Tumors VIII pairs of nerves (Nevnomes) Are there in the middle department of the bridge-cerebellary rocky space and can proceed from the Schwan shell throughout its length, from the bottom of the inner auditory passage until the entrance to the oblongable brain. Recall that the bridge-cerebel rocky space is topographically divided into three departments: front, middle and rear.

Depending on what department is the pathological process, arises corresponding to the syndrome. The tumors of the auditory nerve, (neuromy) are of great interest for otolaryngologists because the first complaints that are a consequence of defeat VIII pairs of nerves (noise in the ears, a decrease in hearing, violation of statics), make the patient for help from a otolaryngologist. Such patients under observation of the otolaryngologist are diagnosed with otosclerosis, diseases of the inner ear or Meniere disease.

Consequently, otiarats are not enough differential diagnosis is carried out Between the tumor VIII pairs of nerves and other diseases of the auditory nerve, the inner ear of unrealious origin. This is the main reason why tumor. VIII pairs of nerves are recognized in the late stage of their development.

Nevnoma in its primary development Sometimes it can occur without disrupting the cochlear and vestibular function. This happens probably in cases where the tumor originates from the medial departments VIII pairs of nerves. The first symptoms of medially located tumors are expressed in the headaches, the feeling of tightening in the back of the head, neck, the paresis of the face nerve, the violation of taste, the pain of the face resembling neuralgia. With such localization of the neurinoma at the beginning of the disease, noise in the ear, the decrease in hearing can be absolutely absent or a change in hearing can be so insignificant that he does not notice the patient, and therefore the hearing impairment does not complain.

Such patients are usually not sent to otolaryngologist for research. When the hearing impairment, the kinetics has achieved a significant extent, only then such patients are sent by a neuropathologist to a specialist to establish a violation of the function of the VIII pair of nerves. In order to avoid late recognition of the lesion of the hearing and old-kinetic apparatus of a tumor nature, it should be put by the rule to produce an in-depth study of the function VIII pair of nerves in any disease of the nervous system.

It should be noted that Lamb. Observed one case of tumor VIII pair of nerves, in which the rumor was normal, and the vestibular function was faded. This clinical observation corresponds to the pathologanomic finds of Goshen in the sense that the tumor took the beginning with Ramus Saccularis N. Vestibulares at the bottom of the inner auditory passage.

Based on the specified topographic location tumors, it is clear that depending on the magnitude of the tumor and the adaptability to the tumor of its surrounding brain tissue, the tanks of the bridge-cerebellary rocky space, the state of which has an effect on liquorism in the appropriate department, semiotics, both othiatric and non-neurological, and neurological, and x-ray, And ophthalmologic, will be different.

Surgical treatment of neuro cranial nerves, for example, a vestibulo-cochlear nerve

The neuromes of the auditory (VIII) nerve (vestibular shwannomes) make up almost 80% of the tumors of the bridge-cerebel angle and in 4-5% of cases are bilateral.

These tumors are benign education, developing from Schwann cells of vestibular portion of the vestibular cholear nerve VIII (more often than the top vestibular portion).
The incidence of non-neuromes of auditory nerve is one case per 100,000 population per year.

In 95% of cases of auditory nerve in 95% of cases is one-sided tumor and develops in persons aged 40-50 years. 5% of the neurine are bilateral, which is pathogenous for neurofibromatosis II type . More often, the nevinomes are found in women.

Clinical symptoms of vestibular swan It consists of three main groups of symptoms - signs of damage to the cranial nerves, stem symptoms and cerebellar disorders. The symptoms of the lesion of the vestibular cholear nerve are the most early sign Diseases. The damage to the auditory nerve is observed in 95% of cases, And the first signs of the disease are usually ringing in the ears, observed in 60% of patients, and a decrease in hearing, first at high tones. Signs of lesions of the vestibular nerve are observed in 60% of patients and are manifested by a periodically arising sensation of instability with sharp turns of the head or body, that is, "dizziness" to a greater extent characterizes the violation of the stake-refinery feeling, while the true vestibular (systemic) dizziness is rarely found. Spontaneous horizontal Nistagm at an early stage of the disease is detected about 30% of patients. The development of the disease over time leads to the complete loss of the function of the vestibular cholear nerve, which is manifested by the deafness and loss of vestibular excitability on the affected side.

The development of the neuromy of the auditory nerve leads to a significant impact on the face nerve, which is closest to the VIII nerve.
Symptoms of defeat trigeny nerve In 15% of patients are noted, when the tumor is propagated, beyond the internal auditory passage (intrastranally) and indicate the size of Schwannomes over 2 cm.
The clinical picture of the lesion of IX, X, XII nerves appears much later and only at large tumors (more than 4 cm). These patients appear hypshethesis and violations of taste on the rear third of the language, hystheses of the mucosa of the upper part of the pharynx, the asymmetry of the soft heaven, manifested by the dysphony, and atrophy of half the tumor side.
At the same stage, in a clinical picture, the symptoms of the brain and cerebellum trunk and cerebellum are detected in the clinical picture.

Currently, there are three options for treating an auditory nerve-nerve - surgery, radiosurgery and observation. The question of treatment tactics is solved individually with each patient.

The use of the microsurgical method allowed in the last decade to significantly reduce postoperative mortality, which does not exceed 1-3% today. Recurrent frequency is about 5%.

Nevnomane There are a kind of benign tumors generated from Schwann cells of tissues of auditory and cranial nerves (VIII couples).

Schwannovsky call the auxiliary cells of the nerve trunks, named after their discoverer - the German physiologist Theodore Schwann. Otherwise, these neoplasms are also called vestibular shwannami or acoustic neurities (Svannomes). This pathology is found quite rarely and amounts to about 10% of the total number of tumors of the CNS (central nervous system). You affect these neoplasms more often than men, the main age range of patients - from 30 to 40 years.

The main function of auditory nerves is sound transmission featurein the appropriate cerebral centers for subsequent processing. In addition, a certain segment of these nerves is responsible for operation of the vestibular apparatus of a person - A special most important device that allows you to control the position of the body in space.

2. Symptoms of the neuromy of the cranial brain nerves

The symptomatic picture of the tumor of the auditory nerve is determined by the factor in the compression of certain nerve fibers. The larger the size of the tumor, the brighter there will be its manifestations. So, among the initial symptoms, you can designate such:

• auditory disorders (decrease in hearing acute, noise or ringing in the ears);
• numbness of persons, taste changes;
• difficulties with equilibrium, dizziness and feeling of uncertainty in walking.

These symptoms are due to the squeezing of small size of the facial and auditory nerve, including its vestibular part.

With further growth of the neoplasm the above symptoms may add:

• nistagm (frequent involuntary movements of eyeballs);
• reducing the sensitivity of the cornea, language, mucous membranes of nasal strokes;
• pain on the side of the tumor caused by the compression of the facial trigeminal nerve;
• violation of coordination of movement.

These disorders are already submitting the most important centers of the brain barrel. If you continue to prevent the tumor growth, the clinical picture is supplemented:

• mental disorders;
• loss of vision and hearing;
• violation of the act of chewing and swallowing;
• increased intracranial pressure.

These negative changes occur due to circulation violation spinal fluid (liquor) and development due to this hydrocephalus, and compression of the centers of a wandering nerve, leading to a paresa (paralysis) of the larynx.

3. Diagnosis and treatment of neuromy

For the diagnosis of neurinoma in most cases, such methods are used:

• MRI or CT (magnetic resonance or cT scan);
• audiogram - a study determining auditory violations;
• electronistogram - determination of the degree of nystagma.

In addition, additional surveys may be carried out if necessary.

