymptomatic) diagnosed on a magnetic resonance imaging (MRI) scan harboring a left vestibular schwannoma, grade T2 (Hannover classification), in 2015. Neurologic examination was unremarkable, and audiometry testing was normal. She was initially treated with observation. Three years later, in 2018, the lesion had enlarged, becoming a grade T3a and reaching the cistern of the cerebellopontine angle. The tumor was then treated with fractionated stereotactic radiosurgery (5 sessions of 5 Gy). MRI scans in 2019 and 2020 showed slight tumor growth. This enlargement was attributed to a pseudoprogression after radiosurgery, and only observation was advocated. In 2022, 4 years later, after radiosurgery, the tumor was still growing, and the patient began to suffer from hearing loss. A failure treatment was considered, and microsurgery was indicated. The patient was counseled about the risk of functional nerve impairment, and surgical consent was obtained. A retro sigmoid approach was planned. A gross total resection was attempted due to the clear subperineural plane during tumor dissection and because it was the only option that would provide a cure for the patient. The adjacent neurovascular structures were firmly adhered to the tumor capsule, which represented a major challenge for microdissection. The tumor was soft, without significant bleeding. A total resection was achieved, and the facial nerve was anatomically preserved. The patient developed facial paresis (House-Brackmann III) in the immediate postoperative period, which improved at the 6-month follow-up. Hearing loss did not improve. Postoperative MRI showed total resection.
CONCLUSION
Microsurgery after radiotherapy for vestibular schwannoma is challenging in terms of indication, when to indicate, resection target, difficulty in dissection due to local changes, and outcome. Gross total resection may be considered, as it is the only treatment that may provide a cure for the patient. However, the patient should be counseled about the risks.
PubMed: 38213456
DOI: 10.25259/SNI_875_2023 -
Frontiers in Neurology 2024Positional vertigo and nystagmus are the main symptoms and signs of dizziness, respectively. Despite the clinical utility of the supine roll test (SRT) and null point...
INTRODUCTION
Positional vertigo and nystagmus are the main symptoms and signs of dizziness, respectively. Despite the clinical utility of the supine roll test (SRT) and null point (NP) in diagnosing light cupula, a type of positional vertigo, there exists a notable gap in the literature concerning the comprehensive evaluation of lateralization values based on various nystagmus characteristics and the intensity of direction-changing positional nystagmus (DCPN) in the SRT, particularly in comparison to the NP. Additionally, limited data on abnormal canal paresis (CP) in light cupula patients underscores the need for further research with a larger patient population to elucidate this mechanism. This study aims to investigate the characteristics of positional nystagmus and lateralization of the horizontal semicircular canal (HSCC) light cupula, which is a type of positional vertigo and nystagmus that is poorly understood.
METHODS
Eighty-five patients (17 males, 68 females; mean age, 60.9 years) with light cupula were reviewed. We summarized the characteristics of spontaneous nystagmus and positional nystagmus, including supine positioning nystagmus, bow nystagmus, and lean nystagmus. Then, the side of the NP was identified as the affected side, and the values of the fast phase direction of the spontaneous nystagmus, supine positioning nystagmus, bow nystagmus, and lean nystagmus, as well as the intensity of the DCPN in the SRT, were used to diagnose the affected sides. Caloric testing was also performed for some patients.
RESULTS
Light cupula was observed in 5.7% of the patients with positional nystagmus. The frequencies of supine positioning nystagmus (88.2%), bow nystagmus (90.6%), and lean nystagmus (83.5%) were higher than spontaneous nystagmus (61.2%) ( < 0.001). The second NP (NP2) (92.9%) and third NP (NP3) (83.5%) were readily detected, affecting the left and right sides in 38 and 47 patients, respectively. Lateralization through the fast phase directions of bow nystagmus and lean nystagmus did not significantly differ from that of NP (all > 0.05). However, the accuracy rate of lateralization through the sides with more vigorous DCPN in the SRT was 63.5%, significantly lower than through NP ( 0.001). Particularly in patients with supine positioning nystagmus ( = 75), the rate was only 58.7% ( 0.001). However, the rate was 100% in patients without supine positioning nystagmus ( = 10). Among the 70 patients who underwent caloric testing, 37 had abnormal CP, and the sides of the reduced caloric reaction were ipsilateral to the affected sides of the light cupula in 83.8% of the patients.
