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Oral Oncology Nov 2009Of malignant tumours with a propensity to invade the perineural space, adenoid cystic carcinoma of the salivary glands is perhaps the best known. However, it is not... (Review)
Review
Of malignant tumours with a propensity to invade the perineural space, adenoid cystic carcinoma of the salivary glands is perhaps the best known. However, it is not known if microscopic evidence of perineural invasion has true prognostic significance in adenoid cystic carcinoma. A review of the available data, which is the aim of this article, reveals the issue is not straightforward. There is a plethora of conflicting data which, on balance, suggest the answer is indeed in the affirmative, particularly if the nerve involved is above a certain size, or "named". Even if the data are equivocal, many head and neck surgeons and oncologists take account of histologically proved perineural invasion when planning treatment for adenoid cystic carcinoma.
Topics: Carcinoma, Adenoid Cystic; Humans; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Prognosis; Salivary Gland Neoplasms
PubMed: 19692291
DOI: 10.1016/j.oraloncology.2009.07.001 -
Journal of Neurological Surgery. Part... Apr 2016This article provides an overview of perineural spread of head and neck malignancy. It defines the problem and explores some of the unique features, which occur with... (Review)
Review
This article provides an overview of perineural spread of head and neck malignancy. It defines the problem and explores some of the unique features, which occur with this pathology. The expectation is for a better understanding of this extraordinary disease, hopefully leading to earlier diagnosis and for a more consistent reporting of results. It summarizes the topics to be covered in this special edition, which should leave the reader with a fairly complete understanding of the contemporary issues of perineural spread.
PubMed: 27123383
DOI: 10.1055/s-0036-1579778 -
Cancer Imaging : the Official... Oct 2010Perineural tumour spread refers to a contiguous neoplastic extension along a nerve. As it may be clinically silent, imaging plays a pivotal role in the evaluation and... (Review)
Review
Perineural tumour spread refers to a contiguous neoplastic extension along a nerve. As it may be clinically silent, imaging plays a pivotal role in the evaluation and delineation of perineural infiltration in head and neck malignancies, which in turn affects treatment planning. This article focuses on the imaging features of perineural spread of head and neck tumours. The important potential perineural pathways and the possible underlying pathogenesis of this phenomenon are also reviewed.
Topics: Cranial Nerve Neoplasms; Diagnosis, Differential; Head and Neck Neoplasms; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 20880778
DOI: 10.1102/1470-7330.2010.9033 -
Head & Neck Jan 2002Perineural invasion is observed in a small subset of patients with carcinomas of the skin of the head and neck. (Review)
Review
BACKGROUND
Perineural invasion is observed in a small subset of patients with carcinomas of the skin of the head and neck.
METHODS
Review of the patient literature highlighting the University of Florida experience.
RESULTS
Patients with early perineural invasion are asymptomatic, and the phenomenon is discovered only on pathologic examination of the excised lesion. These patients are defined as having "incidental" perineural invasion, and treatment with surgery followed by postoperative irradiation results in a cure rate of approximately 80%. Undiagnosed, the perineural carcinoma slowly progresses and eventually results in symptoms, usually facial weakness or numbness. The disease eventually extends to the skull base and becomes incompletely resectable. Symptomatic patients are defined as having "clinical" perineural invasion, and aggressive treatment results in a cure rate of approximately 45%.
CONCLUSIONS
Perineural invasion is an uncommon spread pattern observed in patients with skin cancer and is associated with a relatively poor prognosis. The likelihood of cure is inversely related to the proximal extent of the cancer and is lower for symptomatic compared with asymptomatic patients.
Topics: Carcinoma, Squamous Cell; Cranial Nerves; Female; Head and Neck Neoplasms; Humans; Incidence; Magnetic Resonance Imaging; Male; Neoplasm Invasiveness; Prognosis; Risk Assessment; Risk Factors; Skin Neoplasms; Survival Analysis; Tomography, X-Ray Computed
PubMed: 11774406
DOI: 10.1002/hed.10025 -
Anaesthesia Jul 2021Both perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the... (Meta-Analysis)
Meta-Analysis
Both perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta-analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long-acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2-h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One-hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366-435) min, motor block duration of 369 (330-408) min and analgesic duration of 435 (386-483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160-795) min], followed by perineural dexamethasone [411 (343-480) min] and perineural dexmedetomidine [284 (235-333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236-352) min], followed by intravenous dexamethasone [289 (129-448)min] and perineural dexmedetomidine [258 (212-304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448-589) min], followed by intravenous dexamethasone [478 (277-679) min] and perineural dexmedetomidine [318 (266-371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics.
Topics: Adjuvants, Anesthesia; Administration, Intravenous; Anesthetics, Local; Brachial Plexus Block; Dexamethasone; Dexmedetomidine; Humans; Network Meta-Analysis
PubMed: 33118163
DOI: 10.1111/anae.15288 -
Spine Jul 2008A case series and literature review are presented. (Review)
Review
STUDY DESIGN
A case series and literature review are presented.
