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Acoustic Neuroma [keywords]
- [Fegelers syndrome, acquired port-wine stain or acquired capillary malformation: Three cases and a literature review]. [English Abstract, Journal Article]
- Ann Dermatol Venereol 2013 May; 140(5):341-6.
Port-wine stains or capillary malformations are generally congenital. Very few cases of acquired port-wine stains in adults have been described, and these occur particularly after trauma.We report three cases of acquired port-wine stains and we performed a review of the literature using the keywords "port-wine stain", "capillary malformation", "angioma" and "acquired" in the Medline database PubMed. All relevant articles were included.Two male patients and one female patient consulted for one or more angiomatous lesions, located respectively on the upper rear part of the right thigh (case 1), the left leg (case 2) and the right side of the face, skull and chest (case 3). Each patient's skin biopsy was consistent with port-wine stain. The three patients asserted the acquired nature of the lesions: the male patients were respectively 17 and 38 years old, and the female patient was 11 years old. No causative factors were evident preceding the lesion, and there was no family history of port-wine stain. The topography was systematic in patients 2 and 3. The lesions were light red in patient 1, dark red in patient 2 and pale pink in patient 3. The remainder of the physical examination was unremarkable, except for benign angiokeratoma of the scrotum in case 1 and pigmented leucoderma-type macules in case 3. LITERATURE RESULTS: Sixty-six cases of acquired port-wine stains were reported in the literature. The average age was 25 years (3-69) with a sex-ratio of 0.88. Generally, no causative factor was given. However, trauma (30.5%), estrogenic impregnation (16.5%), and more rarely, medication, solar damage, frostbite, cluster headache, herpes zoster and acoustic neuroma were reported as causatives factors.Acquired port-wine stain is rare. Although often idiopathic, it can result from spinal trauma, which must be explored if suggested by the history. In our series, the clinical presentation suggested a latent congenital vascular malformation of late onset, in particular in patients 2 and 3, because of the segmental distribution.
- Mobile phone use and risk of brain neoplasms and other cancers: prospective study. [JOURNAL ARTICLE]
- Int J Epidemiol 2013 May 8.
BACKGROUND:Results from some retrospective studies suggest a possible increased risk of glioma and acoustic neuroma in users of mobile phones.
METHODS:The relation between mobile phone use and incidence of intracranial central nervous system (CNS) tumours and other cancers was examined in 791 710 middle-aged women in a UK prospective cohort, the Million Women Study. Cox regression models were used to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs). Women reported mobile phone use in 1999 to 2005 and again in 2009.
RESULTS:During 7 years' follow-up, 51 680 incident invasive cancers and 1 261 incident intracranial CNS tumours occurred. Risk among ever vs never users of mobile phones was not increased for all intracranial CNS tumours (RR = 1.01, 95% CI = 0.90-1.14, P = 0.82), for specified CNS tumour types nor for cancer at 18 other specified sites. For long-term users compared with never users, there was no appreciable association for glioma (10+ years: RR = 0.78, 95% CI = 0.55-1.10, P = 0.16) or meningioma (10+ years: RR = 1.10, 95% CI = 0.66-1.84, P = 0.71). For acoustic neuroma, there was an increase in risk with long term use vs never use (10+ years: RR = 2.46, 95% CI = 1.07-5.64, P = 0.03), the risk increasing with duration of use (trend among users, P = 0.03).
CONCLUSIONS:In this large prospective study, mobile phone use was not associated with increased incidence of glioma, meningioma or non-CNS cancers.
- Inner ear disorders. [Journal Article]
- NeuroRehabilitation 2013 Jan 1; 32(3):455-62.
To present a framework for the diagnosis and treatment of inner ear disorders, with an emphasis on problems common to neuro-rehabilitation.Disorders of the inner ear can cause hearing loss, tinnitus, vertigo and imbalance. Hearing loss can be conductive, sensorineural, or mixed; conductive hearing loss arises from the ear canal or middle ear, while sensorineural hearing loss arises from the inner ear or auditory nerve. Vertigo is a hallucination of motion, and is the cardinal symptom of vestibular system disease. It should be differentiated from other causes of dizziness: gait imbalance, disequilibrium, lightheadedness (pre-syncope). Vertigo can be caused by problems in the inner ear or central nervous system.The diagnosis of inner ear disorders begins with a targeted physical examination. The initial work-up of hearing loss is made by audiometry, and vertigo by electronystagmography (ENG). Supplemental tests and MRI are obtained when clinically indicated.The clinical pattern and duration of vertigo are the most important clinical features in the diagnosis. Common inner ear causes of vertigo include: vestibular neuritis (sudden, unilateral vestibular loss), Meniere's disease (episodic vertigo), benign paroxysmal positional vertigo (BPPV), and bilateral vestibular loss. Common central nervous system causes of vertigo include: post concussion syndrome, cervical vertigo, vestibular migraine, cerebrovascular disease, and acoustic neuroma.A basic knowledge of vestibular physiology, coupled with a understanding of common vestibular syndromes, will lead to correct diagnosis and treatment in most cases.