CONCLUSION
Besides utilizing the NP to determine the affected side, the fast phase direction of the bow nystagmus or lean nystagmus can also aid in identification. However, a simple comparison of the intensity of DCPN in SRT cannot provide accurate lateralization, especially in patients with supine positioning nystagmus. There is a high incidence of CP on the affected side of the light cupula.
PubMed: 38450079
DOI: 10.3389/fneur.2024.1357195 -
Cureus Aug 2023Septic arthritis of the shoulder in pediatric patients should be diagnosed and treated urgently to prevent complications of the disease. However, early detection can be...
Septic arthritis of the shoulder in pediatric patients should be diagnosed and treated urgently to prevent complications of the disease. However, early detection can be a challenge due to mild symptoms with ambiguous laboratory and radiological findings. We report a case of an eight-month-old girl who presented to us initially with pseudo paresis of her right shoulder without any signs suggestive of infection. After a negative ultrasound, she was discharged with analgesia upon improvement of range of motion. Three weeks later, she presented with recurrent shoulder pain associated with fever, swelling, elevated CRP, and osteomyelitis changes of the humeral head on a plain radiograph. We proceeded with a minimally invasive arthrotomy washout and commenced on IV antibiotics. At one month follow-up, she regained her full range of motion and recovered fully. No recurrence of septic arthritis until six-month follow-up. This write-up discusses the diagnostic challenge of pediatric shoulder septic arthritis and the surgical technique of minimally invasive arthrotomy washout in a pediatric patient.
PubMed: 37671211
DOI: 10.7759/cureus.42986 -
Intractable & Rare Diseases Research Nov 2023Varicella zoster virus (VZV) causes chickenpox at the primary infection and then becomes latent in the spinal dorsal root ganglia; VZV can reactivate with aging,...
Varicella zoster virus (VZV) causes chickenpox at the primary infection and then becomes latent in the spinal dorsal root ganglia; VZV can reactivate with aging, immunosuppression, stress, and other factors, occurring as herpes zoster (HZ) at 1-2 skin segments. HZ peripheral nerve complications caused by VZV reactivation include Hunt syndrome, segmental HZ paresis, post-herpetic neuralgia, and Guillain-Barré syndrome (GBS). We have encountered the rare HZ complications of upper-limb paresis, myeloradiculitis, and polyradiculoneuritis: an adult woman with upper-limb paresis consistent with the nerve root on segments above the thoracic HZ dermatome; another woman exhibiting ascending myeloradiculitis originating at the Th11-12 roots; an elderly woman with ascending VZV polyradiculoneuritis resembling GBS; an adult with VZV quadriplegia with disseminated HZ; and an elderly patient with VZV-associated polyradiculoneuritis. The three polyradiculoneuritis cases may be a new subtype of HZ peripheral neuropathy, but the pathophysiology for these HZ peripheral nerve complications unrelated to HZ dermatomes is unclear. We analyzed host factors, skin lesions, neurological and virological findings, and MRI results including 3D NerveVIEW in 15 Japanese patients treated at our facility for HZ peripheral neuropathy, including six differing from the HZ dermatome. Based on the clinical findings including MRI results of spinal ganglia and roots, we identified four possible routes for the patterns of VZV spread: () ascending spinal roots, () ascending spinal cord, () polyradiculopathy, and () intrathecal spread. The incidence of HZ is increasing with the aging of many populations, and clinicians should be aware of these HZ neuropathies.
PubMed: 38024578
DOI: 10.5582/irdr.2023.01090 -
BMC Musculoskeletal Disorders Mar 2024The association of LSTV with low back pain has been debated in the literature for nearly a century, but the relationship between LSTV and spondylolisthesis is still...
