Neurinoma, schwannoma: symptoms, treatment, auditory nerve and other
Neurinoma is a benign neoplasm of the nervous system, which become a source of Schwann cells that wrap processes of neurons and form the so-called myelin sheath. Another name of the tumor could be a schwannoma or neurilemmoma.
Neuroma often is diagnosed in women, and among patients is dominated by young and Mature age. Being benign, the tumor has not metastasized, but relapses are possible. In addition, the ability to compress neural tissue and weave different structures of the brain, tightly spaihts with brain lining make it quite dangerous when placed in the cavity of the skull.
Malignant neuroma is a kind of malignant schwannoma, often detected in men of 30-50 years. For it is characteristic of rapid growth, localization in the nerves of the limbs, and invasion of surrounding tissues and destruction of nerves. Fortunately, this type of tumor is rare.
Schwannoma is fairly common, especially among children. Of all brain tumors, accounting for, according to various estimates, up to 10% of cases, and the fifth part of spinal cord tumors are swarnamali. Neoplasm of peripheral nerves and ganglia in half of the cases of neuroma. The tumor is able to defeat both peripheral nerves and the brain with the cranial nerves. Among the cranial nerves most frequently the source of tumor growth becomes vestibulocochlear called among the inhabitants of the hearing. The schwannoma increases very slowly, but even with a small size of the tumor can cause serious problems.
The most frequent localization of schwannoma is considered the vestibulocochlear nerve, responsible for hearing, which inevitably disturbed by the presence of the tumor, so with this pathology usually face ENT doctors. Because of the prevalence of tumors of the auditory nerve, this localization will be given special attention.
Causes of neuromas (swanna)
Causes of tumors of Schwann cells has been insufficiently studied, but to predispose to the disease can:
- Genetic mutations, particularly chromosome 22;
- Exposure to ionizing radiation and some chemicals;
- Genetic predisposition, when a schwannoma composed of neurofibromatosis, a serious hereditary disease.
The role of nerve injury in the development of the tumor is rejected. There is evidence that excessive sound stimuli and vibration can cause acoustic neuroma, affecting the VII and VIII cranial nerves.
Symptoms of neuromas
Symptoms of neuromas are determined by the localization of the tumor and its influence on the surrounding tissue. The symptoms are usually associated with irritation of the affected nerve root, often accompanied by pain, and compression of the nervous tissue, which can lead to paresis, paralysis, disturbance of sensation, hearing, increase in intracranial pressure.
Acoustic neuroma and brain
Acoustic neuroma affects people of Mature and elderly, is formed in the cavity of the skull, «criss-crossing» an auditory nerve. In most patients the disease is unilateral in nature. Signs of neuroma vestibulocochlear nerve are:
Size novoobrazovaniya not always clearly associated with the severity of symptoms. Sometimes even a small tumor can cause severe disorders, located in different parts of the brain. Large tumors provoke an increase in intracranial pressure, then the above claims are added intense headaches, nausea with vomiting, not bringing relief.
Real threat can become an acoustic neuroma large size, compressing the parts of the brain stem, where are located the vital nerve centers (vasomotor, respiratory, etc.). In such cases, the tumor threatens the life, causing malfunction of the cardiovascular and respiratory systems.
Neurinoma of the brain can affect other cranial nerves – trigeminal, facial, abducens. So, neoplasia of the trigeminal nerve accompanied by pain in the face from the growth of education, the violation of the sensitivity in the form of numbness, feeling crawling «pins and needles», loss of function of facial muscles. Possible gustatory and olfactory hallucinations.
Involvement of the facial nerve manifested by numbness of the skin on the face, loss of taste, a violation of the separation of saliva. These same symptoms appear when compression of the facial nerve schwannoma in a different location (acoustic, for example).
Neurinoma of the spine
Neurinoma of the spine commonly found in the cervical and thoracic, is located outside the spinal cord and is able to break him on the outside. Symptoms is to pain, autonomic disorders and signs of a transverse lesion of the spinal cord.