The main method of treating the neuromy is surgical. If the operation was carried out in a timely manner, the patient has a high chance to completely get rid of the disease. As the tumor grows, the changes that it provokes can become irreversible. In this case, the result of treatment is much worse.

Radical surgical intervention provides the ability to remove the neoplasm fully. However, in some cases, its localization and size do not allow to achieve the desired result.

If the tumor is well irradiated, the doctor can resort to her treatment with gamma knife- radiation therapy produced with high accuracy.

Perhaps I. combined treatment using surgical operation and radiological treatment.

The neuromance of the auditory nerve (synonyms acoustic neurinoma or shwannoma, as well as the vestibular shwannoma) is a benign tumor of the VIII pair of cranopy brain nerves.

The incidence is approximately 1 case per 100 thousand population per year. Staying at the same time, one of the most frequent brain tumors, occupying, by different sources, from 10 to 15% of all. It is more common in young (30-40 years) people, cases of development in young children are extremely rare.

The reasons

The only significant factor in the risk of neural development is neurofibromatosis of type 2 (Reflinghausen's disease). In other cases, the reason remains unknown. Relative factors are contact with radiation, chemical harm, and also burdened by an oncological history.

Symptoms

The most characteristic of the symptoms of the gradual loss of hearing, and on the one hand. At the same time, dizziness, though it can develop (due to the influence of the vestibular portion of the nerve), but in the early stages are not typical. On the side of the defeat, noise, ringing in the ear or head can be marked, but it is clearly defined one-sided character. With a further growth, the symptoms of the neurinoma can switch to nearby cranknot, which can manifest a tingling in his face, pain in the face (influence on a triple nerve), also often observed symptoms of the gradual development of the weakness of the face muscles on the one hand (influence on the facial nerve). In the later, the far-sighted stages of the neurinoma can lead to the compression of the brain stem and cause heavy cerebral complications.

Diagnostics

The diagnosis of the eighth pair of the eighth pair is to carry out a careful disposable examination, which includes carrying out neurological, otorinolaryngological examinations, the audiogram, the methods of impedancetry and caused by auditory potentials. It is also necessary to conduct an MRI study (if there are contraindications to the study - Conducting MSCT). After identifying the fact of the presence of a neoplary, it is necessary to hold a neurosurgeon consultation.

Also quite characteristic is the presence of increased content Licvore in the spinal fluid.

Treatment

Treatment of the neuromy of the auditory nerve is made strictly neurosurgeons. Executive intervention is shown, including possibly an operation using a gamma knife. Possible treatment of radiation therapy.

Forecast

The forecast for life is favorable. It is especially important to identify the neurine in the early stages of development, to prevent the germination of other cranial brain nerves to the development of hypertension-hydrocephalic syndrome. The forecast for the restoration of all lost functions in some cases is dubious. For large sizes, neurine even after total tumor removal, such symptoms may remain as a decrease in hearing, dizziness.

The traditional localization site of the neurine is the end portion of the VIII nerve. Its further growth is possible towards the internal auditory channel or a bridge corner. Depending on the direction of growth and the size of the tumor, the compression may apply to the cerebellum, the bridge, V and VII couple Card nerves, burbar cranial nerves. Growth rate, as a rule, does not exceed 2-10 mm per year.

Treatment

In the treatment of neuromy VIII nerve, surgical intervention is applied. The specific method of removing the tumor is determined by its dimensions, anatomy-topographical features of localization, vascularization intensity, capsule characteristic.

The frequency of complications after the operation depends on the size of the neoplasm. So, the function of the facial nerve can be preserved:

• in 95% of cases - if a tumor is less than 2 cm;
• in 80% of cases - if the size is 2-3 cm.

If the size of the neoplasum exceeds 3 cm, then the risk is significantly higher.

With subtotal resection of the neurine VIII nerve in some cases, radiation therapy may be carried out, but there is no reliable data on its positive effect on the further course of the disease.

Considering slow Rost. Tumors, in some situations (especially in older people or patients with a heavy comorbide background), conservative treatment will be justified. It involves monitoring the patient's condition with CT or MRI to assess the clinical situation in the dynamics. The concomitant hydrocephalus is eliminated by shunting, which in this case acts as a palliative method of treatment of neuromy VIII nerve.

Patient E., 28 years old. Complaints of coarsening, chance, headache, lack of hearing on the left ear, numbness of the left half of the face, dry the left eye, violating the facial expressions of the left half of the face

During the examination, a tumor was revealed in the left-place cerebeller corner.

nevnoma VIII nerve tumor spreads into an internal hearing pass

Operation was performed - removal of an innocent VIII nerve using intraoperative electrophysiological monitoring of the causal group of nerves. During the operation, the location of the fiber facial nerve is identified. Due to the high risk of their damage, a slight tumor volume is decided to leave and recommend consultation of radiologists in the postoperative period to solve the issue of radiation treatment.

On postoperative control MRI - minor tumor residues in the field of internal auditory passage.

Nevnoma of auditory nerve: reasons, signs, therapy, removal operation

The neuromance of the auditory nerve is an oncological disease manifested by the hearing loss and symptoms of vestibular dysfunction. The neoplasm does not threaten the life of the patient, but significantly reduces the speed of perception of sound information. This tumor develops from the cells of the myelin shell of the eighth pair of cranopy brain nerves.

The auditory nerve consists of a snail and vestibular branch. The first is responsible for the transfer of sound information from the inner ear in the brain, the second is for changing the position of the body and equilibrium. Neolation is capturing one of them or immediately both, which is manifested by the corresponding symptomatics. Primary intracranial neoplasmism was discovered by scientists at the end of the 18th century.

Nevnoma is a dense knot with an uneven, a buggy surface, surrounded connective tissue. Inside it is vessels, wen, cysts with liquid, fibrosis fields. Gray tumor fabric with yellow and brown-brown areas. These are fat inclusions and traces of old hematomas. The blue tint of the neoplasm is due to the venous stagnation. Microscopically, the neurinoma consists of spindle-shaped polymorphic cells, which form "polisada" structures with sections of the accumulation of hemosiderin, surrounded by fibrous fibers. The tumor on the periphery contains a powerful vascular network. Its central areas are bloodshed from single vessels or vascular clubs.

The neoplasm does not infiltrate the surrounding tissues and is rarely soligified. The tumor can grow, but usually remains unchanged for a long time. In this case, the danger to the life of the patient does not represent. In the growth of tumor tissue and increasing the neoplasm in size, there is a compression of surrounding structures, paresis of facial and discharge nerves develops, which is clinically manifested by dysphonia, dysphagia, dysarthria. During the defeat of the brain, the dysfunction of respiratory and cardiovascular systems is developing.

The neuromance of the auditory nerve is usually developing in persons of the puberty period, but it is often found in adults in an eating. In women, pathology meets 2-3 times more often than in men. The one-sided nevinoma of the auditory nerve is a sporadic disease that is not inherited and is not associated with other tumor diseases of the nervous system. Bilateral neurinoma is a sign of neurofibromatosis, having a family predisposition and arising against the background of intracranial and spinal tumors. Head tumors are always frightened by patients, it is difficult to succumb to therapy and manifest themselves with severe clinical signs. Timely appeal to medical help Makes pathology forecast relatively favorable.

