Cerebellopontine angle: description, possible diseases, diagnosis, treatment. Tumors of the lateral cistern of the pons (cerebellopontine angle) Indications for MRI of the cerebellopontine angles

The cerebellopontine angle is the space between the posterior inner edge of the pyramid, the brainstem and the cerebellum (Fig. 8). Several nerves pass through this area: trigeminal, facial, vestibulocochlear and intermediate.

Accordingly, when certain nerves are damaged, their own specific symptoms. If damaged trigeminal nerve corneal reflexes and sensitivity in the nasal cavity and pharynx are lost.

Damage to the facial and intermediate nerves leads to paresis of the facial muscles and impaired taste.

Rice. 8. Cerebellopontine angle:

1 - brain stem; 2 - posterior inner edge of the pyramid: 3 - trigeminal nerve; 4 - cochlear nerve; 5 - facial and intermediate nerves; 6 - vestibular (vestibular) nerve; 7 - cerebellum

howling sensitivity on the anterior -/w tongue. If the vestibular-cochlear nerve is involved, one-sided deafness or a sharp decrease in hearing, nystagmus and loss of excitability of the labyrinth are characteristic. The syndrome is characteristic of tumors of the cerebellopontine angle - acoustic neuroma, meningioma, neurinoma of the facial nerve and other neoplasms of this area.

A computed tomogram (CT) for cerebellopontine angle syndrome is shown in Fig. 125. adj. With. 238. From the CT scan it follows that the size of the internal hole ear canal on the right - more than 7 mm. The right and left channel apertures are not symmetrical. The posterior wall of the right internal auditory canal has a tortuous surface without signs of bone destruction. A contrast-enhanced tomogram revealed a slowly growing intracanal acoustic neuroma. The tumor pushed aside the dura mater of the posterior cranial fossa and the structures of the cerebellopontine angle space.

1. Cerebellopontine angle syndrome. Etiology. Clinical manifestations.

All pons nerves (5-8) and the cerebellum are involved. All symptoms are on the side of the lesion. Causes:

— acoustic neuroma - adhesive process about the spinal cord of the pontocerebellar angle

Acoustic neuromas are more common, followed by meningiomas and cholesteatomas. Neuromas grow from the sheath of the vestibular branch of the VIII nerve, ^ ^ but its lesion here is detected only during otoneurological examination; dizziness is rare. Usually the first symptom is hearing loss accompanied by noise. The trigeminal nerve root (decreased corneal reflex, pain, paresthesia in the face) and the Wrisberg nerve (taste disorder in the anterior 2/3 of the tongue) are involved early in the process.

In half of the cases, involvement of the facial nerve was noted (pronounced damage is rare), as well as the abducens nerve. As the tumor grows. 5u cerebellar, brainstem (nystagmus) and cerebral symptoms are detected. Bilateral neuromas of the VIII nerve occur in neurofibromatosis of Recklinghausen (see). Radiologically determined expansion of the internal auditory canal is of great diagnostic importance.

pyramids of the temporal bone. With meningiomas, general cerebral symptoms appear faster than with neuromas. Cholesteatomas result from chronic otitis. With them, unlike neuromas, the VIII nerve suffers little. 3 x - Tumors of the IV ventricle. Ependymomas are more common, choroid papillomas are less common. Shows up early intracranial hypertension, headaches are paroxysmal in nature, often accompanied by vomiting and dizziness, disturbance cardiovascular activity, breathing. Cerebellar disorders (primarily gait disturbances) are common. Typically forced head position. Of the cranial nerves, the VI and VIII nerves are most often affected, less often the V, VII, IX, and X nerves. Focal symptoms include attacks of hiccups, respiratory and cardiovascular disorders. Attacks of tonic spasms of the muscles of the trunk and limbs are also observed.

Tumors of the trunk are rare. Among the intracerebral ones there are astrocytomas, spongioblastoma multiforme, and among the extracerebral ones there are meningiomas.

2. Damage to the nervous system due to AIDS. Clinical manifestations.

Etiology and pathogenesis. HIV infection is a disease caused by the human immunodeficiency virus. This virus belongs to non-oncogenic human retroviruses, the so-called lentiviruses (slow viruses), the main point of application is the immune system. Viruses have a long incubation period and are capable of persistence in the body. When they enter the body, the helper population of T-lymphocytes is primarily affected. In addition, they have a clear tropism for certain groups of cells - macrophages, monocytes, and neuroglial cells, which causes chronic demyelinating damage to the nerve system. Activation of endogenous - opportunistic flora (herpes virus, yeast-like fungi) and sensitivity to exogenous microbes (mycobacteria, cryptococci, cytomegaloviruses, toxoplasma, etc.) causing secondary damage to various organ systems.

Clinic and diagnostics. Neurological disorders were observed in 1/3 of cases of the disease and usually correspond to stages III (stage of secondary diseases - cerebral form) and IV (terminal stage - specific damage to the central nervous system). In rare cases, during the period of infection, acute viral meningoencephalitis may develop, manifested by epileptic seizures and disturbances of consciousness up to coma. Lymphocytic pleocytosis is detected in the cerebrospinal fluid. The most common syndromes late defeat nervous system include AIDS dementia complex, sensory polyneuropathy, or a combination thereof. The cause of the AIDS-dementia complex is brain damage in the form of multifocal giant cell encephalitis and progressive diffuse leukoencephalopathy. In the initial stage of the disease, the patient complains of drowsiness, impaired concentration, and memory disorders. Then a slight increase in muscle tone, sucking and grasping reflexes, adiadochokinesis, apathy, indifference to one’s condition, bradykinesia, and tremor are added. In the advanced stage of the disease, mutism occurs against the background of severe dementia, epileptic seizures, paraplegia, ataxia and dysfunction pelvic organs. The cerebrospinal fluid shows slight pleocytosis. Computed tomography and magnetic resonance imaging reveal cortical atrophy and ventricular enlargement.

The syndrome of sensory popineuropathy is manifested by pain and paresthesia in the arms and legs of the “gloves” and “socks” type in combination with a decrease or loss of knee reflexes, flaccid paresis and autonomic disorders. At different stages of the disease, multiple mononeuropathies (damages of the trigeminal and facial nerves), as well as muscle lesions in the form of polymyositis and myopathy, may occur: Treatment. There is currently no pathogenetic treatment. Zidovudine (200 mg 6 times a day) is used, as well as symptomatic therapy. 3. Osteochondrosis g.o.P.

Osteocondritis of the spine is a degenerative process that has developed in intervertebral disc and the vertebrae adjacent to it, which together is called the vertebral motor segment of the PDS.