When lesions of the anterior spinal roots can be observed paresis and paralysis of muscles in the area of their innervation, and the neurinoma posterior roots of suffering sensitive area: numbness, feeling of pins and «needles». The growth of the tumor, these symptoms of transient become permanent, and their severity increases.
Pain when neurilemmoma spinal roots are usually intense, aggravated by adoption of the horizontal position. If the tumor grows in the cervical and thoracic spine, the patient will experience soreness in the neck, chest, between the shoulder blades. Radicular syndrome often resembles an attack of angina pectoris, when the pain is predominantly behind the breastbone and radiates to the left arm and shoulder blade.
When the neuroma of the lumbar spinal cord described the symptoms in the lumbar region and legs. Possible gait disturbance, numbness in the legs, trophic disorders.
Vegetative symptoms determined by the localization of neuromas are reduced to:
- Disorder work pelvic;
- Shortness of breath, sometimes difficulty swallowing;
- High blood pressure;
- Violation of the gastrointestinal tract;
Lesions of the spinal cord diameter is accompanied by paralysis, a sharp decrease of all kinds of sensitivity and trophic changes. This condition is quite dangerous, especially in the cervical and thoracic localization of the tumor, when disorders of the heart or lungs can be fatal.
Neurinoma of the peripheral nerves increases very slowly and often superficially located. Usually it is a single small tumor rounded, growing along the nerve fiber. Neuroma peripheral nerve manifested by intense pain and a decrease in the sensitivity. The progression of tumors causes paresis of the muscular tissue.
If you suspect the presence of a neuroma of the patient referred to a neurologist, which evaluates the function of cranial nerves, spinal cord and brain, reflexes, etc. With the defeat of the vestibulocochlear nerve administered the audiogram and a consultation with Laura. When tumors of the spinal cord and brain occurs of the need for CT and MRI.
Treatment of neuromas
Treatment of neuromas is determined by the location of the tumor, its size, patient’s condition and technical features of its removal. Usually are applied:
- Surgical removal of the tumor;
- Radiation therapy;
- Radiosurgical treatment.
With a small hannomag the patient may be offered surveillance. In tumors of the auditory nerve, if there are no symptoms and the tumor is small, you can also restrict the monitoring and regular MRI or CT control.
Surgery to remove the neuroma
Surgical removal of tumors is the main method of treatment, which consists in excision of the tumor. Regardless of the location of the neoplasia, there is always a risk of nerve damage, so impaired sensation or motor function often following such operations. In the case of acoustic neuroma there is a possibility of hearing loss, which is associated not so much with the surgery itself, as with compression of nerve tissue by tumor. In addition, the facial nerve paresis and dysfunction of facial muscles.
Indications for surgery may be:
Schwannoma of peripheral nerves can be surgically removed completely, and the swelling of the spinal cord is subjected to operation only when it is not rooted in the Dura and it can be removed entirely. In other cases, the neuroma partially removed followed by radiation.
The greatest difficulties can arise when the surgery on the tumors located inside the skull. Such interventions often proceed with complications, the frequency and severity of which depend on the size and localization of neoplasia.
For tumors of the auditory nerve may be produced by trepanning the skull, providing direct access to the tumor. Neuromas large sizes are removed mostly in this way. The risk from surgery is quite high, and among the most frequent complications – damage to the facial nerve and hearing loss. If the rumor was broken even before the operation, the removal of the tumor will not help to get it back, however, from neoplasia, the patient will be cured, and, hence, other parts of the brain will not be squeezed.
Major intracranial neuromas cause increased intracranial pressure and impaired circulation of cerebrospinal fluid, so surgery will not only help to get rid of the tumor, but from these dangerous manifestations of education.
Surgical removal of the neuroma vestibulocochlear nerve should be performed in a hospital, staffed by experienced neurosurgeons who owns endoscopic techniques.