OBJECTIVE
To review relevant data for the management of perineural cysts, and present a case series of 2 patient with symptomatic perineural cysts treated by steroid therapy.
SUMMARY OF BACKGROUND DATA
Perineural cysts are usually an incidental finding, but rarely may cause mechanical nerve root compression. Surgical treatments for perineural cysts are complicated by postoperative pseudomeningocoele and intracranial hypotension, and reoccurrence of the cyst. There are no reported nonsurgical treatments for perineural cysts.
METHODS
We present a case series symptomatic perineural cysts.
RESULTS
Patients with lumbar and cervical perineural cysts were treated successfully with oral and epidural steroid therapy.
CONCLUSION
Steroid therapy may offer a nonsurgical alternative for the treatment of symptomatic perineural cysts.
Topics: Adult; Disease Management; Female; Humans; Male; Middle Aged; Tarlov Cysts
PubMed: 18628699
DOI: 10.1097/BRS.0b013e31817e2cc9 -
Magnetic Resonance Imaging Clinics of... Aug 2002Perineural tumor spread (PNS) is a common and potentially devastating complication of head and neck cancer. Because perineural tumor spread may be asymptomatic, the... (Review)
Review
Perineural tumor spread (PNS) is a common and potentially devastating complication of head and neck cancer. Because perineural tumor spread may be asymptomatic, the radiologist plays a critical role in the evaluation of the head and neck cancer patient. Although PNS may be seen on CT, MR imaging is far more sensitive and is the imaging modality of choice in the evaluation of perineural tumor spread.
Topics: Cranial Nerves; Head and Neck Neoplasms; Humans; Magnetic Resonance Imaging; Neoplasm Invasiveness
PubMed: 12530232
DOI: 10.1016/s1064-9689(02)00013-2 -
Journal of Neurological Surgery. Part... Apr 2016We present a review of the imaging surveillance following treatment for large nerve perineural spread in the skull base. The expected appearance and possible... (Review)
Review
We present a review of the imaging surveillance following treatment for large nerve perineural spread in the skull base. The expected appearance and possible complications following surgery and radiotherapy are discussed. Imaging examples of the possible sites of disease recurrence are also presented.
PubMed: 27123395
DOI: 10.1055/s-0036-1571840 -
Current Opinion in Anaesthesiology Oct 2020Single injection interscalene block (ISB) provides effective analgesia for shoulder surgery. However, the duration of these is limited. This review summarizes the... (Review)
Review
PURPOSE OF REVIEW
Single injection interscalene block (ISB) provides effective analgesia for shoulder surgery. However, the duration of these is limited. This review summarizes the effectiveness of three potential means of extending the duration of analgesia: perineural infusion of local anesthetic agents, addition of adjuvant drugs to local anesthetics in single-injection nerve block, and utilization of liposomal bupivacaine in the surgical field or in the block itself.
RECENT FINDINGS
Perineural infusion of local anesthetics with interscalene catheters provides superior pain relief with reduction of postoperative opioids. Both dexmedetomidine and dexamethasone effectively extend the duration of single injection ISB. Liposomal bupivacaine holds promise when injected perineurally in ISB, either as a sole agent or when mixed with standard bupivacaine.
SUMMARY
Interscalene catheters, adjunctive drugs added to local anesthetics in single-injection interscalene brachial plexus blocks, or liposomal bupivacaine may be used to effectively prolong the duration of analgesia for shoulder surgery patients.
Topics: Anesthetics, Local; Brachial Plexus; Brachial Plexus Block; Bupivacaine; Humans; Pain, Postoperative
PubMed: 32826626
DOI: 10.1097/ACO.0000000000000913 -
Cancer Investigation Sep 2022We searched international databases to identify evidence that refer to the impact of perineural invasion on survival outcomes of patients with squamous cell vulvar... (Meta-Analysis)
Meta-Analysis
We searched international databases to identify evidence that refer to the impact of perineural invasion on survival outcomes of patients with squamous cell vulvar cancer. We identified six retrospective cohort studies that investigated 887 patients. Of those, 234 (26.4%) had perineural invasion in the pathology analysis. Women with perineural invasion were more likely to have inguinal lymph node metastases (HR 3.45, 95% CI 1.12, 10.67). The impact of perineural invasion on progression-free survival rates was significant (HR 1.61, 95% CI 1.21, 2.15) as well as its impact on overall survival rates (HR 2.73, 95% CI 1.94, 3.84).
Topics: Biomarkers; Female; Groin; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoplasm Invasiveness; Neoplasm Staging; Retrospective Studies; Vulvar Neoplasms
PubMed: 35467488
DOI: 10.1080/07357907.2022.2070918