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Seminars in Ultrasound, CT, and MR Oct 2013Perineural spread of tumor is defined as extension of the primary tumor along tissues of the neural sheath (epineurium and perineurium) of a named nerve. Given the... (Review)
Review
Perineural spread of tumor is defined as extension of the primary tumor along tissues of the neural sheath (epineurium and perineurium) of a named nerve. Given the density of cranial nerves in the central skull base region and their extracranial communications, perineural tumor spread from a variety of sources can affect the central skull base region. Common malignancies with perineural tumor spread to central skull base include mucosal squamous cell carcinoma, adenoid cystic carcinoma, and cutaneous malignancies including melanoma. The presence and extent of tumor spread influence selection of treatment and prognosis. Appropriate imaging and interpretation, therefore, play a crucial role in detection and management of perineural tumor spread in the central skull base region.
Topics: Brain Neoplasms; Cranial Nerve Neoplasms; Magnetic Resonance Imaging; Neoplasm Invasiveness; Nerve Sheath Neoplasms; Neuroimaging; Skull Base Neoplasms; Tomography, X-Ray Computed
PubMed: 24216453
DOI: 10.1053/j.sult.2013.09.002 -
Biochimica Et Biophysica Acta Apr 2016Pancreatic cancer is one of the most malignant human tumors. Perineural invasion, whereby a cancer cell invades the perineural spaces surrounding nerves, is acknowledged... (Review)
Review
Pancreatic cancer is one of the most malignant human tumors. Perineural invasion, whereby a cancer cell invades the perineural spaces surrounding nerves, is acknowledged as a gradual contributor to cancer aggressiveness. Furthermore, perineural invasion is considered one of the root causes of the recurrence and metastasis observed after pancreatic resection, and it is also an independent predictor of prognosis. Advanced research has demonstrated that the neural microenvironment is closely associated with perineural invasion in pancreatic cancer. Therapy targeting the molecular mechanism of perineural invasion may enable the durable clinical treatment of this formidable disease. This review provides an overview of the present status of perineural invasion, the relevant molecular mechanisms of perineural invasion, pain and hyperglycemia associated with perineural invasion in pancreatic cancer, and the targeted therapeutics based on these studies.
Topics: Chemokines; Humans; Hyperglycemia; Neoplasm Invasiveness; Pain, Intractable; Pancreatic Neoplasms; Prognosis
PubMed: 26794395
DOI: 10.1016/j.bbcan.2016.01.002 -
Pain Research and Treatment 2014Background. The overall effect of perineural dexamethasone on postoperative analgesia outcomes has yet to be quantified. The main objective of this quantitative review... (Review)
Review
Background. The overall effect of perineural dexamethasone on postoperative analgesia outcomes has yet to be quantified. The main objective of this quantitative review was to evaluate the effect of perineural dexamethasone as a nerve block adjunct on postoperative analgesia outcomes. Methods. A systematic search was performed to identify randomized controlled trials that evaluated the effects of perineural dexamethasone as a block adjunct on postoperative pain outcomes in patients receiving regional anesthesia. Meta-analysis was performed using a random-effect model. Results. Nine randomized trials with 760 subjects were included. The weighted mean difference (99% CI) of the combined effects favored perineural dexamethasone over control for analgesia duration, 473 (264 to 682) minutes, and motor block duration, 500 (154 to 846) minutes. Postoperative opioid consumption was also reduced in the perineural dexamethasone group compared to control, -8.5 (-12.3 to -4.6) mg of IV morphine equivalents. No significant neurological symptoms could have been attributed to the use of perineural dexamethasone. Conclusions. Perineural dexamethasone improves postoperative pain outcomes when given as an adjunct to brachial plexus blocks. There were no reports of persistent nerve injury attributed to perineural administration of the drug.
PubMed: 25485150
DOI: 10.1155/2014/179029 -
Magnetic Resonance Imaging Clinics of... Feb 2018Perineural tumor spread (PNS) substantially alters a patient's prognosis and treatment plan. Therefore, it is critical that the radiologists are familiar with the course... (Review)
Review
Perineural tumor spread (PNS) substantially alters a patient's prognosis and treatment plan. Therefore, it is critical that the radiologists are familiar with the course of cranial nerves commonly affected by PNS and the neuronal connections to appropriately map the extent of PNS. Limited involvement of a nerve by PNS might be resectable, whereas advanced PNS may require radiation therapy.
