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At least 19 recordsLinked to original sources
PubMed2004

Patient perception of comorbid conditions after acoustic neuroma management: survey results from the acoustic neuroma association.

OBJECTIVES/HYPOTHESIS: Based on survey results of the Acoustic Neuroma Association, the patient ratings of the most difficult aspects of acoustic neuroma management were reported and a review of the literature was made regarding comorbid conditions associated with acoustic neuroma treatment and their impact on patient quality of life. STUDY DESIGN: Cohort study of 1940 patients who were members of the Acoustic Neuroma Association. METHODS: A detailed questionnaire was mailed to 2372 members of the Acoustic Neuroma Association to identify preoperative and postoperative symptoms, complications, and long-term effects on physical and psychosocial function. For 1940 respondents (81.8%) who reported the "most difficult aspect of the AN [acoustic neuroma] experience," the responses were analyzed by tumor size, surgical approach, and patient age and sex. Statistical analysis was performed using SPSS software. RESULTS: Respondents reported that the most difficult aspect of the acoustic neuroma experience was hearing loss (25.8%), followed by facial weakness (17.9%), eye problems (10.8%), and headache (10.5%). In order of frequency, men reported hearing loss, balance problems, perioperative surgical experience, and eye and facial weakness, and women reported hearing loss, facial weakness, eye problems, and headache. Facial weakness was a morbidity more often reported for men and women who had large tumors, who were young, or who had undergone the retrosigmoid approach. Balance dysfunction was significant in patients older than 75 years of age. In patients with small tumors, headaches and balance problems were frequently reported. CONCLUSION: In the large cohort study of patients with acoustic neuroma, perceptions regarding the impact of treatment illustrated why it is incumbent on physicians to understand the sentiments of patients with acoustic neuroma when counseling them and recommending optimal management strategies.

Aged↗
PubMed1997

Peptides and neuromas: calcitonin gene-related peptide, substance P, and mast cells in a mechanosensitive human sural neuroma.

We examined and compared a mechanosensitive human sural neuroma and a contralateral sural nerve collected simultaneously from a patient involved in a diabetic neuropathy research protocol. Using indirect immunofluorescence staining. we identified a striking difference in the content within axons of two neuropeptides, substance P (SP) and calcitonin, gene-related peptide (CGRP), between the contralateral nerve and the neuroma. Unlike the contralateral nerve, where immunofluorescence was sparse, a significant number of disorganized axon profiles that stained brightly positive for CGRP or SP were identified in the neuroma. In contrast, staining for tyrosine hydroxylase, a label of sympathetic axons, was largely absent except around one large arteriole. The neuroma specimen also contained large numbers of serotonin-containing mast cells, only noted occasionally in the contralateral nerve. The peptide staining and mast cell accumulation in the human neuroma closely resembled changes we have previously observed in an animal neuroma model. Local neuropeptides may play a role in the injury response of peripheral nerve, and may be related to mechanosensitivity.

Antibody Specificity↗
PubMedDate not supplied

Cerebellopontine angle tumours, other than acoustic neuromas. A report on 34 cases. A presentation of 7 bilateral acoustic neuromas.

The symptoms, preoperative diagnostic results and histological findings in 34 cerebellopontine angle tumour cases, other than acoustic neuromas, are presented. The meningeomas dominate by far this group of tumours. The symptomatology is much less uniform than that of the acoustic neuromas, where the VIII nerve is dominant. The facial nerve is less involved, whereas the other cranial nerves give symptoms more frequently. One remarkable sign is the presence of severe trigeminal neuralgia, which we have not encountered in acoustic neuromas. Only 35% of the 'non-neuroma' patients had elevated spinal fluid protein, compared with 100% in our acoustic neuroma cases. Furthermore, 7 patients with bilateral acoustic neuromas are presented. The connection with von Recklinghausens disease and multiple meningeomas is discussed.

Adult↗
PubMed1986

Treatment of the painful neuroma by neuroma resection and muscle implantation.

The successful treatment of the painful neuroma remains an elusive surgical goal. This report evaluates one approach to the management of this problem which entails neuroma excision and placement of the proximal end of the nerve away from denervated skin, away from tension, and into a well-vascularized environment: muscle. Seventy-eight neuromas in 60 patients with a mean follow-up of 31 months (range 18 to 43 months) were evaluated. Sixty-seven percent of these patients involved Workmen's Compensation and 57 percent had had at least one previous operation to treat their pain. The results demonstrated good to excellent results in 82 percent of the treated nerves in the entire group. Factors that were predictive of a poorer outcome were (1) digital neuroma (p less than 0.0005), (2) Workmen's Compensation (p less than 0.01), and (3) three or more previous operations for pain (p less than 0.01). Transposition of nerves into small superficial muscles or muscles with significant excursion resulted in treatment failures. The etiology and histopathology of treatment failures are reviewed. Treatment of radial sensory neuromas by transposition of the radial sensory nerve into the brachioradialis muscle when any associated injury to the lateral antebrachial cutaneous nerve was also treated, gave good to excellent relief of pain, and improved hand function in 88 percent of the patients.