Disk functions; Shock absorption, Fixation, Providing movement. OCP is a dystrophic lesion or change that begins with the nucleus pulposus, spreads to the fibrosis ring and then to other elements of the PDS and often forms a conflict with adjacent neurovascular diseases . Theorem about the origin of acute acute respiratory syndrome: involutional, hormone, vessel, genetic, infectious, mechanical, abnormal, etc. According etiology zab-e multiphacotrial. There are 2 main factors: decompensation in trophic systems and local overload of the PDS. Pathogenesis. Stages: Chondrosis is a process only in the disc. Osteochondrosis is a process in the disc and bone. Periods: 1 period of intradiscal movement of the pulpous tissue. Drying of the nucleus pulposus, the appearance of cracks in the inner part of the fibrosis ring.

2P-od of instability of the PDS. The nucleus pulposus was completely cracked. ZP-od formation of a hernia. 4P-od of disc fibrosis and total changes in other structures.

Fibrosis - immobilization by scar.

Clinic OCP is determined by the level of damage. First of all, these are vertebral syndromes. They are characterized by the following manifestations: pain in the area of ​​the affected part (local pain during movement and movement, limitation of movements, vertebral deformity (scoliosis, smoothing of lordosis/kyphosis), tension of the paravertebral muscles, pain in protruding striae p, spinous processes), cervical lumbago, cervicalgia, thoracalgia, lumbar lumbago (lumbago), lumbodynia (subacute pain in the lower back), sacralgia, coccygia.

Extrovert syndromes are also distinguished; they develop as follows: post afferent impulses from the affected SMS along the sinovertebral nerve, through the posterior horn, spreading to the anterior and lateral horns of the corresponding segment of the spinal cord. At the same time, some patients develop muscle-tonic ones, others develop vasomotor ones, and others develop neurodystrophic ones.

Flow OCP m.b. chron (no complete remissions), recurrent (alternating exacerbations and remissions), chronically recurrent (the appearance of a new syndrome or increased clinical manifestations against the background of a slowly occurring disease). Each exacerbation has 3 stages: progression, stationary, regression.

Vertebral syndrome - pain in the affected area of ​​the spine 1 .Local pain during active and passive movements. 2.0limited movement.

Z. Vertebral deformation (scoliosis, flattened lordosis, kyphosis, asymmetry of the transverse processes).

4. Direction of paravertebral muscles. b. Pain in protruding structures affected by the SMS Extravertebral syndrome— presence of symptoms at a distance. Radicular syndrome:

Compression of the root can be caused by a herniated disc, bone growth, hypertrophy of the yellow ligament, cicatricial adhesions in the epidural tissue; -deficiency stage: hyporeflexia, hypotrophy, muscle hypotonia, hypo- and anesthesia in the area of ​​the corresponding dermatome; -irritative stage: reflexes are normal or animated, hyperesthesia. Diag. Clinic + X-ray signs:

Local change in vertebral configuration (flattening of physiological lordosis, appearance of kyphosis, scoliosis) - reduction in the height of the m/n disc

The image of marginal bone growths of “osteophytes” (“whiskers”) - subchondral osteosclerosis

Pathological mobility (spondylopisthesis) is displacement of adjacent vertebral bodies. As well as MRI, CG, ultrasound.

Treatment: exhaustive and adequate information about the disease; high-quality, adequate, timely pain relief; orthopedic regimen in the acute period. First-line analgesics are NSAIDs:

Non-select COX-1 and -2 inhibitors: ibuprofen, diclofenac, naproxen, indomethacin, piroxicam, lornoxicam, ketoprofen, ketorolac

Highly selective COX-1 ingers: low doses of acetylsalicylic acid

Selective agents COX-2: nimesulide, meloxicam

Highly selective ing COX-2: coxibs.

They need to be combined with 1 table. Omeprazole (for the stomach)

Muscle relaxants are used: baclofen, tizanidine, topperisone.

Chondroprotectors: stimulate the production of the main components of cartilage in chondrocytes + help slow down the degeneration of cartilage tissue and restore its structure.

Neck fixation with Shants collar pom. Manual therapy, massage, Acupuncture, physiotherapy. For chronic pain syndrome - antidepressants.

At home: rubs, ointments, applications, herbs, cupping massage, self-massage, needle applicators, reflexology with pepper patch, metal and magnetic therapy.

Surgical treatment Absolute indication: acute compression of the spinal column of the brain and cauda equina roots, relative indication: severity and persistence of the root. syndromes in the absence of effect from adequate conservative therapy carried out for more than 3-4 months. 4 .Pseudobulbar syndrome. Research technique for pseudobulbar syndrome.

Central. Develops with damage to the corticonuclear pathways 9, 10 and 12 pairs of h.n. and manifested (with bilateral lesions): dysarthria, dysphonia, dysphagia and pathological pseudobulbar reflexes (oral automatism - Proboscis reflex. Ankylosing spondylitis oral reflex- Lightly tapping with a hammer on the patient’s upper lip or on his finger placed across the lips causes involuntary protrusion of the lips; Sucking reflex. Oppenheim sucking reflex— Streak irritation of the lips leads to the appearance of sucking movements; Wurpe-Toulouse reflex. Wurpa lip reflex- Involuntary stretching of the lips, reminiscent of a sucking movement, occurring in response to stroke irritation upper lip or its percussion; Oppenheim oral reflex- Line irritation of the lips, except sucking reflex, causes chewing and sometimes swallowing movements; Nasolabial reflex. Astvatsaturova nasolabial reflex - Tapping the back or tip of the nose with a hammer causes contraction of the orbicularis oris muscle and protrusion of the lips; Palmochin reflex. Marinescu-Radovic reflex- Caused by streak irritation of the skin of the palm in the thenar area. In this case, contraction of the mental muscle occurs on the same side. Normally caused in children under 4 years of age; grabbed.), violent crying and laughter

Cerebellopontine angle syndrome neurology

Cerebellopontine angle It is a depression in which the middle peduncle plunges into the substance of the cerebellum. Here, at the base of the middle cerebellar peduncle, the VIII, VII, VI and V roots of cranial nerves pass through the lateral cistern of the pons.

Cerebellopontine angle syndrome(lateral pontine cistern syndrome) is a combined lesion of the facial (VII), vestibulocochlear (VIII), trigeminal (V) and abducens (VI) nerves with ipsilateral cerebellar symptoms, and also often contralateral pyramidal insufficiency.

The syndrome most often observed with neurinomas of the VIII nerve, meningiomas, cystic adhesive arachnoiditis of the lateral cistern of the bridge, volumetric processes in the cerebellopontine angle.

