Surgical approaches to acoustic nerve tumours.
A critical account is given of the orthodox neurosurgical approach to acoustic nerve tumours and alternatives through the petrous bone or tentorium.
Biomedical subjects
Publications and source records attributed to T T King.
A critical account is given of the orthodox neurosurgical approach to acoustic nerve tumours and alternatives through the petrous bone or tentorium.
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CT metrizamide cisternography performed in a patient with a non-enhancing cerebellopontine angle tumour demonstrated an increase in attenuation within the cystic area between the immediate scan and that undertaken 4 h later indicating delayed inward diffusion of the contrast. At operation the tumour was found to be a cystic acoustic schwannoma of the cerebellopontine angle. Diffusion of metrizamide was not previously been reported across the wall of a cystic tumour.
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The authors present a case of an intraventricular 14-cm fetus in a 6-week-old infant who presented with enlarging head size. The entire intracranial fetus, with recognizable limbs, trunk, head, and exomphalos, was removed totally from the lateral and third ventricles, with excellent recovery in the patient, who is now 18 months old. The cytogenetical and tissue histological studies are reported. The embryology, operative procedure, and pathology of this condition are discussed and the literature briefly reviewed.
The translabyrinthine route or an extension of it was used to remove 150 acoustic nerve tumors. The mortality was 2% and the morbidity low. Preservation of the facial nerve was achieved in 100% of the small and 80% of the medium-sized tumors, but in only 20% of the large growths. The complications encountered are discussed.
Radical, but subtotal, removal of four craniopharyngiomas, three of which were primarily within the third ventricle, has been carried out by an approach beneath the frontal lobe and through the lamina terminalis. A good result was obtained in two cases, and in two other cases the patients were left with considerable disability from hypothalamic damage. The technique, and the indications for radical surgery on these lesions are discussed.
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One-hundred-and-fifty-two patients who underwent surgery for intracranial aneurysm were studied to determine the incidence of postoperative epilepsy in relation to the site of the aneurysm and the type of surgical approach. The overall incidence of epilepsy was 22%. Of the 116 patients treated by the intracranial approach 27.5% developed epilepsy, in contrast with only 5% of the 36 patients who had carotid artery ligation in the neck. Epilepsy occurred most frequently (35%) with middle cerebral artery aneurysms, especially if moderate or severe operative trauma was sustained and there was postoperative dysphasia.
Sixty-nine patients who had neurosurgical treatment for acoustic neuroma by one of two different techniques were studied with a view to determining the incidence of postoperative epilepsy. Fourty-five patients who had larger tumours underwent a combined translabyrinthine and transtentorial neurosurgical approach. For the others with smaller neuromas a translabyrinthine method was used. Only the combined approach was associated with postoperative epilepsy, and it occurred in 22% of the patients. Epilepsy was associated with temporal love trauma during surgery.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Five cerebellopontine angle tumors from four patients with neurofibromatosis (NF) are described. Three were surgical resection specimens from patients with NF2 and two were removed at autopsy from a fourth patient who appears to have had a variant of NF2. On microscopy the three biopsy specimens appeared to be histologically mixed tumors: although they were predominantly typical benign schwannomas, the tumors also contained islands of meningioma, the two tumor types being closely intermingled. In our fourth patient, consecutive decalcified sections of the tumors in the petrous temporal bones revealed florid arachnoidal proliferation around both schwannomas. This had resulted in the formation of multiple "micromeningiomas", some of which had become partially incorporated into the tumor. There are a few previously reported examples of mixed schwannoma-meningiomas in the literature. Possible mechanisms for such a mixed tumor are discussed: the most likely explanation for the appearances in cases of apparently mixed vestibular nerve tumors is that reactive meningeal changes adjacent to the tumor are responsible. Arachnoidal proliferation appears to be more exuberant in bilateral acoustic neurofibromatosis than in sporadic acoustic schwannomas, possibly the result of a disease-related growth factor.