Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from dam...Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.展开更多
OBJECTIVE Traumatic neuromas are rare benign lesions occurring post-mastectomy,which are usually suspected as tumour recurrences before excision biopsy.We report six cases presenting with palpable nodules post-mastect...OBJECTIVE Traumatic neuromas are rare benign lesions occurring post-mastectomy,which are usually suspected as tumour recurrences before excision biopsy.We report six cases presenting with palpable nodules post-mastectomy,to emphasize the differential diagnosis of traumatic neuroma from recurrent cancer.METHODS Six cases were reviewed.The age of patients ranged from 33 to 61 years.Nodular masses were found close to the mastectomy scar during follow-up over a period of 2.8 to 8 years.RESULTS In one patient three nodular masses were detected.Five patients had received chemotherapy,three of which had also received ra-diotherapy.Ultrasound examinations showed a well-circumscribed,homoge-neous,hypo-echoic subcutaneous nodular lesion in four cases,and a poorly defined hypo-echoic nodule with good conduction in two cases.No obvious distant metastases had been identified.Each patient underwent surgical excisional biopsy.All of nodules had a diameter less than 1 cm.Histopatho-logical examination showed proliferation of nerve fibre bundles,which were disordered,oriented and well circumscribed in fibro-adipose tissue.CONCLUSION It was concluded that all of the lesions were traumatic neuromas,independent from the initial tumor.Traumatic neuromas occur-ring in mastectomy scars are difficult to distinguish from a tumor recurrence.Although radiological evaluation of the mass with ultrasound is of value,the diagnosis can only be confirmed following a histopathological evaluation.展开更多
Symptomatic neuromas are an all-too-common complication following limb amputation or extremity trauma,leading to chronic and debilitating pain for patients.Surgical resection of symptomatic neuromas has proven to be t...Symptomatic neuromas are an all-too-common complication following limb amputation or extremity trauma,leading to chronic and debilitating pain for patients.Surgical resection of symptomatic neuromas has proven to be the superior method of intervention,but traditional methods of neuroma resection do not address the underlying pathophysiology leading to the formation of a future symptomatic neuroma and lead to high reoperation rates.Novel approaches employ the physiology of peripheral nerve injury to harness the regeneration of nerves to their advantage.This review explores the underlying pathophysiology of neuroma formation and centralization of pain signaling.It compares the traditional surgical approach for symptomatic neuroma resection and describes three novel surgical strategies that harness this pathophysiology of neuroma formation to their advantage.The traditional resection of symptomatic neuromas is currently the standard of care for amputation patients,but new techniques including the regenerative peripheral nerve interface,targeted muscle reinnervation,and intraosseous transposition have shown promise in improving patient pain outcomes for postamputation pain and residual limb pain.Symptomatic neuromas are a chronic and debilitating complication following amputation procedures and trauma,and the current standard of care does not address the underlying pathophysiology leading to the formation of the neuroma.New techniques are under development that may provide improved patient pain outcomes and a higher level of care for symptomatic neuroma resection.展开更多
Sporadic vestibular schwannoma (acoustic neuroma) is a benign tumor arising from cochleovestibular nerve. Nowadays, various specialties and medical centers are treating this dis-ease, and the multidisciplinary collabo...Sporadic vestibular schwannoma (acoustic neuroma) is a benign tumor arising from cochleovestibular nerve. Nowadays, various specialties and medical centers are treating this dis-ease, and the multidisciplinary collaboration is the trend. In an effort to promote a uniform stan-dard for reporting clinical results, even for treatment indications, the mainly controversies were posed and discussed during the 7th International Conference on acoustic neuroma, and the agreement was summarized by the Committee of this conference. The main symptoms grading and tumor stage should note its name of classification for making them comparable. The goal of the modern managements for vestibular schwannoma is to improve the quality of life with lower mortality, lower morbidity and better neurological function preservation. The experience of surgical team and their preference might be a major factor for the outcome. Because of lack-ing of long-term follow-up large data after radiotherapy, and with the development of microsur-gery, radiotherapy is now less recommended except for recurrent cases or elderly patients.展开更多
Neuropathic pain of the upper limb results from damage or disease of the upper limb somatosensory system caused by wide range of pathologies including peripheral neuromas.Treatment strategies depend on making an accur...Neuropathic pain of the upper limb results from damage or disease of the upper limb somatosensory system caused by wide range of pathologies including peripheral neuromas.Treatment strategies depend on making an accurate diagnosis,recognizing co-existing pathologies,and formulating an individualized treatment plan that commonly involves multiple modalities.A long list of nonsurgical and surgical methods acting peripherally(neuromodulation,nerve blocks,surgical manipulation of the nerve)and centrally(medications,spinal cord,and deep brain stimulation)has been described and it is clear that no one treatment is wholly reliable.In this article,we briefly review the pathophysiology of pain caused by neuromas,the current treatment options and the latest research in therapeutic developments.展开更多