Adult↗
PubMed1989

Treatment of recurrent metatarsalgia by neuroma resection and muscle implantation: case report and proposed algorithm of management for Morton's "neuroma".

This report describes the theoretical basis for an approach to treating a recurrent Morton's "neuroma." The recurrence, being a true, classic neuroma, is treated by a technique validated in the treatment of the upper extremity painful neuroma: neuroma resection and muscle implantation. A plantar approach, implanting into the deep layer of intrinsics, was used. The three year success of this technique in a long-distance runner is reported.

Adolescent↗
PubMed1976

Comparative ultrastructure of thyroid, tongue and eyelid lesions in the neuroma phenotype of medullary carcinoma of the thyroid: association of amyloid with fibroblasts in thyroid tumor and in mucosal neuromas.

Electron-microscopic and histochemical studies of thyroid tumor, tongue neuromas and eyelid neuromas from the lesions of a patient with medullary thyroid carcinoma were compared. In the thyroid tumor, a significant number of the C cells showed heterogeneity of granule types; no C cells, however, were identified in the tongue and eyelid neuromas. Amyloid was clearly shown by Congo red staining in the thyroid neoplasm and in the tongue neuromas. In all tissues, amyloid fibrils were found to be ultrastructurally closely associated with fibroblasts. These fingings suggest that the fibroblast rather than the C cell may have played the important role in the deposition of amyloid in this patient's thyroid carcinoma.

Amyloid↗
PubMed1992

The palisaded, encapsulated neuroma (solitary circumscribed neuroma).

We describe the clinical and pathological features of 41 palisaded encapsulated neuromas. They present as small, solitary, asymptomatic papules, predominantly on the face in middle age. No case had co-existent neurofibromatosis or multiple mucosal neuromas. Histologically, they have distinctive features, consisting of a proliferation of Schwann cells and large numbers of axons within a perineurial derived capsule, permitting simple and reliable distinction from schwannomas and neurofibromas. Overall, the palisaded encapsulated neuroma accounts for approximately 25% of all nerve sheath tumours of the dermis. True schwannomas rarely occur in the dermis. Despite their original name, many cases are incompletely encapsulated and we support the recent proposal to rename these lesions solitary circumscribed neuroma.

Adolescent↗
PubMed2002

[Solitary circumscribed neuroma (palisaded encapsulated neuroma) of the oral mucosa].

BACKGROUND: The solitary circumscribed neuroma or "Palisaded Encapsulated Neuroma" is an infrequent benign tumor of the skin of adults, often localised on the face, around the orifices. The involvement of the oral mucosa or of the vermilion border of the lips is rare. CASE REPORTS: In our 5 cases, a small painless and more or less protruding nodule had been present for years on the mucosa of the hard palate (50 year-old man, 43 year-old woman), the soft palate (63 year-old woman), the vermilion border of the lower lip (48 year-old woman), and the gingiva (26 year-old man). The non specific clinical aspect did not permit a correct diagnosis. DISCUSSION: Histologically, the solitary circumscribed neuroma is formed by a proliferation of Schwann cells arranged in interlacing bundles, featuring one or several well-limited nodules, sometimes surrounded by a thin capsule. At first sight, this aspect might sometimes mimic schwannoma or neurofibroma. The lesion is interspersed with a variable amount of axons. An association with neurofibromatosis or MEN syndrome type IIb has never been found. Even after incomplete excision the solitary circumscribed neuroma does not recur, a fact supporting a reactive rather than a neoplastic origin.

Adult↗
PubMed1989

Solitary circumscribed neuroma of the skin (so-called palisaded, encapsulated neuroma). A clinicopathologic and immunohistochemical study.

Solitary, circumscribed neuroma is a distinctive benign cutaneous tumor that was first described under the name "palisaded, encapsulated neuroma" over 15 years ago. Despite the fact that it is not uncommon, it has received minimal attention and is very poorly known among pathologists. We have studied the clinicopathologic and immunohistochemical features of 39 cases. These lesions almost always present on the face or close to a mucocutaneous junction in middle-aged adults. Most examples measure less than or equal to 0.5 cm and are composed of a partially encapsulated mass of bland Schwann cells and innumerable tiny axons arranged in interlacing fascicles. The capsule is composed of perineural cells that show epithelial membrane antigen positivity. Solitary, circumscribed neuroma is not associated with von Recklinghausen's neurofibromatosis, nor is there evidence to support its possible relationship to the type IIb multiple endocrine neoplasia syndrome. This entity warrants wider recognition.