Etiology

The reason for the one-sided neurine of auditory nerve is currently unknown. A two-sided tumor is a manifestation of neurofibromatosis - a hereditary disease. As a result of the mutation of some genes, the biosynthesis of protein, which limits the growth of the tumor and leads to excessive growth of Schwann cells. At the same time B. different areas The organism of the patient appears neurofibromes. Pathology is inherited by an autosomal dominant principle. In patients with genetic predisposition to 30 years, neurinoma, meningioma, fibromes and spins or skull glyoma appear. Most of them cease to hear over time.

blooming nerve tumor

Factors contributing to this mutation, causing uncontrolled cell division and provoking the development of the nevinoma of the sentence-snelled nerve:

Symptomatics

Nevnoma of auditory nerve not big size Clinically does not manifest. Symptoms of the disease develop when squeezed by a tumor of surrounding tissues. Early signs of pathology are: the mortgage of the ear, the feeling of pressure in the field of the inner ear, unusual sound sensations: a peak, noise or ringing in the ears, as well as dizziness, gaitty, nastagm.

Stages of the development of the neuromy of auditory nerve:

1. The tumor whose size does not exceed 2.5 cm, manifests poorly pronounced clinical signs. Patients are experiencing difficulties when moving, suffer from dizziness and dummy in the car.
2. The size of the tumor is 3-3.5 cm. Patients appear multiple nystagm (oscillatory movements of the high frequency eye), the discoordination of movements, whistles in the ears, a sharp decline in hearing, distortion of facials.
3. The tumor is more than 4 cm. Clinical signs of pathology are: rough nystagm, hydrocephalus, mental and visual disorders, sudden falls, gait, squint.

Reducing the hearing is due to the squeezing of the ulvek part of the nerve. The rumor can decrease gradually or disappear suddenly. Headowness develops so slowly that the patients do not notice this symptom for a long time. Other times, other functions of the auditory nerve fall out. Patients develop not only deafness, but also vestibular disorders.

Dizziness, nystagm and satenness gait also develop gradually. In severe cases, vestibular crises appear with nausea, vomiting, the inability to be in a vertical position.

For damage to the facial nerve, it is characterized by numbness of the part of the person, the unpleasant feeling of tingling. Paresthesia and pain in the appropriate half of the face occur during the branches of the trigeminal nerve. Dull and constant pain is easy to confuse with dental pain. It's a dull pain Periodically enhances and subsides. Low-forming large size leads to the appearance of a constant trigeminal pain, irradiating in the head.

In patients weakened or disappears a corneal reflex, the chewing muscles are atrophy, taste disappears, salivation is disturbed. The defeat of the discharge nerve is manifested by the transient or permanent diplopia.

In the squeezing of a large neurometry respiratory and vascular centers, life-threatening complications are developing: hyperreflexia, an increase in intracranial pressure, hemianopsy, cattle.

Diagnostics

In suspected oncological pathology, a comprehensive and comprehensive examination of patients is carried out, including traditional techniques and specialized studies. The diagnosis of the neurinoma of the auditory nerve begins with listening to the patient's complaints, the collection of the history of life and illness, as well as physical inspection. During the neurological examination, the neuropathologist defines the functional abilities of the nervous system and the state of reflexes.

Additional research methods: audiometry, electronistagmography, radiography of temporal bones. These methods are used in the initial stages of the disease.

nevnoma of auditory nerve in the picture

Determine the localization of the tumor, its size, features allow more sensitive diagnostic techniques:

• CT and MRI using a contrast agent allows you to identify small neoplasms in the early stages of the disease.
• Ultrasound discovers pathological changes in soft tissues in a tumor growth zone.
• Biopsy - removal of a part of the tumor in order to conduct a histological study of the neoplasm.

Treatment

Treatment of the neuromy of the auditory nerve is carried out different ways: drug, operational, radiotherapeutic or radiosurgical.

Conservative treatment

The expectant tactic is shown if the tumor is small and clinically does not manifest. This is especially true for sick elderly and persons who are impossible to conduct an operation for health. If the neoplasm has been revealed by chance during a medical examination, medical tactics lies in the patient's observation.

Medical therapy - Purpose of patients with drugs:

1. Diuretic - "Furosemid", "Veroshpiron", "Hypothiazid",
2. Anti-inflammatory - "Ibuprofen", "Indomethacin", "Ortofen",
3. Anesthetic - "Ketorol", "Naz", "Nimesil",
4. Cytostatics - "Methotrexat", "Formuracyl".

There are recipes folk Medicinethat contribute to stopping the growth of the tumor. The most common among them are: white mistletoe, horse chestnut, Morder's seeds, a prince of Siberian, Eucalyptus, a sabelnik of a marsh, nine, juniper, lime color, donner of a medicinal, hawthorn.

Thrust growth of the neurinoma is an absolute indication for its surgical removal.

Radiation therapy

Radiation therapy consists in long-term scalp, which is particularly effective in the presence of a tumor of a small size. A gamma-knife is used to treat the disease, with which the gamma rays are applied directly to the tumor due to the system of stereoscopic X-ray navigation. The procedure is carried out under local anesthesia in outpatient conditions. The patient is placed on the couch after fixing the stereotactic frame. During exposure to the sick talk and watch him. The tumor gets the maximum dose of radiation. This process is completely painless, rapid, safe and fairly effective compared to other therapeutic techniques. The procedure gives excellent long-term clinical results.

In addition to the gamma knife for the treatment of Swannomes, cyber-knife and linear accelerators are also used.

Surgery

Surgical treatment is to remove the neurine of the auditory nerve. A week before the operation, patients are recommended to refuse to receive anticoagulants and NSAIDs. For two days, they are prescribed glucocorticosteroids and antibiotics. The choice of operation is determined by the size and localization of the tumor. The surgeon removes small neuromes with a single node along with a capsule. Larger neoplasms are brought out of the capsule, which is completely excised.

extraction of the neuromy of a hearing nerve

Contraindications for surgical removal of acoustic shwannoma: elderly age, the presence of concomitant pathology internal organsunsatisfactory general state patient.

The hospital rehabilitation lasts an average of 5-7 days. The patient at this time is in the department. In the early postoperative period, patients need to take preparations that restore the functions of the body and warning tumor recurrence. Full rehabilitation takes 6-12 months.

In rare cases, the recurrence of Svanoma is possible. At the same time, the tumor grows in the same place. The reason for recurrence is not a complete removal of the neuromy for the first time. Microscopic remains of tumor cells lead to the development of a new pathological process.

Nevnoma of auditory nerve - pathology, leading to the development of dysfunction of vital important organs. To avoid the development of severe complications, it is necessary to identify and treat the disease in a timely manner.

Nevnoma of auditory nerve

The neuromance of the auditory nerve is a benign neoplasm VIII cranial nerve, consisting of cells of the Schwann shell. Clinically manifests itself with a decrease in hearing, noise and ringing in ear, vestibular disorders on the side of the defeat, the symptoms of the compression of the facial, trigeminal, discharge nerves, brain stem and cerebellum, signs of intracranial hypertension and hydrocephalus. The neuro of the auditory nerve is diagnosed due to the radiography of the temporal bones, MRI or CT of the brain. Depending on the size of education, it is possible its surgical and radiosurgical removal, radiotherapy. In some cases, it is advisable to monitor the tumor in dynamics and the solution of the issue of treatment tactics only when identifying the progressive growth of education.

Nevnoma of auditory nerve

VIII Couple of the CHMN - predver-ulitsky, or auditory, nerve consists of vestibular and auditory parts. The first carries in cerebral centers information from the vestibular snail receptors, the second - from the auditory. In the overwhelming majority of cases, the neurinoma is developing in the vestibular part of the sentence-snelled nerve, and the symptoms of the destruction of the auditory department are associated with its squeezing tumor. Near the predver-snital nerve pass: the trunk of the facial nerve, a triple nerve, a discrepancing, languagehill and wandering nerves. As the neurinoma grows in the clinical picture, symptoms of the compression of these nerves can arise, as well as the adjacent structures of the brain stem.

