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Query: UMLS:C0027651 (tumor)
 685,946 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the diagnostic procedure for patients with symptoms and signs indicating VIIIth nerve or brain stem disturbances, the possible presence of tumors, infarcts, bleedings or microvascular loops are taken into account. Ten patients with vertigo, balance disorders, tinnitus or unilateral hearing loss proved to have a similar cause underlying the disturbances. They ranged in age from 51 to 80 years and had a duration of their symptoms of 1-10 years. In the test battery audiology, electronystagmography, broad-frequency rotatory testing and dynamic posturography were used. No uniform pattern was present. The results showed VIIIth nerve as well as CNS signs. Trigeminal neuralgia and hemifacial spasm were observed. CT, NMR or angiography were performed. The common finding for these patients were ectatic vertebral and/or basilar arteries. The size and position of the vessels indicated that compression of the VIIIth nerve or brainstem was the cause underlying their disturbances. To exclude that macrovessels appear in patients without neurotological symptoms and signs 300 consecutive NMR investigations in patients referred for other than neurotogic indications were scrutinized. In these patients no macrovessels were found. The findings indicate that ectatic vessels may cause disturbances mimicking a pontine angle tumor, Meniere's disease and other peripheral or central conditions with inner ear symptoms, vertigo and balance disorders. Arterial loops in the pontine angle may give indications for microvascular surgery, but the big ectatic vertebral and basilar arteries may offer surgical decompression possibilities, though with large risks.
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PMID:Macrovascular causes underlying otoneurological disturbances. 761 Jul 91

A case of painful tic convulsif (trigeminal neuralgia and ipsilateral hemifacial spasm) caused by cerebellopontine angle epidermoid tumor is presented. This tumor was compressed to the trigeminal nerve, and became attached to the facial and auditory nerves. The facial nerve exit-zone of brain stem was also compressed by the tumor along with a branch of the posterior inferior cerebellar artery. Total removal of the tumor was carried out and neuralgia and facial spasm disappeared. Painful tic convulsif caused by brain tumor is rare (eight cases in the literature plus our case), but epidermoid tumor is not rare as a cause of this complaint (seven in eight cases). In preoperative examination of this case, we could not detect this epidermoid in the cerebellopontine angle, because this tumor was the same intensity as CSF liquid on magnetic resonance imaging (T1 and T2 weighted image) and exerting hardly any mass effect on the brainstem. On encountering a case of painful tic convulsif of unknown origin despite the usual preoperative examinations, it may be useful that same kind of brain tumor, especially, epidermoid might be concealed in the cerebellopontine angle lesion.
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PMID:[A case of painful tic convulsif due to cerebellopontine angle epidermoid tumor which could not be clearly detected by MRI]. 763 42

A case is presented of painful tic convulsif caused by a posterior fossa meningioma, with right trigeminal neuralgia and ipsilateral hemifacial spasm. Magnetic resonance images showed an ectatic right vertebral artery as a signal-void area in the right cerebellopontine angle. At operation the tentorial meningioma, which did not compress either the fifth or the seventh cranial nerves directly, was totally removed via a suboccipital craniectomy. The patient had complete postoperative relief from the trigeminal neuralgia and her hemifacial spasm improved markedly with decreased frequency. From a pathophysiological standpoint, the painful tic convulsif in this case was probably produced by the tumor compressing and displacing the brainstem directly, with secondary neurovascular compression of the fifth and seventh nerves (the so-called "remote effect").
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PMID:Tentorial meningioma and painful tic convulsif. Case report. 771 18

A large meningioma in the cerebellopontine angle manifested itself as a contralateral hemifacial spasm. On computed tomographic and magnetic resonance imaging scans, the brain stem was markedly displaced and distorted by the tumor. After total removal of the meningioma, the hemifacial spasm completely disappeared.
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PMID:Hemifacial spasm caused by contralateral cerebellopontine angle meningioma: case report. 773 20

The role of the fiberscope in the management of difficult and failed intubations has been well established and the importance of learning this valuable skill has been emphasized. Nonetheless, the fiberscope is underutilized in anesthesia and critical care practices because of a high rate of intubation failure. The main cause of failure is lack of expertise in maneuvering the fiberscope. Other technical causes of failure include fogging or clouding of the fiberscope's lens, drifting off the midline, and inability to advance the endotracheal tube or withdraw the fiberscope after completing intubation. Proper selection of the size of the fiberscope in relation to the size of the endotracheal tube, adequate lubrication, and careful passage of the fiberscope through the distal opening of the tracheal tube (not the Murphy eye) prevent difficulties encountered during advancement of the tube or upon withdrawal of the bronchoscope. Patient-related causes include inadequate topical anesthesia, which leads to abrupt movement of the larynx, laryngeal spasm, coughing, and copious secretions; a large floppy epiglottis; and tumor and edema of the upper airway, which also interfere with exposure of the larynx. Various approaches for learning and applying fiberoptic endoscopy have been instituted. The key to increased success involves initial training and practice with an intubation model and tracheobronchial tree. These models enable the learner to develop the eye-hand coordination skills needed to use the fiberscope properly. The fiberscope is best used in patients after learning to perform three simultaneous movements--advancing the fiberscope, coordinated rotation of the insertion cord, and bending the tip of the fiberscope while traversing the airway. After the technical skills of the fiberscope become second nature, the endoscopist can give more attention to patient-related factors to improve the success rate of tracheal intubation. Expert use of the fiberscope can be a life-saving measure through alleviating major airway complications and unnecessary tracheostomies.
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PMID:The role of the fiberscope in the critically ill patient. 773 70

