Impairment Tutorial: Rating Cranial Nerve and Spinal Cord Disorders

1997 ◽  
Vol 2 (2) ◽  
pp. 3-4
Author(s):  
Lorne Direnfeld
Keyword(s):  
Spinal Cord ◽  
Facial Nerve ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Visual Fields ◽  
Anorectal Function ◽  
Bladder Function ◽  
Sensory Loss ◽  
Spinal Cord Disorders ◽  
Cranial Nerve Viii

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, discusses rating cranial nerve and spinal cord impairments. Evaluation of impairment of the cranial nerves is based on clinical neurological assessment, and many cranial nerves also are addressed in other chapters of the AMA Guides (eg, the visual system or the ear, nose, and throat). With respect to cranial nerve I, an impairment estimate associated with anosmia or parosmia should be given only if this significantly interferes with daily activities. For cranial nerve II, the AMA Guides recommends ophthalmologic testing of visual fields and best correction. For cranial nerves III, IV, and VI, the reader is referred to section 8.3, and, for cranial nerve V, the AMA Guides provides a method of determining impairment associated with trigeminal neuralgia. A table provides data regarding impairment for conditions that affect the seventh cranial (facial) nerve; sensory loss related to the facial nerve does not interfere with activities of daily living. Auditory impairment (cranial nerve VIII) is rated according to criteria in the ear, nose, throat, and related structures chapter, including tinnitus. Cranial nerves IX, X, XI, and XII are involved in breathing, swallowing, speaking, and some visceral functions, and ratings criteria are presented. In terms of spinal cord impairments, the AMA Guides divides pathology into six categories: station and gait; use of the upper extremities; respiration; urinary bladder function; anorectal function; and sexual function.

INCIDENCE OF CRANIAL NERVE PARALYSIS IN POLIOMYELITIS IN RELATION TO PRESENCE OR ABSENCE OF TONSILS

PEDIATRICS ◽  
1958 ◽  
Vol 21 (1) ◽  
pp. 106-111
Author(s):  
F. H. Top
Keyword(s):  
Facial Nerve ◽  
Rural Area ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Nerve Paralysis ◽  
Cranial Nerve Paralysis ◽  
Clinical Type ◽  
Composite Study

A study of patients from a largely rural area in Iowa corroborates the evidence of many previous studies that bulbar and bulbospinal types of poliomyelitis occur more commonly in persons whose tonsils have been removed irrespective of the time in life the operation was performed. The tonsillectomy rate for all cases was the lowest encountered thus far. Agreement is not on the same level as noted in the author's Detroit composite study previously reported, and is more marked for bulbospinal than for the bulbar type of poliomyelitis (some studies combine bulbar and bulbospinal cases). Adjustment for age reduces differences between cases with tonsils absent and tonsils present by clinical type and further strengthens the finding of Paffenbarger and of the author's Detroit composite study that age must be reckoned with in an assessment of the problem. Incidence of paralyses of cranial nerves by tonsillectomy status is similar to the Detroit composite study in the case of palatal and pharyngeal paralyses but less strongly; incidence of paralysis of the facial nerve is dissimilar.

scholarly journals Repeat stereotactic radiosurgery for progressive vestibular schwannomas after previous radiosurgery: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Anne Balossier ◽  
Jean Régis ◽  
Nicolas Reyns ◽  
Pierre-Hugues Roche ◽  
Roy Thomas Daniel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hearing Loss ◽  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Cranial Nerve ◽  
Meta Analysis ◽  
Cranial Nerves ◽  
Vestibular Schwannomas ◽  
Benign Tumors ◽  
Tumor Control