Digital neuromas can be psychologically and functionally debilitating.While typically the result of penetrating traumatic injury,neuromas also stem from blunt trauma,chronic irritation,or prior inadequate repair.Abnor...Digital neuromas can be psychologically and functionally debilitating.While typically the result of penetrating traumatic injury,neuromas also stem from blunt trauma,chronic irritation,or prior inadequate repair.Abnormal axonal regeneration without an appropriate distal target following nerve injury results in the formation of end-neuromas,often leading to significant pain.Conservative management is centered around a combination of pharmacological interventions and therapeutic modalities.In the setting of failed conservative management,surgical intervention is employed with the goals of excising the neuroma and redirecting axonal growth into healthy tissue.This article focuses on painful digital neuromas and options for both nonoperative and operative management.展开更多
Aim:Centrocentral anastomosis(CCA)can be applied in the treatment of painful neuromas,by connecting nerve ends or fascicles after neuroma resection,with or without an interposed nerve graft.While this technique was de...Aim:Centrocentral anastomosis(CCA)can be applied in the treatment of painful neuromas,by connecting nerve ends or fascicles after neuroma resection,with or without an interposed nerve graft.While this technique was developed directly after the introduction of microsurgical techniques,it is currently not frequently applied in neuroma treatment.Methods:In this article,the literature on CCA was systematically reviewed,both for clinical and experimental studies.Specific attention was paid to the different surgical techniques,potential applications,and pathophysiologic mechanisms that might explain how CCA can prevent neuroma formation.Results:A total of 15 articles were found on this subject,11 clinical and 4 experimental studies.In clinical studies,CCA was mostly applied for neuroma treatment following amputation of fingers and lower limbs.In experimental studies,different combinations of nerve connections and grafts were investigated in the rat sciatic nerve model.Pain reduction in the clinical studies overall was good to excellent,but only in two studies control groups were used.Results from experimental studies showed that the use of an interposed graft was beneficial by entrapment of axons inside the graft.Conclusion:Although CCA has shown promising results for neuroma treatment,there are only a few case series to date,one cohort and one randomized study,and in the latter two,no graft was used.More research is needed to investigate the outcome of CCA,especially for the option of an interposed nerve graft.This investigation should involve comparisons with alternative techniques,utilization of standardized outcome measures,and,preferably,inclusion of longer follow-up periods.展开更多
BACKGROUND Gastrointestinal subepithelial tumors(GSTs),incidentally detected during upper gastrointestinal(GI)endoscopy,may be lesions derived from the GI wall or may be caused by compression from external organs.In g...BACKGROUND Gastrointestinal subepithelial tumors(GSTs),incidentally detected during upper gastrointestinal(GI)endoscopy,may be lesions derived from the GI wall or may be caused by compression from external organs.In general,traumatic neuroma is a benign nerve tumor that results from postoperative nerve injury,occurring in the bile duct as one of the complications after cholecystectomy.This is the first case report demonstrating that neuroma of the cystic duct can be incorrectly perceived as a duodenal subepithelial tumor by compressing the duodenal wall.CASE SUMMARY We report the case of a 72-year-old man with traumatic neuroma of the cystic duct after cholecystectomy.This tumor was mistaken for a duodenal subepithelial tumor on preoperative upper GI endoscopy and endoscopic ultrasonography due to external compression of the GI wall.The patient had no symptoms,and his laboratory test results were normal.However,in a series of follow-up endoscopies,the tumor was found to have grown in size,so it was surgically resected.The lesion was completely removed by laparoscopic endoscopic cooperative surgery.The patient was discharged on postoperative day 7 without complications.CONCLUSION Traumatic neuroma of the cystic duct can be mistaken for GSTs in GI endoscopy.展开更多
Objective To report the authors'experiences in hearing preservation during acoustic neuroma(AN)resection procedures.Methods Two cases of AN removal via retrosigmoid approach were reviewed.Hearing preservation was ...Objective To report the authors'experiences in hearing preservation during acoustic neuroma(AN)resection procedures.Methods Two cases of AN removal via retrosigmoid approach were reviewed.Hearing preservation was attempted in the aid of endoscopic technique along with continuous monitoring of the compound action potential(CAP)and auditory brainstem response(ABR)during the surgery.Results The tumor in Case 1 was 1.5 cm in diameter.The average pure-tone hearing threshold was 30 dB HL and ABR was normal.Waves I,III and V of ABR were present following tumor removal.At 7th month follow-up,audiometric thresholds and ABR inter-peak intervals had recovered to pre-operative levels,with normal facial nerve function.The patient in Case 2 had bilateral AN.The tumors measured 4.0 cm(left)and 5.0 cm(right)on MRI scans.The AN on the right side was removed first,followed by removal of the left AN four months later.Intraoperative CAP monitoring was employed during removal of the left AN.While efforts to preserve the cochlear nerve were not successful,CAPs were still present after tumor removal.Conclusions Intraoperatively recorded CAPs are not reliable in predicting postoperative hearing outcomes.In contrast,ABRs are an indicator of function of the peripheral auditory pathway.Presence of waves I,III and V following tumor removal may represent preservation of useful hearing.展开更多