Nevinoma of auditory nerve originates from Schwann cells surrounding axons of nerve fibers. In this regard, in practical neurology, it is also known as the vestibular (acoustic) shwannoma. The frequency of the tumor occurrence is approximately 1 sick per 100 thousand people. In this case, the neurinoma of the auditory nerve is 12-13% of all cerebral tumors and approximately 1/3 of the tumors of the rear cranial fossa. It develops mostly in an eating. Not a single case of the disease in children of the apprentice period is not marked.

Etiopathogenesis

The ethiology of the neuro auditory nerve remains uncertain. Unilateral neuromans are sporadic in nature, their direct connection with any etientofactors is not traced. Bilateral neurinomans are observed in many patients with neurofibromatosis of type II - genetically due to the disease, for which the benign tumor processes of various tissue structures of the nervous system (neurofibromes, glyomes, meningioma, neurine) are typical. Neurofibromatosis is inherited by an autosomal dominant path, the risk of a disaster disease in the presence of a pathological gene in both parents is 50%.

Pathogenetically allocate 3 stages of the development of vestibular swannoma. In the first small size of the formation (up to 2.5 cm), hearing impaired (hearing loss) and vestibular disorders. The second neoplasm grows to the size of walnut, putting pressure on the brain barrel, which leads to the emergence of nystagma, the discount of movements and equilibrium disorder. In the third stage, when the neurinoma reaches the size of the chicken egg, it causes a sharp compression of cerebral structures, hydrocephalus, violations of vision and swallowing. At this stage, irreversible changes occur in brain tissues, the tumor is intoperable and is the cause of death.

Morphology

Macroscopically neoplasm is a rounded or irregular shape of a dense knot with a buggy surface. Outside it has a connective tissue capsule, local or diffuse cystic cavities filled with brownish liquid can occur inside. The color of formation on the cut depends on its blood supply: usually pale pink with rusty areas, with a venous embossed - the shiny, with the hemorrhages in the tissue of the neurine - a brown-brown fabric.

Microscopically, the neuromance of the auditory nerve consists of cells whose kernels resemble wands. These cells form structures by the type of panels, between which areas consisting of fibers are observed. As the tumor grows, it observes the processes of fibrosis, the formation of hemosidery deposits.

Symptoms

The slow growth of the vestibular scum causes the presence of a certain asymptomatic period and the gradual development of the clinic. In 95% of the victims of the first sign is gradually progressive hearing deterioration. In some cases, the reduction of hearing occurs sharply and suddenly. In 60% of patients, the first complaint is the appearance of noise or stall in the ears. With its absence and the unilateral nature of the lesion of the auditory nerve, the patients often do not notice the incorrect hearing deterioration. Vestibular disorders are marked in 2/3 cases. They are characterized by a feeling of instability or dizziness at the corners of the body and the head, the emergence of nystagma. Sometimes there are vestibular crises, in which nausea arises against the background of dizziness and there may be vomiting. The neuromance of the auditory nerve in the initial stage can be mistakenly adopted for the cochlear neuritis, the disease of the Meniere, Otosclerosis, Maze.

Powerful growth of the tumor over time leads to a complete deafness on the side of the defeat, the attachment of the symptoms of the defeat of nearby structures. However, it should be remembered that the severity of symptoms does not always correlate with the sizes of the tumor. Depending on the localization of the neurine and the direction of its growth, with small sizes, it can give a heavier picture than a major neoplasm, and vice versa.

First of all, the neurinoma of the auditory nerve causes a trigeminal nerve, which is accompanied by facial pains and paresthesia on the side of the tumor. Pain pains have a stupid, suitable character; First, the type of paroxysms occur, and then become permanent. Sometimes they are taken for toothpick or neuralgy of a trigeminal nerve. A little later or simultaneously with face pain, symptoms of peripheral lesion of the facial nerve (parishes of mimic muscles and the associated facial asymmetry, a disruption of sowing, loss of taste on the front 2/3 of the language) and a discharge nerve (diplopia, converging squint). If the neuromance of the auditory nerve is located in the inner hearing aisle, the symptoms of the facial nerve compression can be manifest in the early period of the disease. In such cases, it is necessary to exclude the neurut of facial nerve.

A further increase in the neurinoma leads to the damage to the wandering and language nerves with a violation of the lantern, dysfagia, loss of taste on the back of 1/3 of the language and the extinction of the pharyngeal reflex. When squeezing, the cerebellum appears a cerebelchik ataxia. Even in the launched cases, when squeezing the brain barrel, sensory and motor conductor disorders are expressed extremely weakly; Pares are noted in exceptional cases.

In the third stage of the neuromance of the auditory nerve is characterized by signs of intracranial hypertension. There is a headache in the head and a frontal area, accompanied by vomiting. Ophthalmoscopy notes stagnant discs spectator nerves. Perimetry can identify individual cattle or hemianopia, which is associated with the compression of the chiasma and optical paths.

Diagnostics

Radiography and methods of neurovalization helps more accurately determine the diagnosis of "non-hearing nerve". In the early stages at small sizes of the neurinoma (up to 1 cm), it is usually not visualized by the CT of the brain. Therefore, the skull radiography is carried out with a visible image of the temporal bone. In confirmation of the diagnosis of the vestibular Schwanne, the expansion of the internal auditory pass is evidenced. Since the neurine is well absorbed by the contrast, it is possible to use CT with contrast. At the same time, education with clear sleeve contours is visualized.

MRI of the brain in the case of the neurinoma reveals on T1-suspended images hypox or isopenistic, and on T2-weighted - hyper-trienses. For tumors of 3, and more cm is characterized by the heterogeneity of the signal associated with the presence of cystic sites in them. It is possible to visualize the deformation of the brain and cerebellum. When performing a contrasting mp tomography, a heterogeneous accumulation of contrast is observed in 70%.

Treatment

The radical treatment method is the removal of a neuromet, which can be carried out by an open surgical method or radiosurgery methods. Surgical removal It is advisable for a high tumor, when it is revealed to increase its size in the dynamics of observations, with the growth of the neurine after radiosurgical intervention. Often the consequence of the operation are deafness and paresis of facial nerve. Stereotactic radiosurgical removal is possible for a neuro size of less than 3 cm. It is also carried out in older patients with extended growth after subtotal resection and in cases where the risk of operation is significantly increased due to somatic pathology.

The radiation therapy of the neurinoma has indications similar to the testimony to radiosurgery. Exposure is not a way to remove education, but prevents its further growth and avoids the operation.

Patients with a randomly detected CT or MRI with a non-neural without clinical symptoms, patients with long-term hearing disorders and elderly patients with weak symptomatics showed expectant tactics with constant control of the size of education and the dynamics of clinical symptoms.

Forecast

The outcome of the neurine largely depends on the timeliness of the diagnosis and size of the tumor. The forecast is favorable with adequate treatment of vestibular shwannoma in the I and II stages. In the radiosurgical removal in the early stages of 95%, the cessation of growth and full recovery Patient's ability to work. For surgical intervention High risk of hearing loss and damage to facial nerve. In the third stage of the neuromy, the prognosis is unfavorable: the patient can perish in the surrender of vital cerebral structures increasing the tumor.

Nevnoma of auditory nerve - treatment in Moscow

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Nevnoma VIII Nerva

refers to benign neurogenic browning angle tumors with unfavorable clinical flow. It comes from the cells of the Schwannovskaya shell of the vestibular portion of the VIII nerve from the bottom of the inner auditory passage to the entrance to the oblongable brain.

Distinguish three stages of the disease.