There have been several reports of acute renal failure following the resection of an abdominal neuroblastoma combined with ipsilateral nephrectomy as well as the atrophy or disappearance of an unresected kidney after tumor resection. Spasms or thrombosis of the renal artery during tumor excision are considered to be the major cause. Since 1989, intravenous digital subtraction angiography (IVDSA) has been used to evaluate the renal artery blood flow immediately following surgery in seven patients with abdominal neuroblastomas. IVDSA was performed using a central venous catheter inserted prior to surgery. In all seven patients, IVDSA provided clear images for the evaluation of renal artery blood flow. In one of the two patients whose kidneys briefly became cyanosed during tumor excision, IVDSA demonstrated an occlusion of the renal artery and prompt measures could be taken to reestablish the blood flow. No complications of IVDSA occurred in any of the seven patients. IVDSA using a central venous catheter was thus considered to be useful for evaluating the renal artery blood flow in patients with a suspected renal artery blood flow disturbance without any risk of complications, and this modality obviated the need for intraarterial angiography.
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PMID:Intravenous digital subtraction angiography for the evaluation of renal artery blood flow following the removal of a neuroblastoma. 777 8

An endoscopic approach to the cerebellopontine angle has been suggested by several authors over the last 20 years but it is only recently that the technical and operative conditions for successful endoscopy could be met. The retrosigmoid approach provides simple and direct access to the cerebellopontine zone. The endoscope, with its distal light source, provides excellent illumination of a wide visual field within an anatomical site particularly rich in neurovascular structures. Endoscopic and microsurgical techniques may be combined for the surgical management of acoustic neuroma with the advantage of assuring better exposure of structures adjacent to the tumor and better control of the quality of dissection of the fundus of the internal auditory canal. The addition of endoscopic techniques, during surgery for trigeminal neuralgia or unilateral facial spasm, makes it possible to accurately locate the site of neurovascular compression without either retraction of the cerebellum or unnecessary dissection.
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PMID:[Contribution of endoscopy of the cerebellopontine angle by retrosigmoid approach. Neuroma and vasculo-nervous compression]. 830 98

Two cases of cystic brainstem schwannomas protruding into the fourth ventricle are described. Both patients presented with hemifacial spasm. While there is only one previous case report of an intraventricular brainstem schwannoma, there has been no prior description in the literature of hemifacial spasm associated with such a tumor. The clinical, radiographic, surgical, and histopathological features of these tumors are elaborated. The relationship of hemifacial spasm to the various putative theories of origin proposed for intraparenchymal schwannomas is discussed.
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PMID:Schwannoma of the fourth ventricle presenting with hemifacial spasm. A report of two cases. 845 61

Trigeminal neuralgia and hemifacial spasm are caused by vascular compression of the cranial nerves at the brainstem in the majority of cases. Trigeminal neuralgia occurring in 3.3% of acoustic neurinomas is usually assumed to be a sign of large tumour size; if associated with small tumour size, an additional pathology, such as typical vascular compression must be suspected and has to be explored at surgery. While facial paresis will usually lead to immediate radiological diagnosis of a possible cerebellopontine angle (CPA) neoplasm, facial spasm is usually not expected to be associated with a CPA tumour. We report on clinical presentation, operative findings, surgical treatment and results in 9 cases of small acoustic neurinomas associated with trigeminal neuralgia and on 4 cases associated with hemifacial spasm. The importance of the clinical characteristics is stressed; if these are typical of a vascular compression syndrome, further exploration at the time of tumour surgery and specific treatment by vascular decompression are necessary.
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PMID:Acoustic neurinomas associated with vascular compression syndromes. 874 74

Trigeminal neuralgia and hemifacial spasm were false localizing signs in three patients with contralateral space-occupying mass lesions in the posterior cranial fossa. According to radiological observations, the brainstem was remarkably displaced and distorted toward the side contralateral to the mass in all three cases. In the two cases with trigeminal neuralgia, the fifth cranial nerve was embedded in a thick arachnoid membrane and strongly compressed and angulated between the brainstem and the petrous bone, but there was no apparent vascular involvement. In the case with hemifacial spasm, only the contralateral tumor was removed. Postoperatively, all three patients experienced complete cessation of the symptoms without recurrence. Based on the operative findings, the authors postulate that angulation and distortion of the axis of the cranial nerve due to the contralateral mass, accompanied by thickening of the arachnoid membrane around the nerve, play an important role in false localizing signs, particularly in patients with trigeminal neuralgia.
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PMID:Trigeminal neuralgia and hemifacial spasm as false localizing signs in patients with a contralateral mass of the posterior cranial fossa. Report of three cases. 898 5


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