Topics: Cranial Nerve Neoplasms; Humans; Magnetic Resonance Imaging; Neoplasm Invasiveness
PubMed: 29128008
DOI: 10.1016/j.mric.2017.08.006 -
Surgical Neurology International 2020Perineural invasion (PNI) and spread are one of the grimmest prognostic factors associated with primary skin and head-and-neck cancers, yet remain an often confused, and... (Review)
Review
BACKGROUND
Perineural invasion (PNI) and spread are one of the grimmest prognostic factors associated with primary skin and head-and-neck cancers, yet remain an often confused, and underreported, phenomenon. Adding complexity to reaching a diagnosis and treating perineural spread (PNS) is the finding that patients may have no known primary tumor, history of skin cancer, and/or incidental PNI in the primary tumor. These delays in diagnosis and treatment are further compounded by an already slow disease process and often require multidisciplinary care with combinations of stereotactic radiosurgery, surgical resection, and novel treatments such as checkpoint inhibitors.
METHODS
Six patients with metastatic cancer to the cranial nerves who underwent Gamma Knife radiosurgery (GKRS) treatment were chosen for retrospective analysis. This information included age, gender, any past surgeries (both stereotactic and regular surgery), dose of radiation and volume of the tumor treated in the GKRS, date of PNS, comorbidities, the patient follow-up, and pre- and post-GKRS imaging. The goal of the follow-up with radiographing imaging was to assess the efficacy of GKSS.
RESULTS
The clinical course of six patients with PNS is presented. Patients followed variable courses with mixed outcomes: two patients remain living, one was lost to follow-up, and three expired with a median survival of 12 months from date of diagnosis. Patients at our institution are ideally followed for life.
CONCLUSION
Given the morbidity and mortality of PNS of cancer, time is limited, and further understanding is required to improve outcomes. Here, we provide a case series of patients with PNS treated with stereotactic radiosurgery, discuss their clinical courses, and review the known literature.
PubMed: 32874709
DOI: 10.25259/SNI_146_2020 -
Radiographics : a Review Publication of... Oct 2013Certain tumors of the head and neck use peripheral nerves as a direct conduit for tumor growth away from the primary site by a process known as perineural spread.... (Review)
Review
Certain tumors of the head and neck use peripheral nerves as a direct conduit for tumor growth away from the primary site by a process known as perineural spread. Perineural spread is associated with decreased survival and a higher risk of local recurrence and metastasis. Radiologists play an important role in the assessment and management of head and neck cancer, and positron emission tomography/computed tomography (PET/CT) with 2-[fluorine 18]fluoro-2-deoxy-d-glucose (FDG) is part of the work-up and follow-up of many affected patients. Awareness of abnormal FDG uptake patterns within the head and neck is fundamental for diagnosing perineural spread. The cranial nerves most commonly affected by perineural spread are the trigeminal and facial nerves. Risk of perineural spread increases with a midface location of the tumor, male gender, increasing tumor size, recurrence after treatment, and poor histologic differentiation. Focal or linear increased FDG uptake along the V2 division of the trigeminal nerve or along the medial surface of the mandible, or asymmetric activity in the masticator space, foramen ovale, or Meckel cave should raise suspicion for perineural spread. If FDG PET/CT findings suggest perineural spread, the radiologist should look at available results of other imaging studies, especially magnetic resonance imaging, to confirm the diagnosis. Knowledge of common FDG PET/CT patterns of neoplastic involvement along the cranial nerves and potential diagnostic pitfalls is of the utmost importance for adequate staging and treatment planning.
Topics: Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Multimodal Imaging; Patient Care Planning; Peripheral Nervous System Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed
PubMed: 24108559
DOI: 10.1148/rg.336135501 -
Annali Italiani Di Chirurgia 2017Gallbladder cancer (GBC) is the most incident cancer of the biliary tract with only 5-13% of the sufferers surviving for five years. The aim of this study was to... (Review)
Review
INTRODUCTION
Gallbladder cancer (GBC) is the most incident cancer of the biliary tract with only 5-13% of the sufferers surviving for five years. The aim of this study was to evaluate the prognostic role of perineural invasion (PNI) and its association with several clinicopathological variables in a cohort of surgically treated patients, and through a comprehensive review of the scientific literature.
MATERIALS AND METHODS
Twenty-five consecutive patients submitted to curative surgery for GBC from 2008 through 2016 were enrolled. Demographic, clinical and pathological data were retrieved from medical files, and specimens were re-examined by two experienced pathologists. The Pubmed database was searched for articles reporting on perineural infiltration on gallbladder cancer.
RESULTS
Perineural invasion was observed in 14 (56%) cases, and it was more frequent in higher pathological stages. A statistically significant association was found with high preoperative serum Ca 19-9 levels. Fourteen (56%) patients died during the follow-up; survival was lower in patients with perineural invasion in comparison to those without, but not statistically significant. Twelve English-language articles reporting on PNI were retrieved and discussed.
CONCLUSIONS
Perineural invasion is associated with higher stage and poorer survival in surgically treated GBC patients. In patients with locally advanced GBC resection of the extrahepatic biliary duct and frozen section examination of the distal stump must be taken into consideration, especially in cases of tumor arising from the hepatic side of the gallbladder. In cases without residual disease but with pathological evidence of PNI, a careful follow-up is suggested to early detect recurrences.