The choice of transaction type depends on the characteristics of the lesion and preference of the surgeon. So, to penetrate into the cavity of the skull through the middle cranial fossa, translabyrinthine (with the removal of the structures of the inner ear) or the occipital bone (retrosigmoid access). In the latter case, it is necessary to shift the cerebellum, with visualisation of certain parts of the ear canal is difficult, therefore, endoscopic assistance is required. Almost all neuromas of small and medium size can be removed this way with a minimum of complications, and disorders of the facial nerve are observed not more than 5% of the operated patients. Translabyrinthine access is used for large tumors with hearing loss, as after surgery to get him back will not happen. Access through the middle cranial fossa is the least traumatic and is applied when neuromas up to 1 cm.
After surgery on the skull of the patient is recommended to avoid flying by plane, do not wash your hair for two weeks to care for a postoperative wound.
For large intracranial neurinomas is not always possible to remove the tumor completely because it can be firmly adherent to the surrounding neural structures and blood vessels and abundant blood supply of the tumor from branches of the vertebral and basilar arteries give rise to a high risk of bleeding, and gross neurological disorders. In such cases the surgeon resorts to the partial removal of the tumor, and the remaining part of the tumor is subjected to irradiation or radiosurgical removal.
Radiation therapy and radiosurgery
In the absence of capacity of surgical treatment or when small tumors can be treated with radiation. Until recently used conventional irradiation region of the tumor, but with the advent of radiosurgery has become an advantage to do it.
Radiosurgical removal involves effects on the tumor directed beam of radiation, while damage to surrounding tissues and nerves does not occur, so complications are minimal and rare. The control operation by the CT or MRI allows to remove the tumor with high precision, which is inaccessible to even the most careful surgeon’s hand. Given the frequent localization of neuromas in the cranial cavity, this method is quite relevant and promising.
Radiosurgery involves the use of various types of ionizing radiation, which is fed into the zone of growth of tumors under different angle, acting on the tumor from all sides. The procedure is painless, lasts usually not more than one and a half hours.
Radiation can be removed tumor, not larger than 30 mm, because larger tumors would need to increase the dose of radiation, resulting in undesirable radiation reactions. Radiosurgery as the primary treatment modality can be used in cases of impossibility of radical surgery (severe condition of the patient, age over 65 years, the inaccessibility of the tumor, the risk of damage to neighboring structures), in the recurrence of the neuroma or non-surgical intervention of the patient.
After radiosurgical treatment stops the growth of the neuroma and a gradual decrease of its size. The effectiveness of the procedure when neuromas reaches 90% and the patient’s condition is normalized about a year, depending on the original size of the neoplasia. The average therapeutic dose is 20 to 37 Grams, with the part of cells dies and the rest lose their ability to further reproduce. Violation of blood supply in the tumor after irradiation also prevents its further growth. It should be noted that if the tumor was causing compression and atrophy of the auditory nerve, in the case of even sparing treatment to restore hearing almost impossible.
Complications of treatment of neuromas are reduced by the expiration of the cerebrospinal fluid that occurs in almost every tenth patient, as well as headaches. Infection with the development of meningitis and hemorrhage in the postoperative period are rare. To avoid such complications and to achieve the best possible result of treatment helps precise determination of the location of the tumor, selection of appropriate method of operative intervention and the use of endoscopic techniques.
Forecast and consequences
Consequences neuromas are usually:
- Hearing loss;
- Paresis of the facial nerve.
- Increased intracranial pressure;
- Dysfunction of the cerebellum (impaired gait, coordination, balance problems);
- Paresis and paralysis (for tumors of the spinal cord).
Such changes are typical for large tumors that compress the tissue of the brain or spinal cord. Small in size the growths can be removed without any violations, so it is important to start treatment in time.
Treatment of neurinomas of any location must be carried out in a specialized hospital. The tumor may disappear by itself or when using traditional methods, and the loss of time and neglect of official medicine will only lead to its further growth and aggravation of symptoms.