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=== Vestibularis- und Trigeminusschwannom ===
=== Vestibular and trigeminal schwannoma ===
Sekundäre Spasmen der Gesichtshälfte aufgrund eines Vestibularisschwannoms sind sehr selten. Eine Studie von S Peker et al..<ref>{{cita libro  
Secondary hemifacial spasm due to vestibular schwannoma is very rare. A study by S Peker et al.<ref>{{cita libro  
  | autore = Peker S
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  | autore2 = Ozduman K
  | autore2 = Ozduman K
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  }}</ref> war der erste gemeldete Fall von hemifacialem Spasmus, der auf eine Gamma-Knife-Radiochirurgie bei einem Patienten mit intrakanalikulärem Vestibularisschwannom ansprach. Sowohl die Auflösung des Spasmus als auch die Kontrolle des Tumorwachstums wurden mit einer einzigen Gammamesser-Radiochirurgiesitzung erreicht. Kontrolle des Tumorwachstums wurde erreicht und es gab keine Veränderungen im Tumorvolumen bei der letzten Nachuntersuchung nach 22 Monaten. Der Hemifazialkrampf löste sich nach einem Jahr vollständig auf. Es wurde berichtet, dass die chirurgische Entfernung der vermutlich ursächlichen Massenläsion die einzige Behandlung bei sekundären Hemifacial Spasmen ist.
  }}</ref> was the first reported case of hemifacial spasm responsive to gamma knife radiosurgery in a patient with intracanalicular vestibular schwannoma. Both spasm resolution and tumor growth control were achieved with a single gamma knife radiosurgery session. Control of tumor growth was achieved and there was no change in tumor volume at the last follow-up at 22 months. The hemifacial spasm completely resolved after a year. It has been reported that surgical removal of the presumably causative mass lesion is the only treatment in secondary hemifacial spasm.


<blockquote>[[File:Scwannoma.jpeg|thumb|Abbildung 1: Escwanoma del trigémino y maloclusión dental von Brandon Emilio Bertot et al..]]Man kann an dieser Aussage kritisieren, dass es sich in unserem Fall um den Massetermuskel handelt, aber diese Kritik wird beantwortet: Liegt ein Hemifacial Spasmus aufgrund eines Vestibularis-Swannoms vor, dann könnte ein Kauspasmus aufgrund eines Trigeminus-Swannoms auftreten ? Aus einer Studie von Ajay Agarwa <ref>Ajay Agarwal. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4757116/ Intracranial trigeminal schwannoma]
<blockquote>[[File:Scwannoma.jpeg|thumb|Figure 1: Trigeminal scwannoma and dental maloccusion by Brandon Emilio Bertot et al.<ref name=":0">Brandon Emilio Bertot, Melissa Lo Presti, Katie Stormes, Jeffrey S Raskin, Andrew Jea, Daniel Chelius, Sandi Lam. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451153/#!po=12.5000 Trigeminal schwannoma presenting with malocclusion: A case report and review of the literature.]Surg Neurol Int. 2020 Aug 8;11:230. doi: 10.25259/SNI_482_2019.eCollection 2020.
</ref>]]The criticism that can be made to this assertion is that in our case it is the masseter muscle is involved but this criticism is answered: If there is a hemifacial spasm from vestibular Scwannoma, could then a masticatory spasm from trigeminal Scwannoma occur? From a study by Ajay Agarwa <ref>Ajay Agarwal. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4757116/ Intracranial trigeminal schwannoma]


Ajay Agarwal. Neuroradiol J.2015 Feb;28(1):36-41.
Ajay Agarwal. Neuroradiol J.2015 Feb;28(1):36-41.


