scholarly journals Surgical treatment of glossopharyngeal nerve schwannomas: Results of two-center study (14 patients included) and literature review

2021 ◽  
Vol 27 (4) ◽  
pp. 23-29
Author(s):  
Andrii H. Sirko ◽  
Oleksandr M. Lisianyi ◽  
Оksana Y. Skobska ◽  
Rostislav R. Malyi ◽  
Iryna O. Popovych ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Facial Nerve ◽  
Hearing Impairment ◽  
Cranial Nerves ◽  
Type A ◽  
Jugular Foramen ◽  
Type B ◽  
Tumor Removal ◽  
Type D ◽  
Total Tumor Removal

Objective: This study is aimed to analyze the outcomes of surgical treatment of glossopharyngeal schwannomas based on pre- and postoperative neurological status assessment. Materials and methods: This paper is a retrospective analysis of examination and surgical treatment of 14 patients who were operated on in two large clinics from 2018 to 2021 inclusive. When analyzing the collected data, gender, age, disease symptoms, tumor size and location, surgical approach, tumor to cranial nerves (CN) ratio, jugular foramen (JF) condition, and tumor removal volume were taken into account. All tumors were divided into groups depending on tumor location relative to the JF. Particular attention was paid to assessing cranial nerves functions. Facial nerve function was assessed as per House-Brackmann Scale (HBS), hearing function as per Gardner-Robertson Scale (GRS). Results: 3 (21.4%) patients had total tumor removal: 2 patients had type A tumors and one had type B tumor. Subtotal resection took place in 7 (50%) cases. In 4 cases, a tumor was partially removed: 3 patients had type D tumors and one had type B tumor. 3 (21.4%) patients had preoperative FN deficit (HBS Grade II) and mild dysfunction. 5 (35.7%) patients had postoperative facial nerve deficit: HBS ІІ, 2; ІІІ, 1; V, 2. Preoperative sensorineural type hearing impairment on the affected side was diagnosed in 13 (92.6%) patients. Before surgery, 6 patients had non-serviceable hearing, which remained at the same level after surgery. None of the patients with grade I or II hearing before surgery had any hearing impairment postoperatively. In 2 (14.3%) cases, hearing improved from grade V to grade III after surgery. 6 (42.9%) patients developed new neurological deficit in the caudal group CN. Postoperative deficit of the caudal group CN occurred in type D tumors in 3 patients, type A tumors 2 patients, and type B tumors one patient. Conclusions: Applying a retrosigmoid approach only makes it possible to achieve total tumor removal in case of type A tumors. To remove other tumor types, it is necessary to select approaches that enable access to the jugular foramen and infratemporal fossa. Intraoperative neurophysiological monitoring is an extremely important tool in glossopharyngeal schwannoma surgery. The most common postoperative complication is a developed or increased deficit of the caudal CN group, which can lead to persistent impairments in the patients’ quality of life. Preservation of the CN VII and VIII function in most cases is a feasible task and shall be ensured as a standard for this pathology.

Importance of Preserved Periosteum Around Jugular Foramen Neurinomas for Functional Outcome of Lower Cranial Nerves: Anatomic and Clinical Studies

2011 ◽  
Vol 69 (suppl_2) ◽  
pp. ons230-ons240 ◽  
Author(s):  
Agung Budi Sutiono ◽  
Takeshi Kawase ◽  
Masanao Tabuse ◽  
Yohei Kitamura ◽  
Muh Zafrullah Arifin ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cranial Nerves ◽  
Type A ◽  
Jugular Foramen ◽  
Consecutive Series ◽  
Type B ◽  
Bivariate Correlation ◽  
Type C ◽  
Lower Cranial Nerves ◽  
Mib 1