- Intractable headache after excision of an acoustic neuroma treated by stent revascularisation of the sigmoid sinus. [JOURNAL ARTICLE]
- Br J Neurosurg 2013 May 7.
A 47 year old man developed severe headaches after resection of an acoustic neuroma ipsilateral to non dominant venous drainage. CSF pressures were normal but imaging studies showed acquired, severe narrowing of the sigmoid sinus where it traversed the surgical defect. Stenting the sinus gave a lasting clinical improvement.
- Effect of Bluetooth headset and mobile phone electromagnetic fields on the human auditory nerve. [JOURNAL ARTICLE]
- Laryngoscope 2013 Apr 25.
HYPOTHESIS:The possibility that long-term mobile phone use increases the incidence of astrocytoma, glioma and acoustic neuroma has been investigated in several studies. Recently, our group showed that direct exposure (in a surgical setting) to cell phone electromagnetic fields (EMFs) induces deterioration of auditory evoked cochlear nerve compound action potential (CNAP) in humans. To verify whether the use of Bluetooth devices reduces these effects, we conducted the present study with the same experimental protocol.
STUDY DESIGN:Randomized trial.
METHODS:Twelve patients underwent retrosigmoid vestibular neurectomy to treat definite unilateral Ménière's disease while being monitored with acoustically evoked CNAPs to assess direct mobile phone exposure or alternatively the EMF effects of Bluetooth headsets.
RESULTS:We found no short-term effects of Bluetooth EMFs on the auditory nervous structures, whereas direct mobile phone EMF exposure confirmed a significant decrease in CNAPs amplitude and an increase in latency in all subjects.
CONCLUSIONS:The outcomes of the present study show that, contrary to the finding that the latency and amplitude of CNAPs are very sensitive to EMFs produced by the tested mobile phone, the EMFs produced by a common Bluetooth device do not induce any significant change in cochlear nerve activity. The conditions of exposure, therefore, differ from those of everyday life, in which various biological tissues may reduce the EMF affecting the cochlear nerve. Nevertheless, these novel findings may have important safety implications.
LEVEL OF EVIDENCE:4. Laryngoscope, 2013.
- Volumetric measurement of vestibular schwannoma tumour growth following partial resection: predictors for recurrence. [Journal Article]
- J Neurol Surg B Skull Base 2012 Apr; 73(2):117-20.
Vestibular schwannomas (VS) have a higher risk of recurrence following subtotal resection than following near-total resection. We measured tumor remnant growth volumetrically in an attempt to determine potential predictors for postoperative recurrence following subtotal resection. We reviewed the charts of patients who had undergone VS surgery between 1998 and 2007. Thirty patients had an incomplete resection. The principal outcome measure was change in tumor volume (TV) on serial imaging. At a median follow-up of 6.8 years, volumetric measurements showed that 12 patients (40%) developed further tumor growth, while 18 patients remained with stable residual disease. The median rate of growth was 0.53 cm(3)/year. Two-dimensional measurements confirmed growth in only eight of these patients. The postoperative residual TV correlated significantly with subsequent tumor growth (p = 0.038). All patients with residual volumes in excess of 2.5 cm(3) exhibited recurrence. On univariate analysis, only postoperative TV was significantly associated with growth. Median time to failure was 21.5 months. This is the first report of volumetric measurements of VS tumor growth postoperatively. Volumetric measurements appear to be superior to two-dimensional measurements in documenting VS growth and patients with residual tumors >2.5 cm(3) have a significantly higher rate of recurrence.
- Vestibular schwannoma in the only hearing ear: role of cochlear implants. [Comparative Study, Journal Article, Research Support, Non-U.S. Gov't]
- Ann Otol Rhinol Laryngol 2013 Feb; 122(2):91-9.