AbstractVestibular schwannomas (VS) are slow-growing intracranial extraaxial benign tumors, developing from the vestibular part of the eight cranial nerves. Stereotactic radiosurgery (SRS) has now a long-term scientific track record as first intention treatment for small- to medium-sized VS. Though its success rate is very high, SRS for VS might fail to control tumor growth in some cases. However, the literature on repeat SRS after previously failed SRS remains scarce and reported in a low number of series with a limited number of cases. Here, we aimed at performing a systematic review and meta-analysis of the literature on repeat SRS for VS. Using PRISMA guidelines, we reviewed manuscripts published between January 1990 and October 2020 and referenced in PubMed. Tumor control and cranial nerve outcomes were evaluated with separate meta-analyses. Eight studies comprising 194 patients were included. The overall rate of patients treated in repeat SRS series as per overall series with first SRS was 2.2% (range 1.2–3.2%, p < 0.001). The mean time between first and second SRS was 50.7 months (median 51, range 44–64). The median marginal dose prescribed at first SRS was 12 Gy (range 8–24) and at second SRS was 12 Gy (range 9.8–19). After repeat SRS, tumor stability was reported in 61/194 patients, i.e., a rate of 29.6% (range 20.2–39%, I2 = 49.1%, p < 0.001). Tumor decrease was reported in 83/194 patients, i.e., a rate of 54.4% (range 33.7–75.1%, I2 = 89.1%, p < 0.001). Tumor progression was reported in 50/188 patients, i.e., a rate of 16.1% (range 2.5–29.7%, I2 = 87.1%, p = 0.02), rarely managed surgically. New trigeminal numbness was reported in 27/170 patients, i.e., a rate of 9.9% (range 1.4–18.3%, p < 0.02). New facial nerve palsy of worsened of previous was reported in 8/183 patients, i.e., a rate of 4.3% (range 1.4–7.2%, p = 0.004). Hearing loss was reported in 12/22 patients, i.e., a rate of 54.3% (range 24.8–83.8%, I2 = 70.7%, p < 0.001). Repeat SRS after previously failed SRS for VS is associated with high tumor control rates. Cranial nerve outcomes remain favorable, particularly for facial nerve. The rate of hearing loss appears similar to the one related to first SRS.

scholarly journals Jugular foramen tumors: diagnosis and treatment

2004 ◽  
Vol 17 (2) ◽  
pp. 31-40 ◽  
Author(s):  
Ricardo Ramina ◽  
Joao Jarney Maniglia ◽  
Yvens Barbosa Fernandes ◽  
Jorge Rizzato Paschoal ◽  
Leopoldo Nizan Pfeilsticker ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Lower Cranial Nerve ◽  
Nerve Paralysis ◽  
Great Auricular Nerve ◽  
Csf Leakage ◽  
Nerve Anastomosis

Object Jugular foramen tumors are rare skull base lesions that present diagnostic and complex management problems. The purpose of this study was to evaluate a series of patients with jugular foramen tumors who were surgically treated in the past 16 years, and to analyze the surgical technique, complications, and outcomes. Methods The authors retrospectively studied 102 patients with jugular foramen tumors treated between January 1987 and May 2004. All patients underwent surgery with a multidisciplinary method combining neurosurgical and ear, nose, and throat techniques. Preoperative embolization was performed for paragangliomas and other highly vascularized lesions. To avoid postoperative cerebrospinal fluid (CSF) leakage and to improve cosmetic results, the surgical defect was reconstructed with specially developed vascularized flaps (temporalis fascia, cervical fascia, sternocleidomastoid muscle, and temporalis muscle). A saphenous graft bypass was used in two patients with tumor infiltrating the internal carotid artery (ICA). Facial nerve reconstruction was performed with grafts of the great auricular nerve or with 12th/seventh cranial nerve anastomosis. Residual malignant and invasive tumors were irradiated after partial removal. The most common tumor was paraganglioma (58 cases), followed by schwannomas (17 cases) and meningiomas (10 cases). Complete excision was possible in 45 patients (77.5%) with paragangliomas and in all patients with schwannomas. The most frequent and also the most dangerous surgical complication was lower cranial nerve deficit. This deficit occurred in 10 patients (10%), but it was transient in four cases. Postoperative facial and cochlear nerve paralysis occurred in eight patients (8%); spontaneous recovery occurred in three of them. In the remaining five patients the facial nerve was reconstructed using great auricular nerve grafts (three cases), sural nerve graft (one case), and hypoglossal/facial nerve anastomosis (one case). Four patients (4%) experienced postoperative CSF leakage, and four (4.2%) died after surgery. Two of them died of aspiration pneumonia complicated with septicemia. Of the remaining two, one died of pulmonary embolism and the other of cerebral hypoxia caused by a large cervical hematoma that led to tracheal deviation. Conclusions Paragangliomas are the most common tumors of the jugular foramen region. Surgical management of jugular foramen tumors is complex and difficult. Radical removal of benign jugular foramen tumors is the treatment of choice, may be curative, and is achieved with low mortality and morbidity rates. Larger lesions can be radically excised in one surgical procedure by using a multidisciplinary approach. Reconstruction of the skull base with vascularized myofascial flaps reduces postoperative CSF leaks. Postoperative lower cranial nerves deficits are the most dangerous complication.

