Acoustic Neurinoma with Synchronous Ipsilateral Cerebellopontine Angle Lipoma: A Case Report and Review of the Literature

Lipomas of the cerebellopontine angle (CPA) and internal auditory canal (IAC) are relatively rare tumors. Acoustic neurinoma is the most common tumor in this location, which often causes hearing loss, vertigo, and tinnitus. Occasionally, this tumor compresses the brainstem, prompting surgical resection. Lipomas in this area may cause symptoms similar to neurinoma. However, they are not considered for surgical treatment because their removal may result in several additional deficits. Conservative therapy and repeated magnetic resonance imaging examinations for CPA/IAC lipomas are standard measures for preserving cranial nerve function. Herein, we report a case of acoustic neurinoma and CPA lipoma occurring in close proximity to each other ipsilaterally. The main symptom was hearing loss without facial nerve paralysis. Therefore, facial nerve injury had to be avoided. Considering the anatomical relationships among the tumors, cranial nerves, and CPA/IAC lipoma, we performed total surgical removal of the acoustic neurinoma. We intentionally left the lipoma untreated, which enabled facial nerve preservation. This report may be a useful reference for the differential diagnosis of similar cases in the future.

Case Report on Right Acoustic and Left Trigeminal Schwannoma, Hydrocephalus with Neurofibroma a Rare Case

A vestibular schwannoma or acoustic neurinoma, or acoustic neurilemoma is a slow growing benign tumor arises balance and hearing nerves in the inner ear. It is caused by overabundance of Schwann type of cell, which support and insulate nerve fibers, wrap onion skin around them. The nerves that control hearing and balance are impaired when vestibular schwannoma increases in size, resulting in hearing loss that is one-sided or asymmetric, tinnitus and loss of balance. When a tumor develops large enough, obstruct the facial nerve, resulting in numbness in the face. Vestibular schwannomas can also damage the facial nerve, resulting in facial weakness or paralysis on the tumor's side. If the tumor becomes large enough, it press against surrounding brain areas like the cerebellar and brainstem, posing a life-deteriorating hazard.(1) 17 years old male child was admitted in neuro ward with rare case of right acoustic and left trigeminal schwannoma, hydrocephalus with neurofibroma. In the present case, the treatment approach was mainly underwent in the form of right V.P.Shunt done and treated with antibiotics, antacids, anticonvulsants, analgesics, brain stimulants, protectants, multivitamins and other supportive treatment. Nurses have to play an important role to identify such type of symptoms and they should think critically, take action immediately to provide care to such type of patients.

Masseteric-Facial Anastomosis: A Report of Three Cases

Intoduction The pathways of the facial nerve are variable, and knowledge of that is essential. The worst impact caused by facial paralysis is related to quality of life, especially regarding the self-esteem and social acceptance on the part of the patients, leading to social isolation and disruption on their mental health. Case Report A 33-year-old female patient, with a stage-T3 acoustic neurinoma, presented with a moderate dysfunction (grades II to III) according to the House-Brackmann (HB) Facial Nerve Grading System. A 43-year-old male patient, with a stage-T4B trigeminal schwannoma, underwent a resective surgery and presented grade-VI dysfunction according to the HB scale. And a female patient with a stage-T4A acoustic neurinoma presented grade-IV dysfunction according to the HB scale. Discussion We performed a literature review of papers related to surgeries for masseteric-facial nerve anastomosis and compiled the results in table; then, we compared these data with those obtained from our cases. Conclusion The masseteric nerve is the one that shows the best prognosis among all the cranial nerves that could be used, but it is also necessary to perform well the surgical technique to access the facial branch and consequently achieve a better masseteric-facial nerve anastomosis.

Primary CNS tumors in adults and environmental factors: an update

The incidence of adult primary brain tumors is increasing in some European countries. High-dose ionizing irradiation, rare genetic syndromes, and genetic predisposition in 5 % of families are a few established environmental risk factors for brain tumor. Mobile phone use that causes near brain exposure to radiofrequency electromagnetic waves and thus creates risks of CNS tumors has been the focus of many studies. Nine meta-analyses were available on this subject. The Interphone multi-center case-control study is the largest one to date; it included 2.708 glioma and 2.409 meningioma cases and matched controls in 13 countries. Studies exploring metals (cadmium, lead), pesticides, outdoor pollution, virus, and risk of glioma created by exposure to them were reviewed. Interphone study did not show increased risk of glioma or meningioma in mobile-phone users. One recent meta-analysis in 2017 found that prolonged exposure i.e.,> 10 years of all phone types was associated with increased risk of ipsilateral CNS tumor locations. In another meta-analysis, long-term use of mobile-phones was found to be a risk factor for low-grade glioma. In case of all durations regarding mobile phone use and both sides of the head, the results of pooling data were more discordant. A large prospective study in 2014 showed that long term use vs never use increased risks of acoustic neurinoma (10+ years: RR = 2.46, 95 % CI = 1.07–5.64, P = 0.03), but not of glioma or meningioma. Studies of other risk factors showed no/weak/contradictory association with brain tumor risk. In the absence of robust and consistent evidence, a causal relation between radiofrequency exposure and CNS tumors was not found. Large prospective studies of this kind regarding a disease with low incidence require a high number of participants and a long follow-up period.