Abstract BACKGROUND Surgical removal of jugular foramen (JF) neurinomas remains controversial because of their radicality in relation to periosteal sheath structures. OBJECTIVE To clarify the particular meningeal structures of the JF with the aim of helping to eliminate surgical complications of the lower cranial nerves (LCNs). METHODS We sectioned 6 JFs and examined histological sections using Masson trichrome stain. A consecutive series of 25 patients with JF neurinomas was also analyzed, and the MIB-1 index of each excised tumor was determined. RESULTS In the JF, meningeal dura disappeared at the nerve entrance, forming a jugular pocket. JF neurinomas were classified into 4 types: subarachnoid (type A by the Samii classification), foraminal (type B), epidural (type C), and episubdural (type D). After an average follow-up of 9.2 years, tumors recurred in 9 cases (36%). Type A tumors did not show regrowth, unlike type B tumors, in which all recurred. Radical surgery by the modified Fisch approach did not contribute to tumor radicality in type C and D tumors, even in cases in which LCN function was sacrificed. In preserved periosteum, postoperative LCN deterioration was decreased. Bivariate correlation analysis revealed that jugular pocket extension, tumor removal, MIB-1 greater than 3%, and reoperation or gamma knife use were significant recurrence factors. CONCLUSION For LCN preservation, the periosteal layer covering the cranial nerves must be left intact except in patients with a subarachnoid tumor. To prevent tumor regrowth, postoperative gamma knife treatment is recommended in tumors with an MIB-1 greater than 3%.

scholarly journals CTNI-03. IMAGING FEATURES OF LEPTOMENINGEAL METASTASES OF NON-SMALL CELL LUNG CANCER: A SINGLE-CENTER REAL-WORLD STUDY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii41-ii41
Author(s):  
Junjie Zhen ◽  
Lei Wen ◽  
Shaoqun Li ◽  
Mingyao Lai ◽  
Changguo Shan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Type A ◽  
Brain Parenchyma ◽  
Imaging Features ◽  
Type B ◽  
Type D ◽  
Mri Examination ◽  
Mri Features ◽  
Brain And Spinal Cord ◽  
The Brain

Abstract BACKGROUND According to EANO-ESMO clinical practice guidelines, the MRI findings of LM are divided into 4 types, namely linear enhancement (type A), nodular enhancement (type B), linear combined with nodular enhancement (type C), and sign of hydrocephalus (type D). METHODS The MRI features of brain and spinal cord in patients diagnosed with NSCLC-LM in Guangdong Sanjiu Brain Hospital from 2010 until 2019 were investigated, and then were classified into 4 types. The imaging features were analyzed. RESULTS A total of 80 patients were enrolled in the study. The median age of the patients was 53.5 years old, and the median time from the initial diagnosis to the confirmed diagnosis of LM was 11.6 months. The results of enhanced MRI examination of the brain in 79 cases showed that the number of cases with enhancements of type A, B, C and D were 50 (63.3%), 0, 26 (32.9%) and 3 (3.8%), respectively, and that LM with metastases to the brain parenchyma was found in 42 cases (53.2%). The results of enhanced MRI examination of spinal cord in 59 cases showed that there were only enhancements of type A and C in 40 cases (67.8%) and 3 cases (5.0%), and no enhancement sign in the other 16 cases (27.2%). CONCLUSION MRI examination of brain and spinal cord will improve the detection rate of LM. The MRI features of NSCLC-LM in real world are mainly characterized by the linear enhancements of brain and spinal cord, followed by linear combined with nodular enhancement. The enhancements of type B and type D are rare in clinic. Almost half of the patients have LM and metastases to the brain parenchyma. Therefore, the differentiation of tumor metastases is needed to be paid attention to for the early diagnosis and the formulation of reasonable treatment plans.

scholarly journals The effectiveness of TiO2 additions to mortar to maintain initial conditions in terms of its reflectance to solar radiation

2017 ◽  
Vol 17 (3) ◽  
pp. 39-56 ◽  
Author(s):  
Sérgio Roberto Andrade Dantas ◽  
Fulvio Vittorino ◽  
Kai Loh
Keyword(s):  
Solar Radiation ◽  
Ultraviolet Radiation ◽  
Initial Conditions ◽  
Type A ◽  
Just Noticeable Difference ◽  
Type B ◽  
Climate Conditions ◽  
Type D ◽  
Type C ◽  
Over Time

Abstract Contact of facades with degradation agents and direct incidence of ultraviolet radiation on external coatings make them more opaque over time, affecting their colour and reflectance characteristics. This study evaluated the effect of adding different TiO2 contents to mortars applied in concrete substrates in order to verify the reflectance maintenance on surfaces after exposure over time. Mortar with different concentrations of TiO2 (1%, 5%, 10%) were produced in relation to the total dry premix, added as a powder and compared to unpainted mortar without TiO2 (type "A") and painted mortar without TiO2 (type "B"), both used as a reference for colour and reflectance. Exposed over 16 months to climate conditions in São Paulo, regarding the maintenance of reflectance and solar radiation, the results showed that type "B" (0%TiO2) painted mortar presented the best performance. Type "C" (1%TiO2) and type "D" (5%TiO2) unpainted mortar remained more stable. Type "A" (0%TiO2) and type "E" (10%TiO2) unpainted mortar showed greater differences according to the Just Noticeable Difference (JND) range caused by dirt pick up.