Studies have shown that myelin-associated glycoprotein(MAG)can inhibit axon regeneration after nerve injury.However,the effects of MAG on neuroma formation after peripheral nerve injury remain poorly understood.In thi...Studies have shown that myelin-associated glycoprotein(MAG)can inhibit axon regeneration after nerve injury.However,the effects of MAG on neuroma formation after peripheral nerve injury remain poorly understood.In this study,local injection of MAG combined with nerve cap made of chitin conduit was used to intervene with the formation of painful neuroma after sciatic nerve transfection in rats.After 8 weeks of combined treatment,the autotomy behaviors were reduced in rats subjected to sciatic nerve transfection,the mRNA expression of nerve growth factor,a pain marker,in the proximal nerve stump was decreased,the density of regenerated axons was decreased,the thickness of the myelin sheath was increased,and the ratio of unmyelinated to myelinated axons was reduced.Moereover,the percentage of collagen fiber area and the percentage of fibrosis marker alpha-smooth muscle actin positive staining area in the proximal nerve stump were decreased.The combined treatment exhibited superior effects in these measures to chitin conduit treatment alone.These findings suggest that MAG combined with chitin conduit synergistically inhibits the formation of painful neuroma after sciatic nerve transection and alleviates neuropathic pain.This study was approved by the Animal Ethics Committee of Peking University People’s Hospital(approval No.2019PHE027)on December 5,2019.展开更多
Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function ...Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.展开更多
Traumatic painful neuroma is an intractable clinical disease characterized by improper extracellular matrix(ECM)deposition around the injury site.Studies have shown that the microstructure of natural nerves provides a...Traumatic painful neuroma is an intractable clinical disease characterized by improper extracellular matrix(ECM)deposition around the injury site.Studies have shown that the microstructure of natural nerves provides a suitable microenvironment for the nerve end to avoid abnormal hyperplasia and neuroma formation.In this study,we used a decellularized nerve matrix scaffold(DNM-S)to prevent against the formation of painful neuroma after sciatic nerve transection in rats.Our results showed that the DNM-S effectively reduced abnormal deposition of ECM,guided the regeneration and orderly arrangement of axon,and decreased the density of regenerated axons.The epineurium-perilemma barrier prevented the invasion of vascular muscular scar tissue,greatly reduced the invasion ofα-smooth muscle actin-positive myofibroblasts into nerve stumps,effectively inhibited scar formation,which guided nerve stumps to gradually transform into a benign tissue and reduced pain and autotomy behaviors in animals.These findings suggest that DNM-S-optimized neuroma microenvironment by ECM remodeling may be a promising strategy to prevent painful traumatic neuromas.展开更多
Acoustic Neuroma (AN) arises from the eighth cranial nerve. It primarily involves the vestibular branch of the nerve and is therefore also called vestibular schwannoma(VS). To the date, diagnosis and surgical treatmen...Acoustic Neuroma (AN) arises from the eighth cranial nerve. It primarily involves the vestibular branch of the nerve and is therefore also called vestibular schwannoma(VS). To the date, diagnosis and surgical treatment of AN have advanced significantly. Along with advances in audiology and imaging technologies, cases of diagnosed AN have been increasing, making it a common展开更多
The majority of the tumors arising from the peripheral nerves of the hand are relatively benign.However,a tumor diagnosed as malignant peripheral nerve sheath tumor(MPNST)has destructive consequences.Clinical signs an...The majority of the tumors arising from the peripheral nerves of the hand are relatively benign.However,a tumor diagnosed as malignant peripheral nerve sheath tumor(MPNST)has destructive consequences.Clinical signs and symptoms are usually caused by direct and indirect effects of the tumor,such as nerve invasion or compression and infiltration of surrounding tissues.Definitive diagnosis is made by tumor biopsy.Complete surgical removal with maximum reservation of residual neurologic function is the most appropriate intervention for most symptomatic benign peripheral nerve tumors(PNTs)of the hand;however,MPNSTs require surgical resection with a sufficiently wide margin or even amputation to improve prognosis.In this article,we review the clinical presentation and radiographic features,summarize the evidence for an accurate diagnosis,and discuss the available treatment options for PNTs of the hand.展开更多
文摘Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.