The first stage of development - othiatric (tumor up to 1.5 cm) is characterized by cochleo-vestibular symptoms: a constant noise in the ear, sensuously hearing loss, tonal-speech dissociation (speech intelligibility in the relative safety of tone hearing is disturbed), occasionally pain in ear or headache, Light violations of static equilibrium, some uncertainty of gait, dizziness.

Chain-chain experiments Rinna and Federichi positive. The tonal audiogram has a horizontal, and then downward character, mainly in the high frequency area, with the lack of a bone-air interval. There is an increase in the level of auditory discomfort, the absence of lateralization of the sounds of the audible range in Weber's experience in the presence of lateralization of ultrasounds into a healthy ear. Fung is not detected, the inverse adaptation time increases to 15 minutes, the threshold is shifted by dodb (normally 0-15 dB). Under impedancemetry, the decay of acoustic reflex stirrues is noted. Normally, within 10, the amplitude of the reflex remains constant, or reduced to 50%. The semi-repity of the reflex for 1.5 s is considered pathognomonic for the neurine VIII nerve. Reflex strokes (IPSI - and contralateral) may not be called when stimulated by the affected side. Ocacoustic emission (UAE) is not registered on the side of the lesion. In the audiometry on auditory caused potentials, the interconnect interval I and V KSVP is elongated. With large tumors, the KSWP is not called.

Patients poorly disassemble words during a telephone conversation, there is a strong tensile hearing. In 75% of patients there is a chronic disruption of static equilibrium with instability when walking, horizontal spontaneous Nistagm in a healthy side. In caloric and rotational samples, severe asymmetry of Nistagma is often observed.

On radiographs of temporal bones, the expansion of the internal auditory pass may be occurred. On the components and magnetic resonance tomograms, the yiii nerve tumor is determined. Magnetic-resonance tomography, especially in combination with the introduction of neurinoma, has a greater resonant tomography contrast substances, enhancing image information (Fig. 1.13.1).

The second stage - the otonegological (tumor of 1.5 to 4 cm) is characterized by a headache, an increase in the hearing loss, static disorders, one-sided cerebellar symptoms, the absence of caloric nystagma on the side of the lesion, disruption of the trigeminal nerve function (paresthesia, decrease or absence of corneal reflex), pararese A discharge nerve (condensed squint and diplopia).

The third stage is a neurosurgical (tumor from 4 to 6 cm or more) is manifested by a sharp hearing loss, right up to deafness, lifting the vestibular function. The symptoms of the lesion of the cerebellum, the pyramid system and the pronounced intracranial hypertension (stagnant nipples of optic nerves, strong headache, nausea, vomiting, etc.) are joined. Along with the lesion of the facial, intermediate and discharge nerves, there is more often a violation of the function of a trigeminal and discharge nerve in the bridge corner. In the future, bulbar disorders are developing, the defeat of many cranial nerves, including impairment of vision, including blindness, paralysis of the gaze, disinterested in swallowing, lamp, decrease in sense of smell. Developed pronounced hydrocephalus. The stake-refinery function is broken along the central type with dissociation and disharmonylation of reactions.

For othiatras, it is of particular interest the first two stages of the neuro, when with timely diagnosis and surgical treatment You can prevent further tumor propagation. In the primary diagnosis of unilateral sensorsheral hearing loss, it is necessary to eliminate the neuro with the most modern diagnostic methods.

Differentiate the neuro with the Menietor's disease, the arachnoiditis of the bridge triangle and the hearing loss of various genesis with a whole drumpipe.

Surgical treatment. The most favorable outcomes in the I and II stages of the tumor. Neurosurgery approaches to the neurinoma are carried out through the rear and middle skulls, and othiatric access is transpaired through a mastoid process, temporal bone to the inner auditory passage. Othiatric method is more gentle (Gorokhov A.A., 1989).

Patients with benign and malignant ear tumors are immediately sent to the hospital. After treatment, they are under the dynamic observation of the doctor's doctor. The control inspection by their otolaryngologist is carried out at least once every 6 months. In the testimony, the servicemen are examined under articles 8.9.10 of the Order of the Russian Federation NG.

Nevnoma VIII Nerva

encyclopedic Dictionary According to psychology and pedagogy. 2013.

Watch what is "Nevnoma VIII Nerva" in other dictionaries:

Nevnoma - honey. Nevnoma is a benign tumor emanating from Schwan cells of cranial, spinal and peripheral nerves. Localization in the skull cavity is revealed by the nursery of the VIII cranial nerve, less often the most frequent ... Handbook of Diseases

Hearing syndrome (VIII cranial) nerve - syn.: Syndrome of the Sniply Nerva. Kochleo syndrome vestibular nerve. The nerve consists of the auditory (ulitskaya, cochlearic) and vestibular (predominal) portions. His defeat can manifest themselves with signs of cochlear (see) or vestibular ... Encyclopedic Dictionary of Psychology and Pedagogy

Tumors subtorial - tumors of the rear cranial fossa. Intracranted neoplasms that are growing in the cavity of the skull under the brain nut. In children, they make up 70% of brain tumors. It is more often a medulloblastoma (see) or astrocytoma (see) cerebellum, ependimoblastoma (see ... Encyclopedic Dictionary of Psychology and Pedagogy

Headowness is noto-sensory - honey. Neurosensory hearing loss (NT) weakness of hearing with the preserved perception of speech due to the defeat of the sound visible apparatus or central Department hearing analyzer. Cochlear neuriti diseases of the auditory analyzer, ... ... Disease Handbook

Vestibular shwannoma - or nevinoma of auditory nerve or acoustic neurinoma or acoustic shwannoma. Benignant tumor. Private case of neuromy (Svannoma). Histologically is the result of benign breeding of Schvanna cells growing from ... ... Wikipedia

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Nevnoma (Svannoma). Causes, symptoms and signs, diagnosis, treatment

The site provides reference information. Adequate diagnosis and treatment of the disease are possible under the supervision of a conscientious doctor.

Visually Swannoma is a rounded, dense education that is surrounded by a capsule. It grows very slowly, from 1 to 2 mm per year. However, in some cases (malignant Swannoma), it begins to grow intensively, squeezing the surrounding tissues. Such tumors can reach huge sizes - from one and a half to two and a half kilograms.

Representatives of the Medical Faculty of Harvard and the Research Center from Massachusetts were carried out to study the influence of aspirin on acoustic nevin. 689 patients with a diagnosis of vestibular (acoustic) Swannoma were studied and analyzed. Half of the experiment participants regularly passed magnetic resonance scanning (MRI). Upon completion of the work, the facts proving positive therapeutic effect acetylsalicylic acid On the neuro. In patients who took aspirin, the dynamics of tumor growth fell twice. The study organizers note that the floor and age of the experiment participants are not related to the results of the work performed.

Anatomy of nerves

narrowing and expansion of the pupil;

raising upper century

pain, tactile and deep face sensitivity

the work of the tear and salivary glands (tears, salivation)

the work of the parish gland;

total sensitivity of the oral cavity and ear

the overall sensitivity of the oral cavity and ear;

work cardiac muscle;

maintaining the tone of muscles of bronchi;

work glands and intestines

shoulder movement, blades and clavicle

• 8 pairs of cervical nerves;
• 12 pairs of breast nerves;
• 5 pairs of lumbar nerves;
• 5 pairs of sacral nerves;
• one pair of cleaned nerves.

In the thoracic nerves, innervating intercostal muscles, ribs, chest and belly skin. In the rest of the departments, the nerves are intertwined and form a plexus.

neck and diaphragm muscles

muscles of belly and hips

Classification and functions of nerve fibers

• processing and transformation of information obtained (from the organ and external environment) to the nervous impulse;
• pulse transfer to the highest structures of the nervous system (head and spinal marrow).

