Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors describe an acute facial and acoustic neuropathy following gamma knife surgery (GKS) for vestibular schwannoma (VS). This 39-year-old woman presenting with tinnitus underwent GKS for a small right-sided intracanalicular VS, receiving a maximal dose of 26 Gy and a tumor margin dose of 13 Gy to the 50% isodose line. Thirty-six hours following treatment she presented with nausea, vomiting, vertigo, diminished hearing, and a House-Brackmann Grade III facial palsy. She was started on intravenous glucocorticosteroid agents, and over the course of 2 weeks her facial function returned to House-Brackmann Grade I. Unfortunately, her hearing loss persisted. A magnetic resonance (MR) image obtained at the time of initial deterioration demonstrated a significant decrease in tumor enhancement but no change in tumor size or peritumoral edema. Subsequently, the patient experienced severe hemifacial spasms, which persisted for a period of 3 weeks and then progressed to a House-Brackmann Grade V facial palsy. During the next 3 months, the patient was treated with steroids and in time her facial function and hearing returned to baseline levels. Results of MR imaging revealed transient enlargement (3 mm) of the tumor, which subsequently returned to its baseline size. This change corresponded to the tumor volume increase from 270 to 336 mm3. The patient remains radiologically and neurologically stable at 10 months posttreatment. This is the first detailed report of acute facial and vestibulocochlear neurotoxicity following GKS for VS that improved with time. In addition, MR imaging findings were indicative of early neurotoxic changes. A review of possible risk factors and explanations of causative mechanisms is provided.
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PMID:Acute neurological complications following gamma knife surgery for vestibular schwannoma. Case report. 1623 88

This video illustrates the case of a 51-year-old woman who presented with sudden-onset headache, vertigo, and nausea. Imaging revealed an epidermoid cyst of the posterior fossa with mass effect upon the brainstem and displacement of the basilar artery. This lesion was approached using a left-sided keyhole retrosigmoid craniotomy with monitoring of the cranial nerves. This video illustrates the technique of internal debulking of the cyst contents with minimal manipulation of the cyst capsule, which is often densely adherent to the brainstem, cranial nerves, and vessels in the posterior fossa. Resection of the capsule is often associated with a higher rate of cranial nerve deficits. The tumor was removed completely, but the cyst capsule was left in place. The patient had House-Brackmann grade II facial paralysis postoperatively and complained of some diminished hearing in the left ear. Epidermoid cysts are benign tumors, but the patient may experience much morbidity from their overly aggressive resection, especially when the capsule is densely adhering to critical structures. An alternate strategy is to decompress the contents of the epidermoid cyst, thereby decompressing the brainstem and converting this disease process into a chronic disease that may require reoperation in the long term. Given the tight confines of the posterior fossa, aggressive internal decompression of tumors and mobilization from the brainstem and adjacent nerves are key to avoiding injury to the brainstem and cranial neuropathies. In patients with benign tumors, the goal of the operation should be decompression of the brainstem and preservation of cranial nerve function. The link to the video can be found at: https://youtu.be/nk8-VztB0OI .
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PMID:Retrosigmoid Craniotomy for Resection of an Epidermoid Cyst of the Posterior Fossa. 3045 45