We sought to delineate the role of cochlear implantation in the management of vestibular schwannoma or other cerebellopontine angle tumors in the only hearing ear.We performed a retrospective analysis in a quaternary referral skull base center of all patients who were affected by vestibular schwannoma (or other lesions of the cerebellopontine angle) in the only hearing ear and received a cochlear implant before or after tumor treatment (surgery or radiotherapy) or during the wait-and-scan follow-up. We also performed a systematic review of the English-language literature.The clinical and audiological results of 10 patients are reported. All patients were managed with contralateral cochlear implantation. In 7 patients, cochlear implantation was performed before tumor removal, while hearing in the ear with the tumor was still present. In 3 patients, the implant was placed after curative surgery. Nine of the 10 patients routinely use their implant with subjective benefit and fairly good auditory performance (median disyllabic word recognition, 90%; median sentence comprehension, 75%). The literature search retrieved no major series with assessment of the long-term efficacy of cochlear implantation in this rare clinical scenario.Patients affected by vestibular schwannoma in their only hearing ear may significantly benefit from a cochlear implant on the contralateral side prior to tumor removal. Recent and significant hearing deterioration and tumor growth represent the main indications for cochlear implantation.
- Evidence for multiple mechanisms of cortical plasticity: A study of humans with late-onset profound unilateral deafness. [JOURNAL ARTICLE]
- Clin Neurophysiol 2013 Mar 22.
OBJECTIVE:To investigate 1: plasticity due to partial unilateral deafness of slow onset and 2: the time course of plasticity following abrupt, profound unilateral deafness in adult humans using cortical auditory evoked potentials.
METHODS:Baseline data were measured from six participants with partial unilateral deafness due to an acoustic neuroma and compared with data from six controls. Further measurements were made in the unilaterally deaf group at 1-, 3- and 6-months post surgery for acoustic neuroma removal and consequent profound unilateral deafness. Data were recorded from 30 channels in response to pure tones presented to the intact ear.
RESULTS:Baseline data revealed statistically higher amplitudes in unilaterally deaf participants but with normal hemispheric asymmetry. Longitudinal data revealed further increases in P1 amplitudes by 1-month post-surgery, and in N1 and P2 amplitudes by 6-months post-surgery, with statistically different scalp field topographies indicating reduced hemispheric asymmetries.
CONCLUSION:Different patterns of plasticity occur following partial and profound unilateral deafness. Plasticity occurs both relatively rapidly and more gradually over at least 6-months post-surgery.
SIGNIFICANCE:The different patterns of change over time are consistent with multiple physiological mechanisms of plasticity. Unravelling these mechanisms and their time course in humans may be relevant in understanding and, ultimately, influencing plasticity for therapeutic gain.
- In regard to Rasmussen et al. [Comment, Letter]
- Int J Radiat Oncol Biol Phys 2013 Apr 1; 85(5):1153.
- [Diagnostic value of magnetic resonance imaging in the differential diagnosis of acoustic neuroma and meningiomas of the cerebellopontine angle]. [Comparative Study, English Abstract, Journal Article]
- Vestn Rentgenol Radiol 2012 Sep-Oct; (5):4-9.
To estimate the diagnostic value of differential diagnostic criteria for acoustic neuromas and meningiomas of the cerebellopontine angle in the use of standard magnetic resonance imaging (MRI) modes.The study enrolled 39 patients aged 54 +/- 8 years who had histologically verified acoustic neuromas (n=26) and meningiomas (n=13) of the cerebellopontine angle. MRI scans were compared in the outline and location of a tumor and its signal intensity and uniformity. The quantitative standardized coefficient of tumor signal intensity values was calculated by dividing of the latter by those of cerebrospinal fluid in the lateral ventricles and pons cerebelli.The acoustic neuromas and meningiomas of the cerebellopontine angle exhibited differences in indicators, such as a wide base, the rate of penetration into the internal acoustic meatus, and heterogeneous contrast enhancement on T2-weighted images (T2-WI). The adjacent meninges were different in contrast. Neuromas were hyperintense to the pons varolii on T2-WI and had a low standardized coefficient of cerebrospinal fluid (1.73 +/- 0.3) and the pons (0.73 +/- 0.09) on T1-weighted images (T1-WI). Meningiomas were isointense to the pons varolii on T2-WI had a higher standardized coefficient of cerebrospinal fluid (2.23 +/- 0.36) and the pons (0.86 +/- 0.08) on T1-WI. ROC analysis determined the boundary values for the coefficients with the highest specificity.