文摘OBJECTIVE Traumatic neuromas are rare benign lesions occurring post-mastectomy,which are usually suspected as tumour recurrences before excision biopsy.We report six cases presenting with palpable nodules post-mastectomy,to emphasize the differential diagnosis of traumatic neuroma from recurrent cancer.METHODS Six cases were reviewed.The age of patients ranged from 33 to 61 years.Nodular masses were found close to the mastectomy scar during follow-up over a period of 2.8 to 8 years.RESULTS In one patient three nodular masses were detected.Five patients had received chemotherapy,three of which had also received ra-diotherapy.Ultrasound examinations showed a well-circumscribed,homoge-neous,hypo-echoic subcutaneous nodular lesion in four cases,and a poorly defined hypo-echoic nodule with good conduction in two cases.No obvious distant metastases had been identified.Each patient underwent surgical excisional biopsy.All of nodules had a diameter less than 1 cm.Histopatho-logical examination showed proliferation of nerve fibre bundles,which were disordered,oriented and well circumscribed in fibro-adipose tissue.CONCLUSION It was concluded that all of the lesions were traumatic neuromas,independent from the initial tumor.Traumatic neuromas occur-ring in mastectomy scars are difficult to distinguish from a tumor recurrence.Although radiological evaluation of the mass with ultrasound is of value,the diagnosis can only be confirmed following a histopathological evaluation.
文摘Symptomatic neuromas are an all-too-common complication following limb amputation or extremity trauma,leading to chronic and debilitating pain for patients.Surgical resection of symptomatic neuromas has proven to be the superior method of intervention,but traditional methods of neuroma resection do not address the underlying pathophysiology leading to the formation of a future symptomatic neuroma and lead to high reoperation rates.Novel approaches employ the physiology of peripheral nerve injury to harness the regeneration of nerves to their advantage.This review explores the underlying pathophysiology of neuroma formation and centralization of pain signaling.It compares the traditional surgical approach for symptomatic neuroma resection and describes three novel surgical strategies that harness this pathophysiology of neuroma formation to their advantage.The traditional resection of symptomatic neuromas is currently the standard of care for amputation patients,but new techniques including the regenerative peripheral nerve interface,targeted muscle reinnervation,and intraosseous transposition have shown promise in improving patient pain outcomes for postamputation pain and residual limb pain.Symptomatic neuromas are a chronic and debilitating complication following amputation procedures and trauma,and the current standard of care does not address the underlying pathophysiology leading to the formation of the neuroma.New techniques are under development that may provide improved patient pain outcomes and a higher level of care for symptomatic neuroma resection.
文摘Sporadic vestibular schwannoma (acoustic neuroma) is a benign tumor arising from cochleovestibular nerve. Nowadays, various specialties and medical centers are treating this dis-ease, and the multidisciplinary collaboration is the trend. In an effort to promote a uniform stan-dard for reporting clinical results, even for treatment indications, the mainly controversies were posed and discussed during the 7th International Conference on acoustic neuroma, and the agreement was summarized by the Committee of this conference. The main symptoms grading and tumor stage should note its name of classification for making them comparable. The goal of the modern managements for vestibular schwannoma is to improve the quality of life with lower mortality, lower morbidity and better neurological function preservation. The experience of surgical team and their preference might be a major factor for the outcome. Because of lack-ing of long-term follow-up large data after radiotherapy, and with the development of microsur-gery, radiotherapy is now less recommended except for recurrent cases or elderly patients.