BACKGROUND
The association of LSTV with low back pain has been debated in the literature for nearly a century, but the relationship between LSTV and spondylolisthesis is still under discussion. There is currently no valid information about LSTV's prevalence in Iran. This study investigated the relationship between the presence of LSTV and lumbosacral spondylolisthesis regarding frequency, gender and age variation, grade and level of spondylolisthesis, and clinical signs and symptoms.
METHODS
This cross-sectional study included spondylolisthesis patients admitted for surgery between March 2021 to December 2022. All patients underwent CT imaging. After evaluating medical records, the baseline data were collected. Patients were categorized into No LSTV, Sacralization, and Lumbarization groups. Demographic and clinical characteristics of the studied groups were compared using an independent T-test and Chi-Square. Multiple logistic regression was used to assess the age and sex variations between groups.
RESULTS
219 patients with a mean age of 57.07 ± 11.04 were included. A significant relationship was observed between the presence of sacralization and gender diversity with female predominance (P = 0.01). The level of spondylolisthesis and the presence of motor deficits (paresis) significantly differed among study groups (P < 0.05). Sacralization group exhibited a greater prevalence of higher grades of listhesis compared to the other groups.
CONCLUSIONS
LSTV is frequently seen in spondylolisthesis patients. Sacralization is the common type of LSTV in spondylolisthesis patients, possibly leading to an increased risk for higher grades of vertebral slip and higher rates of motor deficit signs and symptoms. The presence of sacralization results in a significant increase in the incidence of higher levels of spondylolisthesis, especially the L4-L5*(sacralized L5) level. There is no relationship between age and the presence of LSTV in spondylolisthesis.
Topics: Humans; Female; Middle Aged; Aged; Male; Spondylolisthesis; Cross-Sectional Studies; Lumbar Vertebrae; Spinal Diseases; Incidence
PubMed: 38539127
DOI: 10.1186/s12891-024-07318-z -
European Archives of... Jul 2024To compare the hearing results and clinical safety of patients undergoing stapes surgery with conventional technique and diode laser. (Observational Study)
Observational Study Comparative Study
PURPOSE
To compare the hearing results and clinical safety of patients undergoing stapes surgery with conventional technique and diode laser.
METHODS
Retrospective observational study, which included patients treated with primary stapes surgery performed between January 2009 and January 2020. Three audiometric measurements (PTA, GAP and SDS) were evaluated as main results, evaluated by analysis of covariance (controlling the preoperative value). Intraoperative and postoperative complications were also analyzed. Outcomes were measured 6 months (± 1 month) after surgery.
RESULTS
153 cases were included, 97 operated with conventional technique and 56 with laser technique. Postoperative GAP ≤ 10 dB was obtained in 85.6% of the total sample, 82.5% in the conventional technique and 91.1% in the laser technique. Analysis of covariance showed no significant differences in the three surgery outcomes between the two groups (PTA, p = 0.277; GAP, p = 0.509 and SDS, p = 0.530). Regarding surgical complications, sensorineural damage was higher in the conventional technique group (p = 0.05). On the other hand, there were four cases of facial paresis, all in the laser group, three of them with the 980 nm laser.
CONCLUSIONS
Stapedotomy offered a high percentage of hearing success in the two groups studied. There were no significant differences in audiometric result, but there was a differential presentation of complications, being more frequent sensorineural hearing loss in the conventional technique group and facial paresis in the laser group.
Topics: Humans; Stapes Surgery; Female; Retrospective Studies; Male; Middle Aged; Lasers, Semiconductor; Adult; Otosclerosis; Postoperative Complications; Treatment Outcome; Aged; Laser Therapy; Audiometry
PubMed: 38219247
DOI: 10.1007/s00405-023-08429-4 -
Radiology Case Reports Jul 2024Intracranial epidermoid cysts are benign, slow-growing congenital tumors of ectodermal origin. They are rare embryonal benign cystic masses with an incidence rate of...