Comparison of Endoscopic Endonasal Approach and Lateral Microsurgical Infratemporal Fossa Approach to the Jugular Foramen: An Anatomical Study

2021 ◽  
Author(s):  
Jianfeng Liu ◽  
Carlos D. Pinheiro-Neto ◽  
Dazhang Yang ◽  
Eric Wang ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Infratemporal Fossa ◽  
Deep Understanding ◽  
Type A ◽  
Jugular Foramen ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Complex Anatomy

Abstract Objective The jugular foramen is one of the most challenging surgical regions in skull base surgery. With the development of endoscopic techniques, the endoscopic endonasal approach (EEA) has been undertaken to treat some lesions in this area independently or combined with open approaches. The purpose of the current study is to describe the anatomical steps and landmarks for the EEA to the jugular foramen and to compare it with the degree of exposure obtained with the lateral infratemporal fossa approach. Materials and Methods A total of 15 osseous structures related to the jugular foramen were measured in 33 adult dry skulls. Three silicone-injected adult cadaveric heads (six sides) were dissected for EEA and three heads (six sides) were used for a lateral infratemporal fossa approach (Fisch type A). The jugular foramen was exposed, relevant landmarks were demonstrated, and the distances between relevant landmarks and the jugular foramen were obtained. High-quality pictures were obtained. Results The jugular foramen was accessed in all dissections by using either approach. Important anatomical landmarks for EEA include internal carotid artery (ICA), petroclival fissure, inferior petrosal sinus, jugular tubercle, and hypoglossal canal. The EEA exposed the anterior and medial parts of the jugular foramen, while the lateral infratemporal fossa approach (Fisch type A) exposed the lateral and posterior parts of the jugular foramen. With EEA, dissection and transposition of the facial nerve was avoided, but the upper parapharyngeal and paraclival ICA may need to be mobilized to adequately expose the jugular foramen. Conclusion The EEA to the jugular foramen is anatomically feasible but requires mobilization of the ICA to provide access to the anterior and medial aspects of the jugular foramen. The lateral infratemporal approach requires facial nerve transposition to provide access to the lateral and posterior parts of the jugular foramen. A deep understanding of the complex anatomy of this region is paramount for safe and effective surgery of the jugular foramen. Both techniques may be complementary considering the different regions of the jugular foramen accessed with each approach.

scholarly journals Postsurgical residual lung complications following left upper trisegmentectomy

2019 ◽  
Author(s):  
Yutaro Koike ◽  
Aritoshi Hattori ◽  
Takeshi Matsunaga ◽  
Kazuya Takamochi ◽  
Shiaki Oh ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Type A ◽  
X Rays ◽  
Limited Information ◽  
Type B ◽  
Type D ◽  
Thoracic Computed Tomography ◽  
Isolated Segment ◽  
Type C ◽  
Lung Torsion

AbstractOBJECTIVESSegmentectomy has become an increasingly popular surgical procedure for small-sized lung lesions. Left upper trisegmentectomy (LUTS) is one of the most common segmentectomies performed because of its relative ease and simplicity; however, limited information is currently available on the specific postoperative complications associated with this procedure.METHODSAmong 2060 surgically resected cases in our institute between 2009 and 2016, 129 (6.2%) underwent LUTS. Postoperative chest X-rays and/or thoracic computed tomography (CT) scans were retrospectively assessed for all cases to assess postsurgical residual lung complications following LUTS. We categorized cases into 4 groups: type A (atelectasis of the lingular segment), type B (lung torsion of the lingular segment), type C (necrosis of the ‘isolated segment’) and type D (haematoma along stapling lines).RESULTSPostsurgical lung complications following LUTS were observed in 17 (13.1%) patients (type A: n = 7, type B: n = 1, type C: n = 4 and type D: n = 5). Three patients (2.3%) required surgical intervention because of type B (n = 1) and type C (n = 2), namely, decreased permeability and remaining ground glass opacities in the residual lung, showing an exacerbated systemic inflammatory response. In contrast, type A and D cases were successfully observed by chest CT without any surgical intervention, and patients recovered within a few months of surgery.CONCLUSIONSWe identified several postoperative residual lung complications following LUTS. Lung torsion or necrosis of the residual segment may require intensive care, including reoperation. Potentially serious complications always need to be ruled out after LUTS when radiological consolidation is detected postoperatively.

