听神经瘤英文课件

,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Acoustic neuroma,听神经瘤,Acoustic neuroma 听神经瘤,1,Introduction,Acoustic neuroma originate from vestibular branch of aucoustic nerve,Histologic feature: schwanoma, neuroma,Predilection: 30-50y,Unilateral: majority,Bilateral:,Type II acoustic neuroma,Vestibular-,前庭,IntroductionAcoustic neuroma o,2,Pathology,Predominate:,internal auditory canal,Extension to CPA,Compression on brainstem and brain hydrops,Anterior: trigeminal nerve,Medial: abducent nerve,Inferior: IX, X, XI, XII,CPA-,小脑桥脑角,Pathology Predominate:,3,Work-up,Audiometry,Vestibular function:,Neurologic exam,Image study,CT,MRI,Work-upAudiometry,4,Clinical presentations,Hearing loss and tinnitus,Progressive HL 90%,10% of patients complain of sudden HL.,Unbalance,Otalgia and compression due to depression of sensor fiber of facial nerve,Involvement of trigeminal nerve,Compression of cerebellum and brainstem: ataxia, nystagmus and intracranial hypo-pressure,Otalgia-,耳痛，,ataxia-,共济失调 ，,nystagmus-,眼球震颤,Clinical presentations Hearing,5,CT scan,tumor in CPA, density is variform,enlargement of internal auditory canal,Enhanced CT scan, they are markedly enhanced.,CT scan,6,MR scan,（2）The tumors were of hypo or iso,-,hypo intensity on T1 weighted images and hyper or iso,-,hyper intensity on T2 weighted images.,（3）After enhanced the tumors were homogeneously or inhomogeneously or circularly enhanced,MR scan（2）The tumors were of h,7,MR scan,(4）The margins of the tumors were smooth and well delineated.,（5）The affected internal auditory canal usually became shorter in depth and larger in posterior anterior diameter.,（6）MRI appearances of micro acoustic neuromas were that the affected , nerves were normal in size and the tumor revea,l,ed nodular or point enhancement at contrast enhanced,MR scan (4）The margins of the,8,(acoustic tumor),Not reinforced region,T1WI,Contrast T1WI,(acoustic tumor)Not reinforced,Same case,T2WI,Same caseT2WI,Differential Diagnoses,Meningiomas,1、The typical MR signal intensity characteristics of meningiomas are isointensity to slight hypointensity on T1WI,and isointensity to hypertensity,on T2WI.,2、with enhanced MR or CT, they are markly enhanced ,and you may see the “Dural tail”. 3、tumor has wide basement, bony changes can be seen, but internal auditory canal will not enlarge.,Differential DiagnosesMeningio,11,Differential Diagnoses,epidermoid cyst,1、 The tumors were different in size and had irregular shapes, the contours were lobulated or smoot,2、On CT, most cases are homogeneous,hypo,density, and on MRI,most case are,homogeneous,hyp,oin,ten,se,imaging on T1WI,and homogenous hyp,erin,tens,e,on T2WI.Partial cases are inhomogenous hyperintensity on FLAIR,3、 most cases are not enhanced,Differential Diagnosesepidermo,12,听神经瘤英文课件,13,Differential Diagnoses,trigeminal neuroma,1,、,located in middle cranial foss or posterior cranial foss; same cases with typical dumb-bell like in shape grew across middle and posterior cranial foss,2,、,the lesions showed small in size and no capsula, but that large in size can has capsular or necrosis,3,、,The tumors were of slightly hypo or iso-hypo signal intensity on T1WI and hyper or isohyper signal intensity onT2WI.The hypo or mixed density were showed by CT.,Differential Diagnoses trigemi,14,trigeminal neuroma,4,、,On contrast scan,，,the tumors were enhanced homogeneously, inhomogeneously, circularly or nodularly. Hypervascular and dot-stained tumors were found on DSA,5,、,The roots of trigeminal nerves thickening with dysfunction and erosion of petrous bone were found inmost case,trigeminal neuroma4、On contras,15,Managements,Surgery,Middle cranionectomy: useful hearing,Translabyrinectomy:,no useful hearing,Nice exposure of facial nerve,No surgical intervention,-,Knife,observation,Managements Surgery,16,听神经瘤英文课件,17,THANK YOU!,听神经瘤英文课件,18,