Ipsilateral clinical symptoms:
- hearing impairment at the level of the sound-receiving apparatus;
- vestibular disorders in the form of non-systemic dizziness, often in combination with ipsilateral nystagmus and vestibular ataxia;
- peripheral paresis of facial muscles;

Paresis of the external rectus muscle of the eye;
- disorders of all types of sensitivity on the face according to the innervation of the trigeminal nerve or predominantly one of its branches;
- cerebellar disorders in the form of dynamic, but with elements of static ataxia.

Contralateral to the lesion pyramidal insufficiency is often determined, which, as a rule, does not reach the degree of pronounced central hemiparesis.

Cerebellopontine angle syndrome

It appears with neuroma of the cochlear root of the vestibulocochlear nerve, cholesteatomas, hemangiomas, cystic arachnoiditis, leptomeningitis of the cerebellopontine angle, aneurysm of the basilar artery.

Symptoms: hearing loss and tinnitus, dizziness, peripheral paralysis of facial muscles, pain and paresthesia in half of the face, unilateral decrease in taste sensitivity in the anterior 2/3 of the tongue, paresis of the rectus lateral muscle of the eye with convergent strabismus and diplopia on the side of the lesion. When the process influences brain stem hemiparesis occurs on the side opposite to the lesion, cerebellar ataxia on the side of the lesion.

Damage to the cerebellopontine angle. The cerebellopontine angle is topographically divided into three sections: anterior, middle and posterior (Fig. 21). Depending on which department the pathological process is located in; the corresponding syndrome is obtained. Pathological foci located in these sections may belong to the processes of a wide variety of pathological categories (arachnoiditis, abscesses, gummas, tumors of the cerebellum, pons, cranial nerves - neuroma of the trigeminal nerve and the 8th pair, meningeomas, cholesteatomas).

Trigeminal neuromas are observed in the anterior section. In the middle section, neuromas of the 8th pair (tumor of the auditory nerve) most often occur. In the posterior sections there are tumors originating from the substance of the cerebellum and heading to the middle section of the cerebellopontine angle. Not only tumors, but also the above-mentioned formations of a different order can originate in these areas. Since the trunks of the facial and auditory nerves pass through the middle section in almost horizontal and frontal positions, it is clear that pathological foci located in this area will manifest themselves primarily from these cranial nerves.

In general, whatever process develops in the cerebellopontine angle, depending on its location in one of its sections, the auditory nerve root is almost always involved to a greater or lesser extent. The early or late development of the cochlear-vestibular-cerebellar syndrome depends on from which parts making up the cerebellopontine angle the tumor initially originated: 1) from parts of the rocky bone, 2) from the dura mater of the posterior surface of the pyramid, 3) soft meninges of the same area, 4) cerebellum, 5) medulla oblongata and 6) cranial nerves.

Let us examine in sequential order those diseases that usually nest in the cerebellopontine angle, and focus on the oto-neurological syndrome of these diseases, since this area is a selective site for frequently observed pathological processes.

Diagnosis of diseases of the cerebellopontine angle, as a rule, does not present much difficulty, if only the doctor’s attention is paid to the consistent development of both general and cochlear-vestibular cerebellar syndromes. Meanwhile, as a rule, tumor-like diseases of the 8th pair are still not diagnosed by otolaryngologists, which will be discussed below.

Arachnoiditis. Of the acute diseases of the membranes in the cerebellopontine angle, otogenic lepto-meningitis should be noted in the first place. They are usually caused during the development of acute or chronic purulent labyrinthitis by the transfer of infection from the internal auditory canal to the meninges

Tumors of the cerebellopontine angle. As we have already indicated above, a tumor can come from any part that makes up the designated angle. To illustrate, we present a case in which the tumor originated from bone formations jugular foramen and grew into the cerebellopontine angle.

Tumors of the auditory nerve. Tumor-like diseases of the auditory nerve are of great interest to otolaryngologists, because the first complaints resulting from damage to the 8th pair of nerves (tinnitus, decreased hearing, static disturbances) force patients to seek help from an otolaryngologist

Symptoms Diagnostics. The onset of the disease is characterized by noise in the ear; with bilateral processes, which is extremely rare, noise is noted in both ears, followed by a gradual decrease in hearing until it is lost in the corresponding ear. In rare cases, at the beginning of the disease, in the absence of noise, hearing loss is not noticed for a long time and is discovered by the patient by chance (telephone conversation). Sometimes noise and hearing loss are preceded by a headache. Often patients feel pain in the corresponding ear. In this period of the disease, an objective lesion of the cochlear nerve of a radicular nature is established with an akumetric formula typical for this disease. This latter is expressed as follows. The border of low tones is raised, the border of high tones is relatively better preserved; Weber in the healthy direction and bone conduction is shortened.

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Localization of the pathological process in one half of the brain pons can lead to the development of the following alternating syndromes.

Millard-Hübler syndrome- occurs with a unilateral pathological focus in the lower part of the pons and damage to the nucleus of the facial nerve or its root and the corticospinal tract. On the affected side, peripheral paresis or paralysis of the facial muscles occurs, on the opposite side - central hemiparesis or hemiplegia. It was described in 1856 by the French physician A. Millard (1830-1915) and in 1896 by the German physician A. Gubler (1821-1897).

Foville syndrome- occurs with a unilateral pathological focus in the lower part of the pons of the brain, caused by damage to the nuclei or roots of the facial and abducens nerves, as well as the pyramidal tract and sometimes the medial lemniscus. On the affected side it is manifested by peripheral paresis or paralysis of the facial muscles and the external rectus muscle of the eye; on the opposite side - central hemiparesis or hemiplegia and, possibly, a hemitype disorder of pain and temperature sensitivity. Described in 1858 by the French neurologist A. Foville (1799-1879).

Raymond-Sestan syndrome- occurs with a unilateral pathological focus in the pons due to combined damage to the pontine center of gaze, the middle cerebellar peduncle, the medial lemniscus and the pyramidal tract. Paresis of gaze towards the pathological focus is noted, on the side of the lesion - hemiataxia; on the opposite side - central hemiparesis or hemiplegia, hemitype disorders of pain and temperature sensitivity. It was described in 1903 by French neurologists F. Raymond (1844-1910) and E. Cestan (1873-1932).

Gasperini syndrome- occurs due to a pathological focus in the bridge tire. It manifests itself as signs of dysfunction of the auditory, facial, abducens and trigeminal nerves on the affected side and a disorder of pain and temperature sensitivity according to the hemitype on the opposite side. Described by the Italian neuropathologist M. Gasperini.

With extracerebral localization of the pathological focus in the cranial cavity, the following syndromes are possible.