doi: 10.15274/NRJ-2014-10117.</ref>Es scheint, dass intrakranielle Trigeminusschwannome seltene Tumoren sind. Die Patienten stellen sich häufig mit Symptomen einer Dysfunktion des Trigeminusnervs vor, wobei Gesichtsschmerzen das häufigste Symptom sind. Die MRT ist das bildgebende Verfahren der Wahl und in der Regel diagnostisch in der entsprechenden klinischen Umgebung. Axiale 3D-CISS-T2-gewichtete Sequenzen sind wichtig für eine korrekte Beurteilung des zisternalen Abschnitts des Nervs. Sie sind in der Regel hypointens bei T1, hyperintens bei T2 mit Akkretion nach Gadolinium. Aber es kann uns nicht überraschen, dass Fälle wie der von Brandon Emilio Bertot et al..<ref name=":0">Brandon Emilio Bertot, Melissa Lo Presti, Katie Stormes, Jeffrey S Raskin, Andrew Jea, Daniel Chelius, Sandi Lam. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451153/#!po=12.5000 Trigeminal schwannoma presenting with malocclusion: A case report and review of the literature.]Surg Neurol Int. 2020 Aug 8;11:230. doi: 10.25259/SNI_482_2019.eCollection 2020.
doi: 10.15274/NRJ-2014-10117.</ref> it appears that intracranial trigeminal schwannomas are rare tumors. Patients usually present with symptoms of trigeminal nerve dysfunction, the most common symptom being facial pain. MRI is the imaging modality of choice and is usually diagnostic in the appropriate clinical setting. T2-weighted 3D CISS axial sequences are important for a correct evaluation of the cisternal segment of the nerve. They are usually hypointense in T1, hyperintense in T2 with accretion after gadolinium. But we cannot be surprised if cases like the one described by Brandon Emilio Bertot et al.<ref name=":0" /> in which a clinical case was reported of a 16-year-old boy with an atypical presentation of a large trigeminal schwannoma, dental malocclusion, painless and unilateral chewing weakness. The authors confirm that this case is the first documented case in which a trigeminal schwannoma has resulted in malocclusion; it is the 19th documented case of unilateral trigeminal motor neuropathy of any etiology.   
</ref>in dem über einen klinischen Fall eines 16-jährigen Jungen mit atypischer Darstellung eines großen Trigeminusschwannoms, Zahnfehlstellungen, schmerzloser und einseitiger Kauschwäche berichtet wird. Die Autoren bestätigen, dass dieser Fall der erste dokumentierte Fall ist, bei dem ein Trigeminusschwannom zu einer Malokklusion geführt hat; Dies ist der 19. dokumentierte Fall einer einseitigen motorischen Trigeminusneuropathie jeglicher Ätiologie.   
</blockquote>
</blockquote>

Latest revision as of 11:43, 1 May 2023

Vestibular and trigeminal schwannoma

Secondary hemifacial spasm due to vestibular schwannoma is very rare. A study by S Peker et al.[1] was the first reported case of hemifacial spasm responsive to gamma knife radiosurgery in a patient with intracanalicular vestibular schwannoma. Both spasm resolution and tumor growth control were achieved with a single gamma knife radiosurgery session. Control of tumor growth was achieved and there was no change in tumor volume at the last follow-up at 22 months. The hemifacial spasm completely resolved after a year. It has been reported that surgical removal of the presumably causative mass lesion is the only treatment in secondary hemifacial spasm.

Figure 1: Trigeminal scwannoma and dental maloccusion by Brandon Emilio Bertot et al.[2]

The criticism that can be made to this assertion is that in our case it is the masseter muscle is involved but this criticism is answered: If there is a hemifacial spasm from vestibular Scwannoma, could then a masticatory spasm from trigeminal Scwannoma occur? From a study by Ajay Agarwa [3] it appears that intracranial trigeminal schwannomas are rare tumors. Patients usually present with symptoms of trigeminal nerve dysfunction, the most common symptom being facial pain. MRI is the imaging modality of choice and is usually diagnostic in the appropriate clinical setting. T2-weighted 3D CISS axial sequences are important for a correct evaluation of the cisternal segment of the nerve. They are usually hypointense in T1, hyperintense in T2 with accretion after gadolinium. But we cannot be surprised if cases like the one described by Brandon Emilio Bertot et al.[2] in which a clinical case was reported of a 16-year-old boy with an atypical presentation of a large trigeminal schwannoma, dental malocclusion, painless and unilateral chewing weakness. The authors confirm that this case is the first documented case in which a trigeminal schwannoma has resulted in malocclusion; it is the 19th documented case of unilateral trigeminal motor neuropathy of any etiology.

  1. Peker S, Ozduman K, Kiliç T, Pamir MN, «Relief of hemifacial spasm after radiosurgery for intracanalicular vestibular schwannoma», in Minim Invasive Neurosurg, Georg Thieme Verlag, 2004, Stuttgart · New York».
    DOI:10.1055/s-2004-818485 
  2. 2.0 2.1 Brandon Emilio Bertot, Melissa Lo Presti, Katie Stormes, Jeffrey S Raskin, Andrew Jea, Daniel Chelius, Sandi Lam. Trigeminal schwannoma presenting with malocclusion: A case report and review of the literature.Surg Neurol Int. 2020 Aug 8;11:230. doi: 10.25259/SNI_482_2019.eCollection 2020.
  3. Ajay Agarwal. Intracranial trigeminal schwannoma Ajay Agarwal. Neuroradiol J.2015 Feb;28(1):36-41. doi: 10.15274/NRJ-2014-10117.