Primary CNS tumors in adults and environmental factors: an update

The incidence of adult primary brain tumors is increasing in some European countries. High-dose ionizing irradiation, rare genetic syndromes, and genetic predisposition in 5 % of families are a few established environmental risk factors for brain tumor. Mobile phone use that causes near brain exposure to radiofrequency electromagnetic waves and thus creates risks of CNS tumors has been the focus of many studies. Nine meta-analyses were available on this subject. The Interphone multi-center case-control study is the largest one to date; it included 2.708 glioma and 2.409 meningioma cases and matched controls in 13 countries. Studies exploring metals (cadmium, lead), pesticides, outdoor pollution, virus, and risk of glioma created by exposure to them were reviewed. Interphone study did not show increased risk of glioma or meningioma in mobile-phone users. One recent meta-analysis in 2017 found that prolonged exposure i.e.,> 10 years of all phone types was associated with increased risk of ipsilateral CNS tumor locations. In another meta-analysis, long-term use of mobile-phones was found to be a risk factor for low-grade glioma. In case of all durations regarding mobile phone use and both sides of the head, the results of pooling data were more discordant. A large prospective study in 2014 showed that long term use vs never use increased risks of acoustic neurinoma (10+ years: RR = 2.46, 95 % CI = 1.07–5.64, P = 0.03), but not of glioma or meningioma. Studies of other risk factors showed no/weak/contradictory association with brain tumor risk. In the absence of robust and consistent evidence, a causal relation between radiofrequency exposure and CNS tumors was not found. Large prospective studies of this kind regarding a disease with low incidence require a high number of participants and a long follow-up period.

Clinical, paraclinical aspects and complex therapeutical approaches in a patient with incomplete paraplegia, post thoracic menigioma surgically treated, in neurofibromatosis context

Introduction: Neurofibromatosis - type 1 (NF1) and type 2 (NF2) - are genetic disorders of the nervous system that can affect the growth and development of nerve cell tissue and so can determine severe or rather permanent sequels. NF2 implies usually multiple tumors on the cranial and spinal nerves and it is less common than NF1. The most frequent symptom of NF2 is hearing progressive loss, as a consequence of auditory nerves affection and appears at early ages or at twenties. The evolution of a patient with NF2 depends on the number and location of tumors and some of them might develop a life-threatening or disabling condition. With a prompt diagnosis and an appropriate therapy it can be improved the patient prognosis and QOL. Materials and Methods: This paper presents the case of a 43-year-old patient, with personal antecedents of hearing dysfunction, diagnosed in 2013 with neurofibromatosis that was hospitalized at the IV Neurosurgery Clinic of TEHBA in January 2019 and suffered a re-intervention for removal of the spinal cord tumor (psammomatous meningioma) and with spinal cord decompression. In our clinic, the patient was admitted for incomplete AIS/Frankel C paraplegia, he had initially followed a complex nursing program and subsequently a rehabilitation adequate program. The patient was assessed functionally using the following scales: AIS / Frankel, modified Ashworth, Functional Independence Measure (FIM), Life Quality Assessment (QOL), FAC International Scale, Independence Assessment Scale in Daily Activities (ADL / IADL), Walking Scale for Spinal Cord Injury (WISCI). Results: The paraclinical assessments (cerebral and spinal cord MRI) detect multiple cerebral tumors and micro-nodules adjacent to the lumbar spinal roots, which, associated with the bilateral acoustic neurinoma (diagnosed in 2013), contributed to the suspicion of the NF2 diagnosis. The patient had two admissions in our clinic division, benefited from a complex neuro-muscular rehabilitation program, having a favourable evolution, with an increase in the evaluated scales scores, now performing walking with a support from another person in walking frame, as well as sphincter re-education, with the neurogenic bladder remission. Conclusions: Even if there is no cure for neurofibromatosis and no standard treatment, it is important to promptly diagnose such a rare disease and to give an adequate treatment (AINS or other analgesic drugs, surgery, chemotherapy or radiation –when it’s needed, or psychotherapy) for controlling symptoms and also a personalized rehabilitation program (including nursing measures) enhancing including patient's quality of life. Key words: paraplegia, neurofibromatosis, neuro-muscular rehabilitation,