文摘Neuropathic pain of the upper limb results from damage or disease of the upper limb somatosensory system caused by wide range of pathologies including peripheral neuromas.Treatment strategies depend on making an accurate diagnosis,recognizing co-existing pathologies,and formulating an individualized treatment plan that commonly involves multiple modalities.A long list of nonsurgical and surgical methods acting peripherally(neuromodulation,nerve blocks,surgical manipulation of the nerve)and centrally(medications,spinal cord,and deep brain stimulation)has been described and it is clear that no one treatment is wholly reliable.In this article,we briefly review the pathophysiology of pain caused by neuromas,the current treatment options and the latest research in therapeutic developments.
文摘Digital neuromas can be psychologically and functionally debilitating.While typically the result of penetrating traumatic injury,neuromas also stem from blunt trauma,chronic irritation,or prior inadequate repair.Abnormal axonal regeneration without an appropriate distal target following nerve injury results in the formation of end-neuromas,often leading to significant pain.Conservative management is centered around a combination of pharmacological interventions and therapeutic modalities.In the setting of failed conservative management,surgical intervention is employed with the goals of excising the neuroma and redirecting axonal growth into healthy tissue.This article focuses on painful digital neuromas and options for both nonoperative and operative management.
文摘Aim:Centrocentral anastomosis(CCA)can be applied in the treatment of painful neuromas,by connecting nerve ends or fascicles after neuroma resection,with or without an interposed nerve graft.While this technique was developed directly after the introduction of microsurgical techniques,it is currently not frequently applied in neuroma treatment.Methods:In this article,the literature on CCA was systematically reviewed,both for clinical and experimental studies.Specific attention was paid to the different surgical techniques,potential applications,and pathophysiologic mechanisms that might explain how CCA can prevent neuroma formation.Results:A total of 15 articles were found on this subject,11 clinical and 4 experimental studies.In clinical studies,CCA was mostly applied for neuroma treatment following amputation of fingers and lower limbs.In experimental studies,different combinations of nerve connections and grafts were investigated in the rat sciatic nerve model.Pain reduction in the clinical studies overall was good to excellent,but only in two studies control groups were used.Results from experimental studies showed that the use of an interposed graft was beneficial by entrapment of axons inside the graft.Conclusion:Although CCA has shown promising results for neuroma treatment,there are only a few case series to date,one cohort and one randomized study,and in the latter two,no graft was used.More research is needed to investigate the outcome of CCA,especially for the option of an interposed nerve graft.This investigation should involve comparisons with alternative techniques,utilization of standardized outcome measures,and,preferably,inclusion of longer follow-up periods.
文摘BACKGROUND Gastrointestinal subepithelial tumors(GSTs),incidentally detected during upper gastrointestinal(GI)endoscopy,may be lesions derived from the GI wall or may be caused by compression from external organs.In general,traumatic neuroma is a benign nerve tumor that results from postoperative nerve injury,occurring in the bile duct as one of the complications after cholecystectomy.This is the first case report demonstrating that neuroma of the cystic duct can be incorrectly perceived as a duodenal subepithelial tumor by compressing the duodenal wall.CASE SUMMARY We report the case of a 72-year-old man with traumatic neuroma of the cystic duct after cholecystectomy.This tumor was mistaken for a duodenal subepithelial tumor on preoperative upper GI endoscopy and endoscopic ultrasonography due to external compression of the GI wall.The patient had no symptoms,and his laboratory test results were normal.However,in a series of follow-up endoscopies,the tumor was found to have grown in size,so it was surgically resected.The lesion was completely removed by laparoscopic endoscopic cooperative surgery.The patient was discharged on postoperative day 7 without complications.CONCLUSION Traumatic neuroma of the cystic duct can be mistaken for GSTs in GI endoscopy.
文摘Objective To report the authors'experiences in hearing preservation during acoustic neuroma(AN)resection procedures.Methods Two cases of AN removal via retrosigmoid approach were reviewed.Hearing preservation was attempted in the aid of endoscopic technique along with continuous monitoring of the compound action potential(CAP)and auditory brainstem response(ABR)during the surgery.Results The tumor in Case 1 was 1.5 cm in diameter.The average pure-tone hearing threshold was 30 dB HL and ABR was normal.Waves I,III and V of ABR were present following tumor removal.At 7th month follow-up,audiometric thresholds and ABR inter-peak intervals had recovered to pre-operative levels,with normal facial nerve function.The patient in Case 2 had bilateral AN.The tumors measured 4.0 cm(left)and 5.0 cm(right)on MRI scans.The AN on the right side was removed first,followed by removal of the left AN four months later.Intraoperative CAP monitoring was employed during removal of the left AN.While efforts to preserve the cochlear nerve were not successful,CAPs were still present after tumor removal.Conclusions Intraoperatively recorded CAPs are not reliable in predicting postoperative hearing outcomes.In contrast,ABRs are an indicator of function of the peripheral auditory pathway.Presence of waves I,III and V following tumor removal may represent preservation of useful hearing.