Lateral pontine cistern syndrome, or cerebellopontine angle, is a combination of signs of damage to the auditory, facial and trigeminal nerves passing through the lateral pontine cistern. It usually develops with the formation of a pathological process in it, more often with an acoustic neuroma.

Gradenigo syndrome- hearing loss caused by combined damage to the sound-conducting and sound-receiving apparatus of the auditory nerve, in combination with dysfunction of the facial, abducens and trigeminal nerves. Manifested by paresis of facial and chewing muscles, convergent strabismus, diplopia and facial pain. Usually it is a consequence of purulent otitis media, in which the infection penetrates through the apex of the temporal bone pyramid into the cranial cavity, which leads to the formation of limited leptomeningitis with the involvement of these cranial nerves in the process. Described in 1904 by the Italian otorhinolaryngologist G. Gradenigo (1859-1925).

With a unilateral lesion of the so-called pontine center of gaze located in the tegmentum, gaze paresis develops in the direction of the pathological process.

With bilateral damage to the pons, the following syndromes are possible.

Pontine myelinolysis syndrome- bilateral demyelination of mainly efferent pathways at the level of the brain pons: corticospinal (pyramidal), frontopontocerebellar and corticonuclear. Manifested by central tetraparesis, signs pseudobulbar syndrome and cerebellar failure. Characterized by ophthalmoparesis, pupillary disorders, tremor, tonic convulsions, decreased activity of mental processes. Over time, stupor and coma may develop. Occurs due to metabolic disorders during fasting, chronic intoxication (alcoholism, infectious diseases, severe somatic pathology). There is an opinion that pontine myelinolysis can be triggered by excess hydration, leading to severe hyponatremia with edema of brain tissue, which more often occurs in patients with alcoholism, since in them abstinence from alcohol leads to an increase in the level of antidiuretic hormone in the blood and the likelihood of developing hyponatremia with intravenous infusion of fluids and treatment with diuretics is especially high. CT and MRI detect foci of low density in the central part of the pons and in the adjacent parts of the brain stem. The selectivity of damage to the base of the bridge is explained by the peculiarities of its myeloarchitecture.

Dancing eyes syndrome (ocular myoclonus)- hyperkinesis of the eyeballs in the form of friendly fast, irregular, uneven in amplitude of their movements, performed in horizontal plane and especially pronounced in the initial stage of fixing the gaze on an object. Possible when the tegmentum of the pons or midbrain is affected.

Roth-Bielschowsky syndrome (Bielschowsky pseudoophthalmoplegia)- loss of the ability to voluntarily move the eyeballs to the sides while maintaining their reactions to stimulation of the labyrinth, while convergence of the eyes is possible and their movements in the vertical plane are preserved. Occurs as a result of tumor growth or circulatory problems in the trunk tire, and may also be a manifestation multiple sclerosis. Described in 1901 by Russian neuropathologist V.K. Roth (1848-1916), in 1903 the German neuropathologist M. Bielschowsky (1869-1940).

Neuroma is a benign tumor of the cerebellopontine ganglion. However, malignant manifestations of the neoplasm also occur. The tumor has other names - neurofibroma, schwannoma. A tumor grows from the cells of the nerve endings. The mechanism of neuroma development has been little studied. It is believed that the pathology occurs due to a malfunction immune system. Another risk factor is hereditary predisposition. Symptoms of neuroma are manifested by increasing hearing loss and tinnitus over several months or years. In other cases, cranial nerve function may be impaired.

Development of the disease

In women, neuroma of the cerebellar angle pons is detected more often. There is also a relationship between tumor growth from hormones and exposure to radiation. The growth of cerebellar neuroma leads to its compression, compression of the 5th and 7th cranial nerves, the bridge, a group of nerves of the medulla oblongata and spinal cord.

The rate of tumor growth varies in intensity among patients. Most often, cerebral neuroma grows slowly at a rate of 2 to 10 mm per year. In some patients, pathology may not appear until the tumor has grown to a significant size. Neuroma of the cranial nerves is surrounded by a capsule, is not able to grow into adjacent tissues, and can form cysts.

Clinical picture of cerebral neuroma

Symptoms depend on the location and volume of the tumor. Patients complain of whistling or tinnitus. Gradually the noise gives way to partial deafness. The patient may have trouble hearing high pitched tones.

If a neuroma of the right cerebellopontine angle develops, the patient complains of hearing impairment with right side. Accordingly, with a tumor on the left, hearing loss occurs on the left side. After partial deafness in one ear, complete deafness develops.

Patients with neuroma experience periodic and involuntary movements of the eyeballs (nystagmus). Other symptoms include:

  • occipital pain on the side of the tumor;
  • loss of sensation in the facial nerve.

If a tumor develops in the area of ​​the internal auditory canal, the patient experiences impaired salivation, partial loss of taste and sensitivity in the nasal cavity on the side of the tumor. If the tumor grows and affects nervus vagus, the following symptoms appear:

  • weakening of the vocal cords;
  • changing the sound modification during a conversation;
  • swallowing disorder.

When the cerebellum is compressed, the patient experiences characteristic symptoms:

  • weakening of the muscle tone of the arms and legs;
  • slow movements;
  • inability to perform rapidly alternating movements;
  • tremor during purposeful movements;
  • miss;
  • spontaneous movement of the eyeball on the affected side.

With large sizes, neuromas can develop. Patients complain of severe headaches in the morning, which are accompanied by vomiting. Typically, this symptom appears several years after the onset of neuroma formation.

Diagnosis and treatment methods for neuroma

When diagnosing, the patient is excluded from cholesteotoma, Meniere's disease, auditory neuritis, arachnoiditis, vascular pathologies. In addition, an aneurysm is excluded vertebral arteries, tuberculous or syphilitic.

For diagnostics use:

  • computer diagnostics;
  • X-ray examination;
  • angiography.

Since the tumor grows slowly and may in some cases regress, patients are offered conservative treatment. To eliminate cerebral edema it is indicated

If the tumor is small, microsurgical removal is indicated. In this case, patients may retain hearing and nerve function. Rehabilitation after removal of small neuromas up to 2 cm is much faster. With total removal, large neuromas may be observed postoperative complications– paresis and paralysis of the facial nerve. If the neuroma is partially removed, the issue of radiation therapy is considered.

Possible complications after surgery:

  • temperature increase;
  • cramps, nausea;
  • loss of sensation in certain areas of the body;
  • dyspnea;
  • headache;
  • tachycardia.

If pathological symptoms appear, re-diagnosis is carried out in order to correct treatment and further observation.

Traditional methods of treating neuroma

TO folk remedies Treatment of neuroma includes the use of tinctures and decoctions, adherence to a diet.