Non-proteined nerve fibers are responsible for carrying out information obtained from skin receptors (tactile, pressure and temperature receptors).

Myelinated nerve fibers are responsible for collecting and carrying out information from all muscles, organs and organism systems.

• the law of bilateral conduct;
• the law of isolated holding;
• the law of integrity.

According to the law of the bilateral conduct, the impulse passes through the nerve fiber in both directions from the place of its appearance (from the brain to the periphery and back).

According to the case of an isolated conduct, the pulse propagates strictly according to an isolated nerve fiber, without moving to the next lying fiber.

The law of integrity is that the nervous fiber conducts the impulse only if its anatomical and physiological integrity is preserved. If the fiber is damaged, or negative external factors affect it, then its integrity is broken. The transfer of the pulse is interrupted, and the information does not reach the destination. Any damage to the nerve leads to a violation of the organ or tissue, which it innervates.

Causes of the neuromy

The causes of mutation in chromosome 22 are not found out, however there are some risk factors, the presence of which can contribute to the development of this mutation.

• the impact of large doses of radiation at an early age;
• prolonged impact of various chemicals;
• the presence of neurofibromatosis of the second type in the most patient or his parents;
• hereditary predisposition to tumors;
• the presence of other benign tumors.

It should be noted that a genetic predisposition is an important factor in the development of the neurine. This proves the fact that the neurinoma appears in persons with neurofibromatosis of the second type - a hereditary disease that predisposes to the development of neurofibrom in various parts of the body. Neurofibromatosis, as well as neurinoma, is developing due to mutation in chromosome 22. If at least one of the parents has this disease, then the chance is that the child will inherit it, more than 50 percent.

Symptoms and signs of neuromy of various localization

Nevnoma of auditory nerve

In 9 out of 10 cases, the auditory nerve is amazed on the one hand, and then symptoms develop on one side. In those rare cases when bilateral nevinoma, symptoms are developing on both sides.

• tinnitus;
• reduction of hearing;
• dizziness and violation of coordination of movements.

Tinnitus

The ringing in the ears is the first symptom when defeating the auditory nerve. It is observed in 7 out of 10 people who were diagnosed with a neuromance of auditory nerve. It is manifested even when the tumor is very small. With one-sided neurine, the ringing is observed in one ear, with a bilateral neurinoma - in both ears.

Reducing the hearing is also one of the first symptoms of the neuro hearing nerve, which is observed in 95 percent of cases. Headowness develops gradually, starting with high tones. Most often, initially patients make complaints about the difficulties of recognizing voice by phone.

Coordination disorder movements is developing in 60 percent. This symptom manifests itself at the later stages when the neurinoma reached the size of more than 4 - 5 centimeters. It is a consequence of the defeat of the vestibular part of the nerve.

These symptoms are observed in 15 percent cases of neuromy. The defeat of the trigeminal nerve indicates that the tumor reached more than 2 centimeters. At the same time, impairment of the sensitivity of the face and pain on the side of the defeat are noted. Pains wear stupid, constant character and most often they are confused with toothache.

At the later stages of lesions of the trigeminal nerve, weakness and atrophy of chewing muscles are noted.

These symptoms are observed when the sizes of the tumor exceed 4 centimeters. With the damage to the facial nerve, there is a loss of taste, a disorder of salivation, a disturbance of the sensitivity of the face. When squeezing the discharge nerve, the squint is developing, bias in the eyes.

Based on the clinical picture, it is possible to relate to suggest which sizes reached a neuromy. It is believed that tumors up to 2 centimeters are manifested by the dysfunctions of the trigeminal, facial and most sentence-snelled nerve. In the clinic, this stage is called the initial (first stage).

Nevnoma of a trigeminal nerve

• personal sensitivity disorders - crawling of goosebumps, numbness, feeling of cooling;
• pares of chewing muscles - weakness;
• pain syndrome - stupid pain in his face on the side of the defeat;
• violation of taste sensations;
• taste and olfactory hallucinations.

So, in the initial stages there is a disturbance of sensitivity in the appropriate half of the person. Then the weakness of chewing muscles joins.

Nevnoma of the spine

For the neuromy of the spine, the presence of several syndrome.

• root pain syndrome;
• vegetative violation syndrome;
• spinal brain shock damage syndrome.

The symptoms of this syndrome depends on which root was damaged. The front roots are responsible for movement, so when they are damaged, paralysis muscles of the corresponding muscles are developing nerve fiber. With damage to the rear sensitive root, sensitivity disorders develop, pain syndrome.

• numbness;
• feelings of crawling goosebumps;
• feeling cold or heat.

These symptoms are localized in that part of the body, which is innervated by the appropriate spinal plexus. So, if the neurine is localized in the cervical or thoracic spinal cord (the most frequent localization of Svannya), then they appear in the field of the nape, neck, shoulder or elbow. If it is located in lumbar Department, then the sensitivity violation is manifested in the lower abdomen or in the leg.

This syndrome is manifested by violations of functions. pelvic organs, disorders in digestive system and cardiovascular activity. The predominance of one or another disorder depends on the localization of the neuromy.

In the neurinoma of the cervical, disorders of the respiratory function are developing, sometimes swallowing and the development of elevated arterial pressure. The neurine of the thoracic will provoke a violation of cardiac activity, pain in the area of \u200b\u200bthe stomach or pancreas. The violation of cardiac activity is manifested in the slowdown in heart abbreviations (bradycardia) and violation of the conductivity of the heart.

This syndrome is also called Brown-Secary Syndrome. It includes spastic paralysis on the sidelines of the neurinoma, as well as a breaking of deep sensitivity (muscular-articular feeling). Also on the side of the defeat, vegetative and trophic violations are developing.

• parez or paralysis of the muscles on the side of the lesion;
• loss of pain and temperature sensitivity on the opposite side;
• reducing the feeling of pain when pressing on muscles and joints (muscular and articular feeling);
• vasomotor disorders on the side of the defeat.

Initially develops sluggish paralysis, which is characterized by a decrease in tone and power in muscles and loss of reflexes. However, spastic paralysis develops subsequently. They are characterized by an elevated tone and muscle tension (spasm).

Nevnoma of peripheral nerves

Diagnosis of neuromy

Neurological examination

• nistagm;
• malfunction and gait;
• symptoms of damage to the hearing aid;
• impairment of skin sensitivity;
• shots in the eyes;
• reduction or absence of corneal, swallowing reflex;
• symptoms of a paresis of a facial nerve.

Nistagm

Incoming oscillatory movements of the eyes (either of one eye) are called Nistagm. This phenomenon is revealed at the moment when the doctor asks to fix the look behind the movement of the hammer or its index finger.

Violated equilibrium is detected during the sample of Romberg. The doctor asks the patient to close his eyes and pull out his hands, the legs are shifted. The patient in this case is inclined in one direction. The inability to maintain balance in this pose speaks of the defeat of that part of the eighth pair of nerves, which is responsible for the equilibrium. Also, the violation of the gait and coordination of movements is revealed.

To identify these symptoms, the doctor uses akton (tool for sound playback). Tambleton is driven to oscillation by compressing its legs. Further, the neurologist takes it to the patient's ear - first to one, then to another. In this case, the audience is assessed by one and other ear. Then the doctor, leading to the oscillation of the Tamington, puts his leg on the skull bone behind the ear (on the mastoid process of temporal bone). The patient says to the doctor when he ceases to hear the vibration of Tamarton first in one ear, then another. Thus, the bone conductivity of the ear (trial of rinn) is investigated. After the study of the bone conductivity proceeds to the study of air conduction. In this case, the vibrating feet of the tape is applied to the theme, the patient's head. Normally, a person perceives the sound in both ears. In the never, the sound shifts towards a healthy ear.