基金the National Natural Science Foundation of China,No.31771322Major R&D Program of National Ministry of Science and Technology of China,No.2018YFB1105504+1 种基金Beijing Natural Science Foundation of China,No.7212121and Shenzhen Science and Technology Plan Project of China,No.JCYJ20190806162205278(all to PXZ).
文摘Studies have shown that myelin-associated glycoprotein(MAG)can inhibit axon regeneration after nerve injury.However,the effects of MAG on neuroma formation after peripheral nerve injury remain poorly understood.In this study,local injection of MAG combined with nerve cap made of chitin conduit was used to intervene with the formation of painful neuroma after sciatic nerve transfection in rats.After 8 weeks of combined treatment,the autotomy behaviors were reduced in rats subjected to sciatic nerve transfection,the mRNA expression of nerve growth factor,a pain marker,in the proximal nerve stump was decreased,the density of regenerated axons was decreased,the thickness of the myelin sheath was increased,and the ratio of unmyelinated to myelinated axons was reduced.Moereover,the percentage of collagen fiber area and the percentage of fibrosis marker alpha-smooth muscle actin positive staining area in the proximal nerve stump were decreased.The combined treatment exhibited superior effects in these measures to chitin conduit treatment alone.These findings suggest that MAG combined with chitin conduit synergistically inhibits the formation of painful neuroma after sciatic nerve transection and alleviates neuropathic pain.This study was approved by the Animal Ethics Committee of Peking University People’s Hospital(approval No.2019PHE027)on December 5,2019.
文摘Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.
基金supported by the National Natural Science Foundation of China,No.82171650(to CBZ)Guangdong Province Key Research and Development Project,No.2020B1111150003(to DPQ)Guangdong Basic and Applied Basic Research Foundation,No.2020A1515011143(to CBZ)。
文摘Traumatic painful neuroma is an intractable clinical disease characterized by improper extracellular matrix(ECM)deposition around the injury site.Studies have shown that the microstructure of natural nerves provides a suitable microenvironment for the nerve end to avoid abnormal hyperplasia and neuroma formation.In this study,we used a decellularized nerve matrix scaffold(DNM-S)to prevent against the formation of painful neuroma after sciatic nerve transection in rats.Our results showed that the DNM-S effectively reduced abnormal deposition of ECM,guided the regeneration and orderly arrangement of axon,and decreased the density of regenerated axons.The epineurium-perilemma barrier prevented the invasion of vascular muscular scar tissue,greatly reduced the invasion ofα-smooth muscle actin-positive myofibroblasts into nerve stumps,effectively inhibited scar formation,which guided nerve stumps to gradually transform into a benign tissue and reduced pain and autotomy behaviors in animals.These findings suggest that DNM-S-optimized neuroma microenvironment by ECM remodeling may be a promising strategy to prevent painful traumatic neuromas.
文摘Acoustic Neuroma (AN) arises from the eighth cranial nerve. It primarily involves the vestibular branch of the nerve and is therefore also called vestibular schwannoma(VS). To the date, diagnosis and surgical treatment of AN have advanced significantly. Along with advances in audiology and imaging technologies, cases of diagnosed AN have been increasing, making it a common
基金Supported by the National Natural Science Foundation of China,No.81702135Natural Science Foundation of Zhejiang Province,No.LQ20H060008 and No.LY20H060007Zhejiang Medicine and Hygiene Research Program,No.2018KY055.
文摘The majority of the tumors arising from the peripheral nerves of the hand are relatively benign.However,a tumor diagnosed as malignant peripheral nerve sheath tumor(MPNST)has destructive consequences.Clinical signs and symptoms are usually caused by direct and indirect effects of the tumor,such as nerve invasion or compression and infiltration of surrounding tissues.Definitive diagnosis is made by tumor biopsy.Complete surgical removal with maximum reservation of residual neurologic function is the most appropriate intervention for most symptomatic benign peripheral nerve tumors(PNTs)of the hand;however,MPNSTs require surgical resection with a sufficiently wide margin or even amputation to improve prognosis.In this article,we review the clinical presentation and radiographic features,summarize the evidence for an accurate diagnosis,and discuss the available treatment options for PNTs of the hand.