scholarly journals The microsurgical anatomy of the glossopharyngeal nerve with respect to the jugular foramen lesions

2004 ◽  
Vol 17 (2) ◽  
pp. 12-21 ◽  
Author(s):  
Mehmet Faik Özveren ◽  
Uđur Türe
Keyword(s):  
Surgical Treatment ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Glossopharyngeal Nerve ◽  
Detailed Knowledge ◽  
Microsurgical Anatomy ◽  
Anatomical Landmarks ◽  
Related Area ◽  
Deep Layers ◽  
Lower Cranial Nerves

Removal of lesions involving the jugular foramen region requires detailed knowledge of the anatomy and anatomical landmarks of the related area, especially the lower cranial nerves. The glossopharyngeal nerve courses along the uppermost part of the jugular foramen and is well hidden in the deep layers of the neck, making this nerve is the most difficult one to identify during surgery. It may be involved in various pathological entities along its course. The glossopharyngeal nerve can also be compromised iatrogenically during the surgical treatment of such lesions. The authors define landmarks that can help identify this nerve during surgery and discuss the types of lesions that may involve each portion of the glossopharyngeal nerve.

A New Classification of Cochleovestibular Malformations and Implications for Predicting Speech Perception Ability after Cochlear Implantation

2015 ◽  
Vol 20 (2) ◽  
pp. 90-101 ◽  
Author(s):  
Sung-Wook Jeong ◽  
Lee-Suk Kim
Keyword(s):  
Speech Perception ◽  
Cochlear Implantation ◽  
Test Scores ◽  
Type A ◽  
Cochlear Nerve ◽  
Type B ◽  
New Classification ◽  
Type D ◽  
Type C

Objectives: The aims of this study were to introduce a new classification of cochleovestibular malformation (CVM) and to investigate how well this classification can predict speech perception ability after cochlear implantation in children with CVM. Methods: Fifty-nine children with CVM who had used a cochlear implant for more than 3 years were included. CVM was classified into 4 subtypes based on the morphology of the cochlea and the modiolus on temporal bone computed tomography (TBCT): normal cochlea and normal modiolus (type A, n = 16), malformed cochlea and partial modiolus (type B, n = 31), malformed cochlea and no modiolus (type C, n = 6), and no cochlea and no modiolus (type D, n = 6). Speech perception test scores were compared between the subtypes of CVM using analysis of covariance with post hoc Bonferroni test. Univariate and multivariate regression analyses were used to identify the significant predictors of the speech perception test scores. Results: The speech perception test scores after implantation were significantly better in children with CVM type A or type B than in children with CVM type C or type D. The test scores did not differ significantly between the implanted children with CVM type A or type B and those without CVM. In univariate regression analysis, the type of CVM was a significant predictor of the speech perception test scores in implanted children with CVM. Multivariate regression analysis revealed that the age at cochlear implantation, cochlear nerve size and preimplantation speech perception test scores were significant predictors of the postimplantation speech perception test scores. The chance of cochlear nerve deficiency increased progressively from CVM type A to type D. Conclusion: The new classification of CVM based on the morphology of the cochlea and the modiolus is simple and easy to use, and correlated well with postimplantation speech perception ability and cochlear nerve status. This simple classification of CVM using TBCT with cochlear nerve assessment by magnetic resonance imaging is helpful in the preoperative evaluation of children with CVM.

Myocardial and vascular lesions in the LA/N-corpulent rat

1986 ◽  
Vol 64 (10) ◽  
pp. 1272-1280 ◽  
Author(s):  
J. C. Russell ◽  
R. M. Amy
Keyword(s):  
Spontaneously Hypertensive Rat ◽  
Disease Process ◽  
Inflammatory Cells ◽  
Type A ◽  
Experimental Manipulation ◽  
Arterial System ◽  
Vascular Lesions ◽  
Type B ◽  
Muscle Scar ◽  
Type D