To identify such violations, the doctor with a special needle touches the skin of the patient. At the same time, symmetric sections of the face are investigated. The patient evaluates the severity of sensations. In the neuromet of a trigeminal nerve, as well as with a large neuro hearing nerve, sensitivity is reduced on the side of the defeat. With bilateral neuromes, sensitivity falls on both sections of the face.

Film in the eyes or diplopia occurs in the case of the neuromerance of the discharge nerve, which is extremely rare. More often, a similar phenomenon can be observed at large sizes of the neuromet of the auditory nerve, which squeezes the leakage nerve with its volume.

The absence or weakening of the corneal reflex is an early sign of the neurine of a trigeminal nerve. This reflex is detected when a wet cotton swab to the cornea is easily touched. Healthy person Reacts to this manipulation of blinking. However, with a newar of a trigeminal nerve, this reflex is weakening.

This symptomatic appears when the neurinoma is located in the inner hearing aisle. It includes a disorder of salivation and taste, as well as asymmetry of the face. This asymmetry is most pronounced with emotions. When frowning the forehead on the side of the defeat, the skin is not going to the fold. When you try to close the eyes of the eyelids on the same side are not fully closed. Part of the face at the same time amimic - nasolabial fold is smoothed, the corner of the mouth is omitted.

• muscle weakness;
• stiffness of movements;
• sensitivity disorders;
• increase tendon reflexes.

Muscular weakness

Muscular weakness in the limbs is an important indicator of the damage to the spinal nerves. Checking the power in his hands, the doctor asks the patient equally squeezing his two fingers. So he appreciates whether the power is the same in both hands. Further, it estimates the power in the lower limbs - asks to raise one at first, then another leg. The patient sitting on the couch with the legs bent in his knees, trying to raise his leg. But at the same time, the doctor has resistance to him. Muscular power is estimated in points from 0 to 5, where 5 is a normal force, and 0 is a complete lack of movement in the limb.

Stiffness in movements or rigidity is manifested by increased muscle tone and sustainable resistance. The doctor asks the patient to relax his hand and not to give him resistance, and himself checks her movement in the shoulder, elbow and cranky joint. When trying to "break" the doctor's hand meets resistance.

Evaluating sensitivity, the doctor checks not only tactile, but also painful and cold sensitivity. Cold sensitivity is checked with warm and cold tubes, painful - with the power of a special apparatus (algezimetra). Thus, when the spine is a loss of tactile sensitivity on the side of the localization of Svanoma and, at the same time, the weakening of cold and pain sensitivity on the opposite side is noted.

The increase in tendon reflexes (knee, achille) on the lower limbs indicates the defeat of the spinal cord in the transverse level, which is observed with bulk nevurines. The knee reflex is provoked by the blow hammer on the tendon of the four-headed muscle, which is just below the knee cup. When you hit the hammer, the patient's shin is extension, which at this time sits, bent his legs in the knees. Achilles Reflex is checked by a blow hammer over achille teon, resulting in an extension of an ankle joint.

Audiogram

CT and NMR

With the neurinoma of the spinal cord, a tumor-like rounded formation is also visualized. With germination of the neurine through the intervertebral hole, it takes the shape of an hourglass. This form is very well visualized on a computed tomogram.

Treatment of neuromy surgically

When do you need an operation?

• tumor growth after radiosurgery;
• increase in the size of the tumor;
• the emergence of new or increasing existing symptoms.

With the newar of the auditory nerve, operational treatment allows you to preserve the facial nerve and avoid the paralysis of the face, to prevent the hearing loss. In the neurine of the spine, the operation is carried out in case the tumor does not sprout into the brain shell, and there is a possibility of removing the neuromy completely together with the capsule. In the inverse cases, partial resection of the neoplasm is performed.

• patient age older than 65 years;
• severe patient's condition;
• cardiovascular and other pathologies.

How is the operation?

• a tumor of small sizes in the absence of a hearing impairment;
• age of the patient, up to 60 years;
• tumor of large sizes (more than 3.5 - 6 cm).

Preparation for the operation

48 hours before the operation, steroid preparations are prescribed to the patient, and immediately before carrying out an operation - antibiotics.

In some cases, a week before surgery, the reception of aspirin and other anti-inflammatory drugs, as well as clopidogrel, warfarin and other dignity of drugs, are stopped.

• translactic access;
• retrogram-shaped (podental) access;
• cross-temporal access (through the middle skull).

Translabinet method

This operational intervention is advisable in cases where there is a significant loss of hearing or with a tumor to three centimeters, the removal of which is impossible to otherwise. For direct access to the auditory passage and tumors in the skull behind the ear, a hole is made. At the same time, the maternity process (part of the temporal bone in the form of cone) and the bone in inner ear Delete. With this approach, the surgeon sees the facial nerve and the entire tumor, which allows you to prevent a lot of complications. The consequence of the removal of the neurinoma by the translabinritative method is the constant loss of the hearing function of the ear on which the operation was carried out.

A propellant method makes it possible to operate tumors, the size of which exceeds three centimeters. Opening the skull is performed behind the ear. This species Operational intervention is used to remove both minor and large neuro and allows you to maintain a patient's hearing.

Cross-temporal access is used to operate in the neuro, the size of which does not exceed one centimeter. A nozzle is made on the skull over own sink. The trepanation of the temporal bone is performed, and the removal of the neurine occurs through an internal hearing pass. This method is applied in cases where there are high chances of complete preservation of the hearing function in the patient.

Rehabilitation after surgery

• elevated eye dryness;
• coordination problems;
• tinnitus;
• numbness of the face;
• headache;
• infection;
• bleeding.

After the operation, the patient must spend one night under the supervision of a doctor in the intensive care unit. The total period of stay in the hospital after surgery is from four to seven days.

The postoperative period in the neurinoma includes the early, recovery and rehabilitation stages. In the early period, the course of treatment is appointed, the purpose of which is to restore and maintain the vital functions of the body, to prevent the development of infection. The following stages imply a regular survey to prevent recurrence (re-exacerbation of pathology). Rehabilitation measures are also prescribed to restore the hearing function and the mobility of the facial muscles. After discharge from the hospital, a number of rules should be followed that will help speed up restoration and prevent complications.

• systematically change the bandage;
• the area of \u200b\u200bthe section contains clean and dry;
• refrain within two weeks from head washing;
• eliminate the use of cosmetics for hair for a month;
• refrain three months from flights by plane.

Over the next few years, MRI needs to do, which will allow you to see the tumor in a timely manner if it starts to grow. With the emergence of new or resumption of old complaints, you need to consult a doctor.

• signs of infection (fever, chills);
• bleeding and other separation from the location of the cut;
• redness, swelling, pain in the place of cut;
• tension of the occipital muscles;
• nausea, vomiting.

Diet

Power After a neural removal operation should contribute to the normalization of metabolism and healing of the operating wound. To do this, it is necessary to include in the diet products enriched with vitamin C (Bulgarian pepper, rosehip, kiwi). Increase the resistance of the body to infections and thereby prevent the development of complications will help unsaturated fatty acids, which are contained in walnuts and red fish.

• peanuts, dairy products, legumes and grains - contain valine;
• beef liver, almond, cashew, chicken meat - contain isoleucine;
• brown rice, nuts, chicken meat, oats, lentils - contain leucine;
• dairy products, eggs, legumes - contain threonine.

Products that should be excluded in the postoperative period:

• fatty grade meat;
• acute, salty;
• chocolate, cocoa;
• coffee;
• cabbage, corn;
• mushrooms;
• seeds.