KEY WORDS
Adenocarcinoma, Cancer, Gallbladder, Perineural infiltration, Surgery.
Topics: Adenocarcinoma; Aged; Aged, 80 and over; Bile Ducts, Extrahepatic; Biomarkers, Tumor; CA-19-9 Antigen; Cholecystectomy; Female; Follow-Up Studies; Frozen Sections; Gallbladder Neoplasms; Humans; Male; Margins of Excision; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Prognosis
PubMed: 29339591
DOI: No ID Found -
Journal of Medicine and Life Jun 2014perineural invasion is an under-recognized way of metastatic spread via tumoral invasion of the nerves. It is encountered in malignancies located in the head and neck... (Review)
Review
RATIONALE
perineural invasion is an under-recognized way of metastatic spread via tumoral invasion of the nerves. It is encountered in malignancies located in the head and neck but also in cancers involving the pancreas, colon and rectum, prostate, biliary tract and stomach. For some tumors, it may be the only way of metastatic spread. It represents a marker for poor outcome, with increased risk for locoregional recurrence and reduced survival rates. The molecular mechanisms behind this process are not yet fully understood; research is done to identify new therapeutic targets in order to achieve disease control.
OBJECTIVE
to make a rigorous analysis of this phenomenon and to highlight the best therapeutic approach.
METHOD AND RESULTS
a review of the current literature in order to harmonize the international protocols to our local pathology.
DISCUSSIONS
the surgical intervention is decisive to defeat the malignant process but must be associated with modern therapeutic methods, such as the image-guided radiation therapy and immunotherapy.
Topics: Head and Neck Neoplasms; Humans; Immunotherapy; Neoplasm Invasiveness; Neurosurgical Procedures; Peripheral Nerves; Radiotherapy, Image-Guided
PubMed: 25408713
DOI: No ID Found -
Anesthesiology Jun 2023The authors hypothesized that both perineural and systemic dexamethasone as adjuncts to bupivacaine increase the duration of an ulnar nerve block compared with... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The authors hypothesized that both perineural and systemic dexamethasone as adjuncts to bupivacaine increase the duration of an ulnar nerve block compared with bupivacaine alone, and that systemic dexamethasone is noninferior to perineural dexamethasone.
METHODS
The authors performed bilateral ulnar nerve blocks with 3 ml bupivacaine 5 mg/ml in 16 healthy volunteers on two trial days. According to randomization, subjects received adjunct treatment with 1 ml dexamethasone 4 mg/ml + 1 ml of saline (perineural condition) in one arm and 2 ml saline in the other arm (systemic condition, through absorption and redistribution of the contralaterally administered perineural dexamethasone) on one trial day; and 2 ml saline in one arm (placebo condition) and 2 ml of lidocaine in the other arm (lidocaine condition) on the other trial day. The primary outcome was the duration of the sensory nerve block assessed by temperature discrimination.
RESULTS
Mean sensory block duration was 706 ± 94 min for the perineural condition, 677 ± 112 min for the systemic condition, and 640 ± 121 min for the placebo condition. The duration of the sensory nerve block was greater with perineural dexamethasone versus placebo (mean difference 66 min (95% CI, 23 to 108). Block duration was similar between systemic dexamethasone and placebo (mean difference 36 min; 95% CI, -30 to 103).
CONCLUSIONS
Perineural dexamethasone as an adjunct to bupivacaine in healthy volunteers resulted in a greater duration of an ulnar nerve block when compared with placebo. Systemic dexamethasone resulted in a similar duration as placebo.
Topics: Humans; Dexamethasone; Anesthetics, Local; Healthy Volunteers; Bupivacaine; Nerve Block; Lidocaine; Pain, Postoperative; Double-Blind Method
PubMed: 36912613
DOI: 10.1097/ALN.0000000000004557 -
Insights Into Imaging Dec 2018Perineural tumour spread (PNTS) in head and neck oncology is most often caused by squamous cell carcinoma. The most frequently affected nerves are the trigeminal and... (Review)
Review
Perineural tumour spread (PNTS) in head and neck oncology is most often caused by squamous cell carcinoma. The most frequently affected nerves are the trigeminal and facial nerves. Up to 40% of patients with PNTS may be asymptomatic. Therefore, the index of suspicion should be high when evaluating imaging studies of patients with head and neck cancer. This review describes a "quick search checklist" of easily detected imaging signs of PNTS. TEACHING POINTS: • A distinctive feature of head and neck tumours is growth along nerves. • Perineural tumour spread is most often caused by squamous cell carcinoma. • There are several key findings for the detection of perineural tumour spread.
PubMed: 30446949
DOI: 10.1007/s13244-018-0672-8