Adolescent↗
PubMed1977

The ultrastructure of oral neuromas in multiple mucosal neuromas, pheochromocytoma, medullary thyroid carcinoma syndrome.

The ultrastructure of oral neuromas from 2 patients with multiple mucosal neuromas, pheochromocytoma, medullary thyroid carcinoma syndrome reveals numerous hypertrophic unmyelinated and myelinated axons, hyperplastic neurilemmal cells and associated collagen fiber formation. These tumors are described and compared ultrastructurally with neurilemmomas and neurofibromas as described by other authors. On the basis of this comparison, these tumors are not considered to be of neurilemmal origin. On the basis of light and electron microscopic histology it is postulated that these tumors represent hypertrophy of axons similar to that noted in amputation neuromas.

Adolescent↗
PubMed2000

Interdigital neuroma: intermuscular neuroma transposition compared with resection.

This prospective, randomized study compares the treatment of an interdigital neuroma (IDN) by the standard resection operation with a technique in which the IDN is transposed into the inter-muscular space between the adductor hallucis and the interossei muscles after division of the digital nerves distal to the IDN. The resection group contained 22 patients and 22 neuromas and the transposition group contained 22 patients and 23 neuromas. An interviewer, blinded as to the operative technique used, telephoned each patient preoperatively, and at 1 month, 3 months, 6 months, 12 months, and 36-48 months postoperatively. The interviewer recorded the patient's reported pain level on a numerical rating scale of 0 to 100. In the resection group the average pain level was slightly lower through the first 6 month period, but at the 12 month review the resection group had a slightly higher average pain level . At the 36-48 month survey the resection group again reported a greater average pain level and fewer asymptomatic patients. It was concluded that it is unnecessary to excise the IDN to obtain excellent relief of pain. It was also concluded that transposition of the IDN into an intermuscular position between the adductor hallucis and the interossei muscles produced significantly better long term results than did the standard resection operation.

Adult↗
PubMed1991

[Diagnostic strategy of acoustic neuroma. Evaluation of efficacy of auditory evoked potentials. Apropos of a series of 50 neuroma cases].

The authors carry out a retrospective study of the diagnostic procedures used in a series of 50 acoustic neuromas. AEP were performed for thirty-four neuromas at some stage of their history. The findings were perfectly normal for eight of them, which represents a sensitivity level of 76%. Various elements likely to account for this are put forward, then the role of AEP and MRI in the diagnostic strategy for neuroma is discussed in the light of this study. Finally, the authors emphasize the necessity to regularly evaluate the diagnostic methods in order to guarantee their quality and reliability.

Evoked Potentials, Auditory↗
PubMed1990

Hypoglossal neuroma following excision of a huge recurrent acoustic neuroma and facio-hypoglossal anastomosis. A complex management problem.

A case of neuroma of the intracranial part of the hypoglossal nerve, not associated with neurofibromatosis, is presented. The patient had previously undergone surgery for the removal of a contralateral acoustic neuroma, and subsequent facio-hypoglossal anastomosis. The importance of early diagnosis, pre-operative clinical assessment and post-operative care is stressed.

Adult↗
PubMed2004

Treatment of end-neuromas, neuromas-in-continuity and scarred nerves of the digits by proximal relocation.

This paper reports the results of treatment by proximal relocation of 104 painful nerves in 57 digits in 48 patients. These included 86 digital nerves and 18 terminal branches of the superficial radial nerve and the dorsal branch of the ulnar nerve. Eighty-three were end-neuromas and 14 were neuromas-in-continuity, of which nine followed nerve repair and five occurred following a closed crush injury. Seven were painful as a result of tethering in scarred tissue. Eighty nerves (77%) required a single relocation and 24 (23%) required more than one operation. Ninety-eight per cent of nerve relocations achieved complete pain relief at the primary site. One patient had mild pain on pressure at the primary site after relocation of two nerves from this site. Over 90% of the nerves had no spontaneous pain, pain on movement or hypersensitivity of the overlying skin at the final site of relocation. However, the incidence of mild or no pain on direct pressure at the site of nerve relocation was lower at 83% as relocated nerves, although traumatized less often at the sites chosen for relocation, can still be painful on direct pressure.

Adult↗
PubMed2005

Headache: a quality of life analysis in a cohort of 1,657 patients undergoing acoustic neuroma surgery, results from the acoustic neuroma association.