The nervous system

2018 ◽  
Author(s):  
James Thomas ◽  
Tanya Monaghan
Keyword(s):  
Peripheral Nerves ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
The Elderly ◽  
The Unconscious ◽  
Applied Anatomy ◽  
Presenting Symptoms ◽  
Primitive Reflexes ◽  
System P ◽  
Cranial Nerve Viii

HistoryPresenting symptomsThe rest of the historyExaminationThe outline examinationGeneral inspection and mental stateCognitive functionSpeech and languageCranial nerve examinationCranial nerves II, III, IV, and VICranial nerve I: olfactoryCranial nerve V: trigeminalCranial nerve VII: facialCranial nerve VIII: vestibulocochlearCranial nerves IX and XCranial nerve XI: accessoryCranial nerve XII: hypoglossalMotor: applied anatomyMotor: inspection and toneMotor: upper limb powerMotor: lower limb powerTendon reflexesOther reflexesPrimitive reflexesSensory: applied anatomySensory examinationCoordinationSome peripheral nervesGaitThe unconscious patientImportant presenting patternsThe elderly patient

Posterior Fossa Level: Brainstem and Cranial Nerve Nuclei

2017 ◽  
pp. 561-594
Author(s):  
Eduardo E. Benarroch ◽  
Jeremy K. Cutsforth-Gregory ◽  
Kelly D. Flemming
Keyword(s):  
Spinal Cord ◽  
Posterior Fossa ◽  
Neural Tube ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Internal Anatomy ◽  
Tentorium Cerebelli ◽  
The Core ◽  
Derivatives Of

The posterior fossa level contains all the structures located within the skull below the tentorium cerebelli and above the foramen magnum. These structures are derivatives of the embryonic mesencephalon, metencephalon, and myelencephalon and include portions of all the systems discussed in other chapters. The major structures of this level are the brainstem, cerebellum, and segments of cranial nerves III-XII before their emergence from the skull. The brainstem, the core of the posterior fossa level, is a specialized rostral extension of the embryonic neural tube that preserves, even in the mature state, many of the longitudinal features of the spinal cord and provides for segmental functions of the head. This chapter describes the general anatomy of the posterior fossa, the anatomy and functions of cranial nerves III-XII, and the internal anatomy of the medulla, pons, and midbrain.

Continuous intraoperative electromyographic monitoring of cranial nerves during resection of fourth ventricular tumors in children

1996 ◽  
Vol 1 (2) ◽  
pp. E3 ◽  
Author(s):  
Paul A. Grabb ◽  
A. Leland Albright ◽  
Robert J. Sclabassi ◽  
Ian F. Pollack
Keyword(s):  
Facial Nerve ◽  
Nerve Injury ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Lateral Rectus ◽  
Emg Activity ◽  
Facial Muscle ◽  
Nerve Injuries ◽  
Seventh Nerve ◽  
Sixth Nerve