Beginning of food intakes after surgery follows from light seafront soups or cas cooked on the water. Food should be fractional - at least five times a day. Size portions - no more than two hundred grams.

Treatment of non-neurine radiotherapy

When is radiotherapy?

• nevnoma is located in a hard-to-reach place;
• the tumor is located next to the vital organs;
• the patient's age exceeds 60 years;
• severe forms of heart disease;
• the last stage of diabetes;
• renal failure.

Radiotherapy is used both in cases of primary detection of neuromy and for patients with relapses or continued growth of the neoplasm after surgical treatment. In situations when when conducting surgical operations It fails to remove the entire tumor without risk for the patient, radiation treatment is prescribed within the framework of postoperative treatment.

Radiotherapy is a treatment with ionizing radiation with X-ray radiation, gamma and beta-radiation, neutron radiation and elemental particles beams. With external irradiation, the radiation source is located outside the patient's body and is directed to the tumor.

• the location of the tumor is detected;
• the patient is recorded;
• a ray is aimed;
• the shape of the beam is selected, which corresponds to the form of a neoplary;
• the dose of irradiation is used sufficient to damage the anomalous cells and preserving healthy.

Stages of preparation for radiotherapy:

• neurological examination;
• conducting X-ray, MRI, CT and other diagnostics;
• additional tests.

Radiotherapeutic treatment does not cause the patient of pain and does not apply to traumatic techniques. The period of rehabilitation after radiotherapy is significantly less than after surgery.

• gamma knife;
• cyber knife;
• linear medical accelerator;
• proton accelerator.

Gamma-knife

Before applying the gamma knife, the exact localization of the tumor is determined using a stereotactic frame. The metal frame is fixed on the patient's head under local anesthesia. Next, a number of pictures are carried out using MRI and CT, allowing to determine the optimal place to cross the radiation rays (the place where the tumor is located). Based on the obtained images, a treatment plan is drawn up, which is transmitted to the control panel.

• tumor location;
• neow formation form;
• adjacent healthy fabrics;
• adjacent critical organs;

A special helmet is put on the head of the patient, on the surface of which are heads from radioactive cobalt. After that, the patient takes a horizontal position, and a special installation is installed under his head, locking his head in a fixed position. From the heads on the helmet, the radiation rays come, which intersecting in the Item destroy the tumor cells. The difference between this method from the remaining methods of radiation therapy is that several radiation beams act on the neoplament. The operation passes without the use of general anesthesia and occupies, depending on the type of device, from one to six hours. In the process of irradiation with the patient, double-sided audio and video links are supported.

Cyber-knife

• pouch for the patient;
• robotic installation with a source of irradiation;
• x-ray chambers and devices to control the position of the tumor;
• computer control system.

The robot can move in six directions, which allows to provide a point effect on any sections of the body. Before each dose of irradiation, the system program takes pictures of CT and MRI and directs the beams of radiation exactly to the tumor. Therefore, the use of cyber knife does not require the patient fixation and the use of a stereotactic frame. This system, in contrast to the gamma knife, can be used to treat not only acoustic neurine, but also other types of tumors.

Before using a cyber knife for the treatment of a neuromy, located in the skull cavity, a special plastic mask is manufactured for the patient. The goal of the mask is to prevent the patient's strong displacement. It is made of a grid material that envelops the head of the patient and quickly becomes solid. In the treatment of the neuromy of the spine to configure the system, special identification markers are manufactured. In order to convenience and minimize movements, individual mattresses or beds are made, repeating the patient's body shape.

Linear accelerators

Refinition by the linear accelerator precedes preparation, during which the patient passes a survey with CT and MRI. On the basis of the information received, a three-dimensional image of the organ and tumor is drawn up. Using this data, the doctor is a treatment plan.

• necessary dose of radiation;
• the amount and angle of inclination of the rays;
• diameter and form of rays.

During treatment, the patient is located on a special mobile couch, which can move in different directions. For maximum accuracy of the linear accelerator, the patient's head is fixed using a stereotactic frame. The mask is attached with the help of a bracket directly to the skin of the patient. To reduce the painful sensations of the patient, anesthetic drugs of local action are introduced. The duration of the session depends on the size and location of the neurine and can vary from half an hour to one and a half hours.

Proton therapy

Proton therapy, regardless of the localization and size of the neuromy, consists of three stages.

• Preparation - the manufacture of individual mechanisms for fastening the patient to the chair or couch. The type of device depends on the location of the neurine.
• The treatment plan - during this stage, the dose of irradiation, the shape and power of the beams are determined.
• Treatment - proton therapy is carried out by sessions, the duration of which depends on the size of the neurine.

Complications of radiotherapy

Radiotherapy causes early and late side effects. The first category includes those complications that occur during or immediately after irradiation. There are such phenomena for several weeks. Typical earlier side effects are fatigue and irritation. skin Pokrov. In places of exposure to radiation, the skin blues and becomes very sensitive. The appearance of itching, dryness, peeling. The remaining complications are manifested individually and are determined by the irradiation area.

• hair loss in irradiation;
• ulcers on the mucous membrane in the mouth;
• difficulty swallowing;
• lack of appetite;
• indigestion;
• nausea;
• diarrhea;
• violation of urination;
• swelling at the place of exposure to radiation;
• headaches;
• weak mobility of the lower jaw;
• unpleasant smell of mouth.

To Late by-effects Presents complications that arise after months or even years after radiotherapy. These include violations of the functionality of vital organs. Factors that increase the likelihood of complications include the patient's old age, chronic diseases, Previous operations.

Under local reactions on the skin during radiotherapy, it is necessary to use agents that reduce inflammation and promoting skin regeneration. The tool is applied with a thin layer on the surface of the irritated area of \u200b\u200bthe skin.

• methyluracil ointment;
• ointment Salcossuril;
• panteshein gel;
• sea \u200b\u200bbuckthorn oil.

It should be discarded clothing that fits tightly to those areas of the body that were exposed to irradiation. It is undesirable to carry things from synthetic tissues. It is necessary to give preference to spacious cotton clothing. Going out to the street, you need to protect the affected skin from the sun rays.

• take food in small portions - four - five times a day;
• products must be calorie;
• when problems with swallowing, you need to use nutrient mixtures in the form of beverages;
• food must be balanced and contain proteins, fats and carbohydrates in a ratio of 1: 1: 4;
• a large amount of liquid should be used (two and a half - three liters during the day);
• drinking should be diversified by fruit juices, tea with milk, herbal drinks;
• between meals to eat yogurts, kefir, milk.

For the speedy recovery of the shape of patients after radiotherapy, it is necessary to rest more and be in the fresh air. Excludes excitement and stressful situations. Mandatory condition is the refusal to smoking and drinking alcoholic beverages.

One month after the completion of the course of radiotherapy, the doctor must conduct an external inspection and neurological examination. To estimate the results achieved, magnetic resonance imaging is carried out or computed tomography.

• signs of infection (high temperature, chills, fever);
• preserving over two days after the statement of nausea and vomiting;
• convulsions;
• seizures of insensitivity;
• heart palpitations;
• head and other types of pain not passing after taking painkillers.

The consequences of the neuromy

• one-sided or bilateral deafness;
• paris of facial nerve;
• paralysis;
• cerebellum disorders;
• syndrome intracranial hypertension.

One-sided or bilateral deafness

Paris of facial nerve

• asmetry of the face (the smoothness of the nasolabial fold, the different size of the eye cracks);
• loss of taste sensations;
• slyunomy disorder (on the side of the lesion of saliva implies);
• dryness eyeball On the side of the defeat.

These symptoms appear due to the squeezing of the entire facial nerve or its separate branches. Long squeezing leads to nerve atrophy and loss of its function.