OBJECTIVES: On the basis of survey results of the Acoustic Neuroma Association (ANA), we report patient ratings of postoperative headache (POH) symptoms, determine its effect on quality of life (QOL), and review the literature regarding POH after acoustic neuroma (AN) treatment. STUDY DESIGN: In this cohort study, 1,657 patients who underwent surgical treatment of AN reported their experiences of POH. METHODS: A detailed questionnaire was mailed to members of the ANA to identify preoperative and postoperative headache symptoms, complications, and long-term effects on physical and psychosocial function. Questions were answered by 1657 (85.4%) respondents that were intended to qualify and quantify the effects of POH, including QOL issues. Responses were analyzed by tumor size, surgical approach, and patient age and sex. Statistical analysis was performed with the SPSS software. RESULTS: Preoperative headache was reported in approximately one third of respondents. Typical POHs occurred more than once daily (46%), lasted 1 to 4 hours in duration (43.1%), and were of moderate intensity (62.6%). The worst headaches were rated as "severe" by 77% of respondents. Treatment most often reported for typical headaches were nonprescription medications including nonsteroidal anti-inflammatory drugs in 61.3% (P < .01) and regular use of narcotics in 15%. Patients who underwent the retrosigmoid approach were significantly more likely to report their worst POH as "severe" (82.3%) compared with the translabyrinthine (75.2%) and middle fossa approaches (63.3%). Women and younger patients tended to have poorer outcomes with regard to POHs. CONCLUSIONS: In this large cohort study of AN patients, POH was a significant morbidity among AN patients with persistent headaches. Treating physicians should be aware of the risk factors identified and the effect POH has on the QOL when counseling patients regarding optimal treatment management.

Adolescent↗
PubMed2001

Palisaded encapsulated neuroma (solitary circumscribed neuroma of skin) of the eyelid: report of two cases and review of the literature.

BACKGROUND/AIMS: Palisaded encapsulated neuroma of the skin (PEN) is an uncommon benign neural tumour that occurs on the head and neck, including the eyelid, but is unfamiliar to many ophthalmic clinicians. For the first time in the ophthalmic literature, the clinical and histopathological features of two patients with PEN of the eyelid are described. METHODS: Two cases of PEN were identified in the archives of the Department of Pathology, Institute of Ophthalmology, London. Clinical details were derived by a case note review and the histopathological features defined using standard methods including immunohistochemistry. RESULTS: Two cases of PEN are described, from the eyelids of patients aged 43 and 70 years. The tumours were virtually identical in nature, being painless solid masses composed of a mixture of S100 positive Schwann cells and scattered neurofilament positive nerve fibres. An incomplete thin fibrous capsule, which contains EMA positive perineural cells, partially surrounded each lesion. The lesions were distinguishable from other more common eyelid lesions only on histopathological examination. Both tumours were completely excised with no evidence of recurrence. Neither patient had signs of any associated systemic disease. CONCLUSION: PENs are usually solitary, firm, non-pigmented, dome-shaped lesions that are found on the face of patients usually over the age of 40 years. Most often these lesions are diagnosed clinically as basal cell carcinomas, dermal naevi, or skin adnexal tumours. Histologically, PENs must be differentiated from other neural tumours that may be associated with systemic syndromes, such as neurofibromas or mucosal neuromas.

Adult↗
PubMed1988

Diagnostic strategies in search for acoustic neuromas. Findings in 300 acoustic neuroma patients.

The diagnostic findings in 300 patients with acoustic neuromas are reported. Because of a centralized treatment of acoustic neuromas, we have a uniform work-up of all the patients, which enables us to make a non-selected comparison of the diagnostic efficiency of the various tests. Diagnostic dilemmas in patients with normal hearing, anakusis, normal auditory brainstem recordings, normal vestibular function and normal tomography of the internal acoustic meatus are discussed. In patients with hearing better than 80 dB, a normal ABR, the presence of recruitment and a normal caloric reaction can exclude the presence of a tumour, making tomography superfluous. In patients with poor hearing, the need for tomography is imperative. We perform CT if two procedures among the following produce tumour-positive results: ABR, recruitment tests, caloric test, and tomography. Those who have only one tumour-positive finding at the screening are re-examined after one year. If, even with contrast enhancement, CT proves negative, we continue to perform air CT. Only then do we know for sure whether the patient has a tumour or not. An advantage with using many tests for the same physiological function is that they complement each other, though, on the other hand this often adds to the confusion. With fewer tests, the confusion is reduced, but the requirements regarding technical quality must be very stringent. ABR, the Metz recruitment test and tomography are purely objective, while the caloric test is subjective on the part of the investigator. The Hallpike procedure, however, has stood the test of time in separating pathologic from normal.

Adolescent↗