Important! Any traditional medicine recipe, even a harmless one, should be discussed with a doctor.

Traditional medicine recipes:

  1. Tincture horse chestnut. 50 g of flowers are poured into 0.5 liters of vodka, left for 10 days, and squeezed out. Apply 10 drops 3 times a day. The tincture is diluted with water. The course of treatment is 2 weeks. After a break of 7 days, the course is repeated.
  2. Tincture of Sophora japonica. 50 g of raw material is poured with 0.5 alcohol, left for 40 days, filtered, and squeezed. Take 10 ml tincture every day. The tincture is diluted with water. The course of admission is 40 days. If necessary, the course is repeated after a two-week break.

The following fruits and vegetables have antioxidant effects:

  • beet;
  • blueberry;
  • grape;
  • blackberry;
  • garlic;
  • broccoli;
  • cherry;
  • a pineapple;
  • green tea.

Dangerous foods include fatty meat and dairy foods, smoked foods, sugar, flour products, and canned foods. Proper nutrition helps cells recover, improves the patient’s well-being, protects against inflammatory processes, improves metabolism.

In conclusion, it is worth noting that if you experience tinnitus or deafness, you should consult a doctor and undergo a comprehensive examination. Thanks to timely detection and removal of the neuroma, the patient has an increased chance of maintaining hearing and cranial nerve function.

PONTOCEREBELLAR ANGLE (angulus cerebellopontinus) - the space where the pons (pons), medulla oblongata and cerebellum meet. M. u. open anteriorly, to the base of the skull, in the region of the posterior cranial fossa (Fig. 1). On the ventral side of M. u. covered arachnoid, the edge does not go deep into it, but is located superficially, as a result of which a container for cerebrospinal fluid is formed in this area - the lateral cistern of the bridge (cisterna pontis lat.), often identified in the literature with M. at. in the broad sense of the word. In this case, under M. u. understand a narrow space resembling a flattened irregular pyramid in shape, bounded in front and on the side by the posterior surface of the pyramid of the temporal bone, from the inside by the junction of the pons, medulla oblongata and cerebellum, constituting the apex of the cerebellopontine region, behind by the surface of the cerebellar hemisphere, and above by the tentorium of the cerebellum. In the area of ​​M. u. (Fig. 2) the roots of the V-XI pairs of cranial nerves, the anterior inferior cerebellar and labyrinthine arteries and numerous cerebellar veins flowing into the superior petrosal sinus are located, among which the flocculus vein is distinguished by its constancy.

Pathology

In M. u. patol, processes of both inflammatory and tumor nature develop.

Arachnoiditis M. u. usually develops after infection, in acute stage there is pleocytosis in the cerebrospinal fluid, in chronic - the cerebrospinal fluid is normal, there are no changes in the internal auditory canal on radiographs, audiometry reveals bilateral hearing loss, and vestibular excitability often increases (symptom of cochleovestibular scissors); dizziness is common. Arachnoiditis (see) often leads to the formation of arachnoid cysts, which cause symptoms of an inflammatory and compression nature.

Of the neoplasms of M. u. the most common are neuromas of the auditory (vestibular-cochlear, T.) nerve (see vestibular-cochlear nerve), less often meningiomas, cholesteatomas and tumors of the cerebellum or brain stem, spreading to the M. at. These tumors appear first focal symptoms, which are caused by damage to the area of ​​the brain or nerve that is the source of tumor growth (auditory nerve, brain stem), and then, as the tumor grows, symptoms of damage to adjacent brain formations and general cerebral symptoms develop (headache, hypertensive changes on craniograms, congestion on fundus). The latter are associated with secondary occlusion of the cerebrospinal fluid ducts at the level of the posterior cranial fossa (see Occlusion syndrome).

Neuromas give pronounced symptoms of damage to the auditory nerve; edges often appear long before all other symptoms. The disease usually begins with local symptoms- slow and gradual hearing loss in one ear of the sensorineural type. Wedge, the picture with neuromas is initially characterized by damage to the cranial nerves in the cerebellopontine angle. Later, brainstem and cerebellar disorders appear, more pronounced on the side of the tumor. All symptoms have a clear lateralization. The phenomena of increased intracranial pressure develop relatively late. There are 3 stages in the development of neuromas:

1. Early stage- the tumor is small in size (1.5-2 cm). During this period, only the cranial nerves in the mucous membrane are affected: vestibular-cochlear, trigeminal, facial, glossopharyngeal (on the side of the tumor, hearing, vestibular excitability, and taste in the anterior 2/3 of the tongue are reduced or lost; mild dysfunction of the trigeminal and facial nerves is noted ). Hearing loss begins at high frequencies, and the intelligibility of received speech suffers more; sound in Weber's experiment (see Weber's experiment) does not lateralize, despite unilateral deafness. There are no stem and hypertension symptoms. In almost half of the patients, radiographs show that the internal auditory canal is widened, and in almost all patients the protein content in the cerebrospinal fluid is increased. Some of these tumors are clearly detected by computed axial tomography. At this stage, diagnosis is difficult. Surgery is the most effective (the tumor is completely removed). Facial nerve function is often preserved.

2. Stage of pronounced wedge, symptoms - tumor size approx. 4-4.5 cm in diameter. The tumor affects the brain stem, cerebellum, and often causes hypertension. Multiple spontaneous nystagmus is detected (in the direction of the tumor it is larger, tonic, and in the healthy direction it appears even with direct gaze), optokinetic nystagmus is disrupted (see), ataxia appears on the side of the tumor, the trigeminal and facial nerves. The clinical picture of the disease at this stage in most patients is clearly expressed. In most cases, the tumor can be completely removed. After surgery, facial paralysis often develops.

3. In an advanced stage, swallowing disorders, damage to the cranial nerves and brain stem are added healthy sides e, severe hypertensive-hydrocephalic phenomena.

Meningiomas and cholesteatomas M. u. the symptoms are similar to acoustic neuromas, but signs of damage appear later and may not be so pronounced. With cholesteatomas, the cerebrospinal fluid contains an increased content of cellular elements with a normal protein content.

The diagnosis of patol, processes localized in M. u., is based on data from the clinical picture and rentgenol, research methods - craniography (see) and radiopaque studies of the cerebrospinal fluid and vascular systems of the brain (see Vertebral angiography).

Thorough tomographic examination of the skull, in particular the pyramids temporal bones(see Tomography), the use of pneumoencephalography (see) and cisternography (see Encephalography) make it possible in most cases to detect even relatively small tumors of M. at. Has high diagnostic efficiency CT scan(see Computer tomography), with the help of a cut you can detect space-occupying formations of M. at. diameter, up to 1.5-2 cm (Fig. 3).

