[Total or partial ablation in surgery of acoustic neuroma].
The authors present the indications of partial or subtotal versus total removal of acoustic tumors and the removal prognosis of recurrence with methods of post surgical control.
Biomedical subjects
Publications and source records attributed to P Dorland.
The authors present the indications of partial or subtotal versus total removal of acoustic tumors and the removal prognosis of recurrence with methods of post surgical control.
The authors emphasize the frequency of intracranial tumors in psychiatric patients. They make a distinction between the rare cases of psychiatric patients with intracranial tumors and the even most-frequent cases of tumors that express themselves through psychiatric disorders. According to the authors, the most important detection-tests are the brain scan and, more recently, the EMI scan or tomodensitometer.
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One case of trigeminal neuralgia and operative giant basilar aneurism is reported. This feature is quite rare, this case however emphasizes the importance of further investigations before surgery, especially if a direct approach is considered.
It is well-known today that there is a cisternal "no man's land" between the petrous bone and the cerebral trunk in which a tumour can develop insidiously. The clinical signs are very variable and often in contradiction with those described for larger tumours. Tomodensimetry is indicated, but it is not conclusive if the mass is limited to the internal auditory canal or if it extends into the angle for less than 15 mm. Opaque meato-cisternography alone, gives the following information: 1. When a pseudo-tumoural syndrome is present, the auditory canal and cisterna are well opacified. 2. If there is a tumour which extends for more than 20 mm into the cisterna, the oil has a rounded, interrupted contour, and other radiological examinations are useful in this case. 3. When the tumour extends for less than 20 mm into the angle a rounded continuous contour is seen, and Hirtz's axial incidence can be used to measure the tumour diameter. 4. Finally, when temporary opacification faults have been eliminated (after retilting), opaque meato-cisternography is the only examination able to demonstrate the early stages of a tumour, in the intra-canal stage. This early diagnostic procedure has enabled one of us to excise tumours of moderate of even very small volume, under the best surgical conditions, and with functional and vital results which we would not have obtained at a later date.
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Tomodensitometry allowed us to discover smaller and smaller tumors in the cistern and even in the internal auditory canal. We report 5 cases, amongst others, where the tumor is visible in the canal and we show the conditions which are necessary to make the diagnosis. Nevertheless, lipiode meatocisternography is well tolerated if we use between 0.6 and 1.5 ml of oil, and often necessary to confirm the diagnosis of a neuroma. We first use tomodensitometry when the symptoms could be due to a neuroma or another tumor. When the syndrome is characteristic, limited to the contents of the internal auditory canal, we often do the meatocisternography straight away, because in a single examination we know that there is or is not a tumor. We can also check the same time the opposite side.