Intracranial epidermoid cysts are benign, slow-growing congenital tumors of ectodermal origin. They are rare embryonal benign cystic masses with an incidence rate of approximately 0.04%-0.6% of intracranial tumors. Computed tomography (CT) and magnetic resonance imaging (MRI) are fundamental diagnostic tools providing valuable information for surgical management. We reported a 59-year-old male patient with right limb weakness twelve hours prior to admission, slurred speech, and paresis of the facial nerve. Based on history taking, physical examination, and radiology examinations, we concluded a diagnosis of non-communicated hydrocephalus due to a right cerebellar intra-axial tumor with a suspicion of low-grade glioma (Pylocitic Astrocytoma). CT and MRI in intracranial epidermoid cysts are fundamental diagnostic tools for diagnosing and obtaining helpful information for surgical planning. Intracranial epidermoid cysts appear as lobulated lesions filling and expanding CSF spaces and exerting a gradual mass effect, insinuating between structures and encasing adjacent nerves and vessels. In this case, we noted a hypodense lesion with irregular calcifications and well-defined on the right cerebellar region measuring 6.15 × 5.47 × 5.7 cm, surrounded by a hypodense image suggesting an intra-axial mass suspected of low-grade glioma with a differential diagnosis of brain abscess. The hypointense lesion on the T1WI sequence found in the MRI examination, with no significant contrast enhancement and restricted diffusion area on DWI, was one of the notable features described in the epidermoid cyst. Intracranial epidermoid cyst rarely occurs in the intracranial, resulting in many symptoms in this case, which should be diagnosed and treated promptly. Imaging aids in proper diagnosis and provides more valuable information for further treatment.
PubMed: 38680739
DOI: 10.1016/j.radcr.2024.03.061 -
Journal of Clinical Medicine Research Mar 2024Migraine, vestibular migraine (VM) and tension-type headache (TTH) are the most common disorders in dizziness and headache clinics, associated with dizziness or vertigo...
Presence of Spontaneous Nystagmus, Benign Paroxysmal Positional Vertigo, and Tumarkin Fall in Patients With Primary Headache and Their Responses to Caloric and Video Head Impulse Tests.
BACKGROUND
Migraine, vestibular migraine (VM) and tension-type headache (TTH) are the most common disorders in dizziness and headache clinics, associated with dizziness or vertigo and postural imbalance, causing a substantial burden on the individual and the society. The objective of this research was to examine the presence of spontaneous nystagmus, comorbidity of benign paroxysmal positional vertigo (BPPV), and Tumarkin fall in patients; additionally, the study focused on assessing the patients' responses to bithermal caloric irrigation and video head impulse test (vHIT).
METHODS
Consecutive patients diagnosed with migraine, VM, and TTH according to the International Classification of Headache Disorders, third edition (beta version (ICHD-3β)), who were referred to Dizziness and Headache Clinic were enrolled. BPPV and Tumarkin fall were assessed by questionnaires. The presence of BPPV was further evaluated through Dix-Hallpike or head roll maneuver, while spontaneous nystagmus was monitored using video-oculography during interictal period. Lastly, patients' responses to bithermal caloric irrigation and vHIT were analyzed.
RESULTS
There was a significantly higher incidence of spontaneous nystagmus in VM compared to both migraine and TTH. The drop attack episodes were slightly more frequent in VM than in TTH and migraine, though not statistically significant. The prevalence of BPPV was significantly higher in VM than in migraine and TTH. Unilateral vestibular paresis was more common in the VM group than in migraine and TTH. There was profound unilateral weakness (UW) in VM patients than in migraine, but no significant difference was found between VM and TTH. In VM, the percentage of saccades along with reduced vHIT gain was significantly higher than in migraine. Lastly, the percentage of abnormal response in vHIT was significantly lower than the percentage of abnormal UW in caloric irrigation across all groups.
CONCLUSIONS
In VM patients, the prevalences of decompensated peripheral damage and BPPV were higher than in migraine and TTH patients as disclosed by the presence of peripheral spontaneous nystagmus and abnormal vHIT during the interictal period. Our findings suggest that the peripheral vestibular system acts as a significant mechanism in the pathogenesis of VM, and it might also be involved in migraine and TTH cases without vertigo symptoms.
PubMed: 38550548
DOI: 10.14740/jocmr5088