The LA/N-corpulent (LA/N-cp) rat is a normotensive strain derived from Koltesky's original mutant strain of the spontaneously hypertensive rat (SHR). When homozygous for the cp gene (cp/cp), the rats are hyperphagous, hyperlipidemic, hyperinsulinemic, and obese. The rats have been shown, by scanning electron microscope observation of the arterial system, to develop arterial lesions and occasional occlusive thrombi. These are significantly more frequent in the corpulent rats. Histological examination of the heart has shown the presence of four distinguishable types of lesions: type A, muscle scar or cell dropout with pigment deposition and inflammatory cell accumulation; type B, necrosis of a small number of myocytes with reactive inflammatory cells; type C, nodule of chronic inflammatory cells; type D, muscle scar without chronic inflammatory cells. Complete transverse sections of three regions of the heart were examined from rats 3, 6, and 9 months of age. Rats that were homozygous normal (+/+) showed an absence of all types of cardiac lesions. Male corpulent rats showed frequent lesions of all types with the frequency rising consistently with age. Female corpulent rats showed a similar incidence of types C and D lesions to males, but no type B lesions were found. Type A lesions, the most common in corpulent males, were found at a greatly reduced relative frequency. In some instances, we have found occlusive thrombi in a coronary artery of corpulent rats. The disease process in these animals occurs with a normal low fat, virtually cholesterol-free diet and no experimental manipulation.

scholarly journals Microsurgical Management of Hypoglossal Schwannomas Over 3 Decades: A Modified Grading Scale to Guide Surgical Approach

2011 ◽  
Vol 69 (suppl_2) ◽  
pp. ons121-ons140 ◽  
Author(s):  
Yoichi Nonaka ◽  
Peter M. Grossi ◽  
Ketan R. Bulsara ◽  
Raymond M. Taniguchi ◽  
Allan H. Friedman ◽  
...  
Keyword(s):  
Sural Nerve ◽  
Hypoglossal Nerve ◽  
Type A ◽  
Nerve Graft ◽  
Type B ◽  
Nerve Reconstruction ◽  
Type D ◽  
Grading Scale ◽  
Type C ◽  
Sural Nerve Graft

Abstract BACKGROUND Schwannomas originating from the hypoglossal nerve are extremely rare. Microsurgical resection with the goal for cure has traditionally been associated with a high risk of postoperative deficits. OBJECTIVE To summarize our clinical experience using tailored cranial base approaches for these formidable lesions. METHODS The clinical records of 13 patients were retrospectively reviewed. In addition, all reported patients in the literature were reviewed. The extreme lateral infrajugular transcondylar-transtubercular exposure approach was used in all of our patients. Based on our experience and literature analysis, we propose the following modified grading scale to facilitate surgical planning: type A, intradural tumors; type B, dumbbell-shaped tumors; type C, extracranial tumors; and type D, peripheral tumors. RESULTS All 13 patients underwent total, near-total, or subtotal tumor resection. Eight patients were men, 5 were women (mean age, 41.7 years). Sural nerve graft reconstruction for the hypoglossal nerve was performed in 4 patients. Three of the 4 patients in whom nerve reconstruction was performed regained satisfactory movement of their tongue. In the review of the literature, the mean patient age was 45.8 years. Patients presented with tongue atrophy (91.6%), headache (60.9%), and dysphagia (31.8%). The tumors were categorized as type A in 31.7% of these patients, type B in 38.6%, type C in 6.2%, and type D in 23.4%. CONCLUSION The extreme lateral infrajugular transcondylar-transtubercular exposure approach, which is a modification of the extreme lateral suboccipital approach, provides sufficient exposure for most intracranial dumbbell-shaped hypoglossal schwannomas. Hypoglossal nerve reconstruction using a sural nerve graft improves tongue atrophy and movement for patients with resected nerves.

scholarly journals Crossings and Nestings in Set Partitions of Classical Types

10.37236/392 ◽  
2010 ◽  
Vol 17 (1) ◽  
Author(s):  
Martin Rubey ◽  
Christian Stump
Keyword(s):  
Type A ◽  
The Other ◽  
Type B ◽  
Set Partition ◽  
Set Partitions ◽  
Type D ◽  
Other Hand ◽  
The One

In this article, we investigate bijections on various classes of set partitions of classical types that preserve openers and closers. On the one hand we present bijections for types $B$ and $C$ that interchange crossings and nestings, which generalize a construction by Kasraoui and Zeng for type $A$. On the other hand we generalize a bijection to type $B$ and $C$ that interchanges the cardinality of a maximal crossing with the cardinality of a maximal nesting, as given by Chen, Deng, Du, Stanley and Yan for type $A$. For type $D$, we were only able to construct a bijection between non-crossing and non-nesting set partitions. For all classical types we show that the set of openers and the set of closers determine a non-crossing or non-nesting set partition essentially uniquely.

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