Craniographic diagnosis of tumors of M. u. is based on local changes in the bones of the skull caused by the direct influence of the tumor, and long-term changes caused by displacement of brain structures and compression of bones, disruption of the outflow of cerebrospinal fluid and displacement of its reservoirs, compression and displacement of blood vessels in the posterior cranial fossa.

For greater reliability, rentgenol. signs of a tumor are produced by the following paired craniograms of the diseased and healthy sides on one film under identical shooting conditions: transverse radiographs of the temporal bones according to Stenvers; direct radiographs with projection of the pyramids into the orbits; Posterior semiaxial radiographs to identify destruction of the posterior surface of the pyramid. Of primary importance are the Stenvers images, which give an idea of ​​the size of the internal auditory canal on the side of the tumor, the state of its upper and lower walls, the deep ampullary part, the relationship of the tumor bone defect to the cochlear capsule and the vertical semicircular canal of the labyrinth (Fig. 4, i, b ). Sometimes photographs with a projection of the pyramids into the eye sockets are more informative.

According to craniography data, it is sometimes possible to differentiate various tumors of M. u. Thus, meningiomas rarely cause expansion of the internal auditory canal, more often destruction of the apex of the pyramid and its surfaces with uneven outlines, calcareous inclusions are often observed along the periphery of the tumor (Fig. 5); with cholesteatomas, there is a sharp expansion of the internal auditory canal with destruction of the anterior surface of the pyramid and linear arched calcareous marks with smooth outlines of the adjacent bones.

On vertebral angiograms for acoustic neuromas, the tumor vasculature is rarely contrasted, and therefore symptoms of vascular displacement (secondary signs) are of primary importance. When the tumor spreads caudally, the basilar artery is pressed against the clivus (Blumenbach's clivus) and laterally displaced in the opposite direction. As the tumor grows in the oral direction, the basilar artery moves posteriorly from the clivus and in the opposite direction.

The superior posterior cerebellar arteries on the side of the tumor are displaced upward and medially. The inferior cerebellar artery on the side of the tumor is usually displaced downward. With meningiomas, the tumor vasculature is often visible.

Pneumocisternography and pneumoencephalography can reveal different rentgenol signs: lack of filling of the lateral cistern of the bridge due to its closure by a tumor; detection of a tumor in the form of a filling defect in the lateral cistern of the bridge; displacement of the IV ventricle, cerebral aqueduct (Aqueduct of Sylvius) to the opposite side and compression of the lateral inversion of the IV ventricle by the tumor. When the tumor spreads orally, the cerebral aqueduct and the fourth ventricle are displaced posteriorly. Positive ventriculography (see) with mayodil emulsion for M. tumors. reveals a displacement of the cerebral aqueduct and the fourth ventricle in the opposite direction with defects in the filling of the lateral eversion of the fourth ventricle. When the tumor spreads orally, these formations move in an arcuate manner backwards and upwards. Such symptoms can be detected both with occlusion of the fourth ventricle and in the absence of disturbances in the patency of the cerebrospinal fluid pathways, which is important for the early diagnosis of tumors. The severity of the symptoms described above depends more on the direction of tumor growth than on its nature.

Operations in the field of M. at. taken for diseases associated with damage to the nerves passing through the muscle. (Meniere's disease, neuralgia of the trigeminal and glossopharyngeal nerves); arachnoiditis M. u. and its tumors (acoustic neuromas, meningiomas, cholesteatoma, etc.).

During operations, unilateral approaches are used. The most widespread are the accesses proposed by W. Dendy and A. W. Adson (Fig. 6, a, b).

With the Dandy approach, a parabola-shaped incision of soft tissue is made.

The skin, subcutaneous tissue, aponeurosis and muscles covering the occipital bone on the side of the operation are dissected. A skin incision is made at the midline, at the point of intersection of the midline with the lower nuchal line (linea nuchae inf.). From this point, the incision is directed towards the lesion and, rising in an arcuate manner, reaches the junction of the upper nuchal line (linea nuchae sup.) with the lambdoid suture.

Then the incision line goes down along the convexity of the mastoid process, almost to its apex.

Bleeding is stopped by diathermocoagulation (see). Educated thus. the flap is separated from the bone and retracted downwards. If there is bleeding from the emissary veins of the bone, it is stopped by rubbing wax.

Then a milling hole is made in the exposed surface of the occipital bone and expanded with pliers to the required size.

At the midline, the burr hole does not reach the external occipital crest; outward it reaches the mastoid process, from above it reaches the superior nuchal line or the lower edge of the transverse sinus. From below, the edge of the trepanation window ends approximately at the level of the upper edge of the foramen magnum, which corresponds to the place of thickening of the occipital scales. The dura mater of the brain is cut with a cross-shaped incision. During operations on the nerves that take place in the cerebellum, after opening this membrane, good access to its formations is created, for which purpose the cerebellar hemisphere is lifted upward and somewhat medially with a careful movement.

The cerebellopontine angle is exposed after the leakage of cerebrospinal fluid from the lateral pons cistern.

For tumors of M. u. Often, to create good access, it is necessary to resort to resection of the lateral part of the cerebellar hemisphere. For this purpose, the cerebellar cortex is coagulated and after its dissection and aspiration of the white matter, the desired portion of the cerebellum is removed.

When using the Adson approach, a linear skin incision is made approximately halfway between the midline of the occiput and the mastoid process (Fig. 6, a). At the top, the incision begins from a point located 2-3 cm above the upper nuchal line, and then is lowered vertically down to the level of the arch of the atlas. Skin and underlying soft fabrics gradually cut to the bone. Bleeding is systematically stopped by coagulation, due to which the operation, as a rule, is almost bloodless. The muscles are separated from the bone using a raspatory and a coagulation knife and spread apart using automatically self-retaining wound retractors. Then a milling hole is made. If, when biting the bone towards the mastoid foramen and damaging the emissary vein passing through this hole, venous bleeding appears from the emissary, it must be covered with wax in order to prevent air embolism. The dura mater of the brain is dissected as described during the Dendy approach, and further manipulations are performed. Some neurosurgeons, in addition to the described trepanation of the occipital bone, additionally bite the edge of the occipital bone and the arch of the atlas on the corresponding side. This is usually done when removing large tumors (neurinomas, meningiomas) of the cerebellopontine angle.

Chemotherapy and radiation therapy, combined with surgical intervention, are identical to those for other brain tumors - see Brain, tumors.