The authors reviewed the results of continuous intraoperative electromyographic (EMG) monitoring of muscles innervated by cranial nerves in 17 children whose preoperative imaging studies showed compression or infiltration of the fourth ventricular floor by tumor to determine how intraoperative EMG activity correlated with postoperative cranial nerve morbidity. Bilateral lateral rectus (sixth) and facial (seventh) nerve musculature were monitored in all children. Cranial nerve function was documented immediately postoperatively and at 1 year. Of the 68 nerves monitored, nine new neuropathies occurred in six children (sixth nerve in four children and seventh nerve in five). In five new neuropathies, intraoperative EMG activity could be correlated in one of four sixth nerve injuries and four of five seventh nerve injuries. Electromyographic activity could not be correlated in four children with new neuropathies. Of 59 cranial nerves monitored that remained unchanged, 47 had no EMG activity. Twelve cranial nerves (three sixth nerves and nine seventh nerves) had EMG activity but no deficit. Of four children with lateral rectus EMG activity, three had new seventh nerve injuries. Lateral rectus EMG activity did not predict postoperative abducens injury. The absence of lateral rectus EMG activity did not assure preserved abducens function postoperatively. Likely because of the close apposition of the intrapontine facial nerve to the abducens nucleus, lateral rectus EMG activity was highly predictive of seventh nerve injury. Although facial muscle EMG activity was not an absolute predictor of postoperative facial nerve dysfunction, the presence of facial muscle EMG activity was associated statistically with postoperative facial paresis. The absence of facial muscle EMG activity was rarely associated with facial nerve injury. The authors speculate that EMG activity in the facial muscles may have provided important intraoperative information to the surgeon so as to avoid facial nerve injury.

Facial nerve outcome after acoustic neuroma surgery: A study from the era of cranial nerve monitoring

1994 ◽  
Vol 111 (5) ◽  
pp. 561-570 ◽  
Author(s):  
A LALWANI ◽  
F BUTT ◽  
R JACKLER ◽  
L PITTS ◽  
C YINGLING
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Cranial Nerve ◽  
Nerve Monitoring ◽  
Acoustic Neuroma Surgery

Bioelectrodes for Neural Prostheses

1985 ◽  
Vol 55 ◽  
Author(s):  
F. Terry Hambrecht
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Urinary Bladder ◽  
Cochlear Implants ◽  
Neural Prostheses ◽  
The Future ◽  
Spinal Cord Disorders ◽  
The Central Nervous System ◽  
Auditory Prostheses

ABSTRACTNeural prostheses which are commercially available include cochlear implants for treating certain forms of deafness and urinary bladder evacuation prostheses for individuals with spinal cord disorders. In the future we can anticipate improvements in bioelectrodes and biomaterials which should permit more sophisticated devices such as visual prostheses for the blind and auditory prostheses for the deaf based on microstimulation of the central nervous system.

scholarly journals Resection of a Lower Clival Meningioma via Posterolateral Approach: Two-Dimensional Operative Video

2020 ◽  
Author(s):  
Pinar E. Ocak ◽  
Selcuk Yilmazlar
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Posterolateral Approach ◽  
Left Vertebral Artery ◽  
Posterior Arch ◽  
Upper Cervical Spine ◽  
Two Dimensional ◽  
Lower Cranial Nerve ◽  
Complex Anatomy ◽  
Microsurgical Resection

Abstract Objectives This study aimed to demonstrate resection of a craniovertebral junction (CVJ) meningioma via the posterolateral approach. Design The study is designed with a two-dimensional operative video. Setting This study is conducted at department of neurosurgery in a university hospital. Participants A 50-year-old woman who presented with lower cranial nerve findings due to a left-sided lower clival meningioma (Fig. 1). Main Outcome Measures Microsurgical resection of the meningioma and preservation of the neurovascular structures. Results The patient was placed in park-bench position and a left-sided retrosigmoid suboccipital craniotomy, followed by C1 hemilaminectomy and unroofing the lip of the foramen magnum, was performed. The dural incision extended from the suboccipital region down to the posterior arch of C2 (Fig. 2). The arachnoid overlying the tumor was incised, revealing the course of the cranial nerve (CN) XI on the dorsolateral aspect of the tumor. The left vertebral artery (VA) was encased by the tumor which was originating from the dura below the jugular foramen. The mass was resected in a piecemeal fashion eventually. At the end of the procedure, all relevant cranial nerves and adjacent vascular structures were intact. Postoperative magnetic resonance imaging (MRI) confirmed total resection and the patient was discharged home on postoperative day 3 safely. Conclusions Microsurgical resection of the lesions of the CVJ are challenging as this transition zone between the cranium and upper cervical spine has a complex anatomy. Since adequate exposure of the extradural and intradural segments of the VA can be obtained by the posterolateral approach, this approach can be preferred in cases with tumors anterior to the VA or when the artery is encased by the tumor.The link to the video can be found at: https://youtu.be/d3u5Qrc-zlM.

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