Bibliography: Egorov B.G. Neuroma of the VIII nerve, p. 80, M., 1949; 3 l about t-n and to E.I. and Sklyut I.A. Neuromas of the auditory nerve, Minsk, 1970; K o p y-l ov M. B. Fundamentals of X-ray diagnostics of brain diseases, p. 211, M., 1968; Fundamentals of practical neurosurgery, ed. A. L. Polenova and I. S. Babchina, p. 233 and others, L., 1954; Ad son A. W. A straight lateral incision for unilateral suboccipital craniotomy, Surg. Gynec. Obstet., v. 72, p. 99, 1941; G u s h i n g H. Acoustic neuromas, Laryngoscope, v. 31, p. 209, 1921; D a n d y W. E. Removal of cerebellopontile (acoustic) tumors through a unilateral approach, Arch. Surg., v. 29, p. 337, 1934; Kleinhirnbriickenwinkel-Tu-moren, Diagnostik und Therapie, hrsg. v. D. Plester u. a., B., 1978; P ertui set B. Les neurinomes de l'acoustique developpes dans 1'angle ponto-cerebelleux, P., 1970; T a v e r a s J. M. a. W o o d E. H. Diagnostic neuroradiology, Baltimore, 1964. I. S. Blagoveshchenskaya (otoneurologist),

E. I. Zlotnik (neurosurgeon), 3. N. Polyanker (rent.), V. V. Turygin (anat.).

Another picture, also quite well outlined, is tumor of the cerebellopntine angle. Here we are talking about a neoplasm, which is located in a depression limited by the pons, medulla oblongata and the cerebellum. Most often, such tumors come from the auditory nerve, less often from other neighboring ones. To make the picture of the disease clearer to you, I will list the formations located here that are functionally important: 1) the auditory nerve; 2) facial nerve - by location, two nerves very close to each other; 3) other bulbar nerves; 4) abducens nerve; 5) trigeminal nerve; 6) pons; 7) medulla oblongata and 8) one hemisphere of the cerebellum. The progression of the disease here is very slow. The beginning is very typical with irritation of the auditory nerve: the patient has been bothered by noise in one ear for many months, sometimes even several years. Then symptoms of loss appear: he becomes deaf in this ear. At the same time, paresis of a close neighbor, the facial nerve on the same side, appears. We can say that this entire stage of the disease is the most important for diagnosis: if the doctor himself can observe it or get an accurate story about it from the patient, then this will be the basis for the diagnosis. At the same time, partly general cerebral phenomena, which are usually expressed very rarely here, partly irritation of the trigeminal nerve is created by headaches, and objectively - loss of corneal and conjunctival reflexes. Then compression of the cerebellum begins and the development of cerebellar phenomena. They can be expressed first by hemiataxia on the side of the tumor, and then by general cerebellar ataxia, adiadochokinesia, unsteady gait, and a tendency to fall towards the tumor. decreased muscle tone and dizziness. Even later comes the turn of the bulbar nerves, as well as the abducens and trigeminal nerves. And finally, compression of the pyramids in the pons or in the medulla oblongata causes paralysis of the limbs.

I repeat once again that general cerebral phenomena here, as in general with tumors of the posterior cranial fossa, are strongly expressed, especially starting from the second stage of the disease, when paralysis develops. From this point on, the disease generally moves forward quickly, in contrast to the first period, which most often lasts for a very long time.

8. course of brain tumors.

To end the clinical picture of brain tumors, it remains for me to say a few words about their course. It is always protracted, chronically progressive, the disease slowly grows over many months or even several years, and according to the rule common to all neoplasms, in the absence of medical intervention inevitably leads to death. Occasionally, during the course of the disease, exacerbations are observed - due to hemorrhages into the tumor substance.

I have given you a quick sketch of the brain tumor clinic. You probably noticed what I warned you about from the very beginning, namely, the vagueness and indistinctness of all these pictures, especially striking if you remember many of those clear, sharply defined clinical descriptions that you've heard before. The reason for this phenomenon does not depend at all on the lack of good will on my part - it lies in the fact that now it is generally impossible to do anything more. And this, in turn, depends on the lack of our diagnostic information. Indeed, when you try to apply everything that I have told you in practice, you will often be seriously disappointed: you will not be able to correctly make a topical diagnosis. I can reassure you, if this can only be called reassurance; the most experienced specialists make the same mistakes in a very large percentage of cases.

Rice. 129 Brain tumor. Bilateral ptosis.

If this is so, then it is quite natural to need some more auxiliary research techniques that could have their say when ordinary neurological research refuses to say more.

Recent years have been rich in attempts to propose such methods. Most of them are clearly temporary in nature: they are technically difficult, burdensome, and sometimes even unsafe for patients. But I will still list them for you so that you can once again see for yourself what difficult and winding paths science takes.

I'll start with a regular x-ray examination. Such images especially facilitate the diagnosis of a tumor of the appendage of the brain if an expansion of the sella turcica has already been created. Tumors: vaults, emanating, for example, from the membranes and giving rise to the bones, are also sometimes suitable for a conventional x-ray. But most of them are still not suitable for conventional radiography. Therefore, there are also attempts at so-called ventriculography: air is blown into the cavity of the cerebral ventricles through a needle, and then a picture is taken. Air creates contrasts, and sometimes you can, for example, consider the following pictures: an undiagnosable tumor sits in the white matter of the hemisphere, it protrudes one of the walls of the ventricle and changes its contours; This contour is used to judge its localization. In addition to air, they are trying to use various contrasting mixtures, for example indigo carmine; the essence of their action is the same as that of air.

Under local anesthesia, a series of test punctures are made: a needle is injected into different parts of the brain to different depths, tissue particles are sucked in with a syringe and examined under a microscope. In this way, it is possible to obtain a tumor particle and find out not only its location, but also its anatomical nature. The smoothly shaved skull is tapped and listened to: sometimes the “sound of a cracked pot” and other shades of percussion sound are heard over the tumor; Sometimes noises are heard during auscultation. A series of punctures are used: ordinary lumbar, so-called suboccipital and finally puncture of the cerebral ventricles. At the same time, the state of fluid pressure in the subarachnoid cavity and in the ventricles is determined. If, for example, the pressure in the ventricles is much greater than in the spinal cavity, then this indicates a complete or partial blockade, that is, narrowing or closing of the foramina of Magendie and Luschka; and in case of tumors this indicates localization in the posterior cranial fossa. By the way, a few words about cerebrospinal fluid. In general, it can represent different paintings, ranging from normal to an increased amount of protein, pleocytosis, xanthochromia. But in the mass there is still a tendency to give a kind of dissociation: increased protein content and absence of pleocytosis. Of course, lues cerebri, especially its gummous form, must be excluded by all existing means. But you know that modern technology research cannot always do this, and often the doctor remains suspicious of syphilis, despite negative data. That is why the rule still remains in force: when there is a picture of a compression brain process, always prescribe a so-called explorator, trial course specific treatment. It should be done for about a month, since shorter periods do not provide complete confidence that there is no syphilis. pathological anatomy. Almost all known types of neoplasms can develop in the brain, some primarily, some metastatically. Cancer can develop primarily in the appendage of the brain, but in other places it occurs only in the form of metastasis. Largest number tumors, almost half of all cases. constitute gliomas; then about 20% give rise to adenomas; and finally the last third of all cases occur in all other species. The microscopic picture of tumors has already been studied by you in the course of pathological anatomy, and therefore I will not dwell on it (Fig. 130).

As for the changes in the nervous tissue itself, they come down to the well-known degeneration of fibers, cell disintegration, sometimes to a weak inflammatory reaction on the part of the blood vessels and to significant phenomena of edema and stagnation. pathogenesis and etiology. The pathogenesis of clinical phenomena has already been partly discussed by me and partly should be understandable to you based on everything that you already know about vascular processes and syphilis of the brain. Therefore, there is no point in talking about this again. Likewise, it is not difficult to imagine the mechanism of anatomical changes on the part of the nervous system: the reasons that create them are: 1) mechanical compression of the nervous tissue by the tumor; 2) its swelling due to dropsy and stagnation from compression of the vascular system; 3) random hemorrhages and softening; 4) toxic effects from the tumor on nervous tissue and 5) general metabolic disorders: cachexia, anemia, diabetes, etc.

Men get the disease approximately twice as often as women. Neoplasms can develop at any age, from early childhood and ending old age. But the vast majority of all cases, about 75%, occur in youth and middle ages, up to 40 years old. Before and after this period, tumors are rarely observed. You have probably heard a lot about the causes of tumors in lectures on pathological anatomy, and you know that these causes are currently unknown. The main doctrine, which is still dominant today, sees in neoplasms the result of embryonic anomalies, the development of stray tissue sprouts, which for a long time were, as it were, in a dormant state, and then under the influence of some additional conditions suddenly received the energy of growth.

Rice. 130. Tumor of the occipital lobe of the brain.

In general, as you can see, the main method of treating tumors - surgery - does not promise much for the patient. And therefore, only a small percentage of patients can count on recovery - complete or with a flaw.

Behind last years Before our eyes, a new principle of treatment of neoplasms is emerging - already conservative, with the help of so-called radiation therapy: I mean treatment with radium and X-rays. These methods are still in the development stage, and it is too early to talk about them categorically. Scattered observations of individual authors provide both undoubted failures and dubious successes. Here we still have to wait for the accumulation of facts.

In the absence of radical therapy, we are left with the sad and unfruitful task of symptomatic therapy. Unfortunately, there is no need to talk much about it. This is the entire arsenal of painkillers, including the most powerful ones - in the form of morphine. This is followed by specific, mainly mercury, treatment, which helps the resorption of edema and dropsy and thus gives temporary relief to the patient. Finally, the so-called palliative valve-trepanation is sometimes used: part of the bone of the vault is removed in order to reduce intracranial pressure and thus temporarily alleviate the course of the disease.


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Alternative names: magnetic resonance imaging of the brain and cerebellopontine angle.

The cerebellopontine angle is a small area of ​​the brain bounded by the cerebellum, medulla oblongata, and pons. Within this angle, two pairs of cranial nerves leave the brain - VII and VIII (vestibular-cochlear and facial nerves). In the immediate vicinity of the cerebellopontine ganglion, there are two more pairs of cranial nerves - V and VI (trigeminal and abducens nerves).

When various pathological processes, such as tumors or inflammation, are localized in the area of ​​the cerebellopontine ganglion, symptoms of damage to these nerves are noted. The most informative method for diagnosing damage to this area is magnetic resonance imaging of the brain with targeted scanning of the cerebellopontine angle area.

Indications for MRI of the cerebellopontine angles

MRI of the brain, of which MRI of the cerebellopontine angle is part, is done for the following conditions and diseases:

  • suspected brain tumor;
  • diagnosis of intracerebral and subarachnoid hemorrhages;
  • infectious diseases central nervous system;
  • abscess of the cerebellopontine region;
  • abnormalities of brain development;
  • thrombosis of the venous sinuses;
  • postoperative monitoring of patients undergoing brain surgery;
  • preparation for surgical treatment of brain tumors.

The basis for targeted tomography of the cerebellopontine ganglion is signs of damage to the cranial nerves from the V to the VIII pairs.

Such signs are the patient’s complaints about:

  • hearing disorders – hearing loss;
  • dizziness, which is a sign of damage to the vestibular apparatus;
  • paralysis of facial muscles;
  • impaired sensitivity of facial skin;
  • taste disorders;
  • hypersecretion of tears.

Preparation

No special preparation is required. Before the procedure, the patient must remove all metal objects.


For children and emotionally labile patients, MRI of the brain can be performed under sedation.

How is an MRI of the cerebellopontine ganglion performed?

Scanning is carried out in T1 and T2 modes, which improves diagnostic accuracy.

The procedure takes 15-30 minutes. According to indications, tomography with intravenous administration contrast agent.

Interpretation of results

The most common tumor of the cerebellopontine angle is neuroma (schwannoma) of the 8th cranial nerve. On a series of tomograms of a tumor of the cerebellopontine ganglion, these tumors are visualized quite clearly. In difficult cases, intravenous contrast is used to more clearly determine the boundaries of the tumor.


In the protocol described by the doctor radiology diagnostician, reflects the state of the brain structures, its symmetry. The presence or absence of pathological volumetric formations, when their tumors are measured, they are measured. Tomograms can be used to determine whether other brain structures are involved in the tumor process - this fact affects the prognosis of surgical treatment of tumors.

Additional Information

MRI of the cerebellopontine angle is a fairly accurate method for diagnosing tumor processes in this area. The advantages of this method are high accuracy of the study, the disadvantage is high cost and inaccessibility for some categories of patients.

Alternative this method research - positron emission tomography, however, it is less accessible, and in terms of diagnostic accuracy it is only slightly superior to MRI.

Literature:

  1. Rameshvili T.E. Difficulties in X-ray diagnostics of tumors of the brainstem and peri-brain region // 4th All-Union. Congress of Neurosurgeons: Proc. report: - M., 1988.-S.
  2. Enzmann DR, O"Donohve J. Optimizing MR imaging for detecting small tumors in the cerebellopontine angle and internal auditory canal. Am J Neuroradiol, 1987
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