Benign neoplasm VIII cranial nerve, consisting of cells of the Schwann shell. Clinically manifests itself with a decrease in hearing, noise and ringing in ear, vestibular disorders on the side of the defeat, symptoms of the compression of the facial, trigeminal, discharge nerve, brain barrel and cerebellum, signs intracranial hypertension and hydrocephalus. The neuro of the auditory nerve is diagnosed due to the radiography of the temporal bones, MRI or CT of the brain. Depending on the size of education, it is possible its surgical and radiosurgical removal, radiotherapy. In some cases, it is advisable to monitor the tumor in dynamics and the solution of the issue of treatment tactics only when identifying the progressive growth of education.

General

VIII Couple of the CHMN - predver-ulitsky, or auditory, nerve consists of vestibular and auditory parts. The first carries in cerebral centers information from the vestibular snail receptors, the second - from the auditory. In the overwhelming majority of cases, the neurinoma is developing in the vestibular part of the sentence-snelled nerve, and the symptoms of the destruction of the auditory department are associated with its squeezing tumor. Near the predver-snital nerve pass: the trunk of the facial nerve, a triple nerve, a discrepancing, languagehill and wandering nerves. As neurinoma grows in clinical picture Symptoms of compression of these nerves may arise, as well as the adjacent brain structures.

Powerful growth of the tumor over time leads to a complete deafness on the side of the defeat, the attachment of the symptoms of the defeat of nearby structures. However, it should be remembered that the severity of symptoms does not always correlate with the sizes of the tumor. Depending on the localization of the neurine and the direction of its growth, with small sizes, it can give a heavier picture than a major neoplasm, and vice versa.

First of all, the neuro of the auditory nerve causes compression trigeny nerveThat is accompanied by facial pains and paresthesias on the side of the tumor. Pain pains have a stupid, suitable character; First, the type of paroxysms occur, and then become permanent. Sometimes they are taken for dental pain or neuralgia of a trigeminal nerve. A little later or simultaneously with face pain, symptoms of peripheral lesion of the facial nerve (parishes of mimic muscles and the associated facial asymmetry, a disruption of sowing, loss of taste on the front 2/3 of the language) and a discharge nerve (diplopia, converging squint). If the neuromance of the auditory nerve is located in the inner hearing aisle, the symptoms of the facial nerve compression can be manifest in the early period of the disease. In such cases, it is necessary to exclude the neurut of facial nerve.

A further increase in the neurinoma leads to the damage to the wandering and language nerves with a violation of the lantern, dysfagia, loss of taste on the back of 1/3 of the language and the extinction of the pharyngeal reflex. When squeezing, the cerebellum appears a cerebelchik ataxia. Even in the launched cases, when squeezing the brain barrel, sensory and motor conductor disorders are expressed extremely weakly; Pares are noted in exceptional cases.

In the third stage of the neuromance of the auditory nerve is characterized by signs of intracranial hypertension. Arises headache In the back of the head and the frontal area, accompanied by vomiting. At ophthalmoscopy, congestive discs of optic nerves are noted. Perimetry can identify individual cattle or hemianopia, which is associated with the compression of the chiasma and optical paths.

Diagnostics

Radiography and methods of neurovalization helps more accurately determine the diagnosis of "non-hearing nerve". On the early stages With small sizes of the neurine (up to 1 cm), it is usually not visualized using a CT brain. Therefore, the skull radiography is carried out with a visible image of the temporal bone. In confirmation of the diagnosis of the vestibular Schwanne, the expansion of the internal auditory pass is evidenced. Since the neurine is well absorbed by the contrast, it is possible to use CT with contrast. At the same time, education with clear sleeve contours is visualized.

MRI of the brain in the case of the neurinoma reveals on T1-suspended images hypox or isopenistic, and on T2-weighted - hyper-trienses. For tumors of 3, and more cm is characterized by the heterogeneity of the signal associated with the presence of cystic sites in them. It is possible to visualize the deformation of the brain and cerebellum. When performing a contrasting mp tomography, a heterogeneous accumulation of contrast is observed in 70%.

Treatment

The radical treatment method is the removal of a neuromet, which can be carried out by an open surgical method or radiosurgery methods. Surgical removal is appropriate with a high tumor, when it is revealed to increase its size in the dynamics of observations, with the growth of the neurine after radiosurgical intervention. Often the consequence of the operation are deafness and paresis of facial nerve. Stereotactic radiosurgical removal is possible for a neuro size of less than 3 cm. It is also carried out in older patients with extended growth after subtotal resection and in cases where the risk of operation is significantly increased due to somatic pathology.

The radiation therapy of the neurinoma has indications similar to the testimony to radiosurgery. Exposure is not a way to remove education, but prevents its further growth and avoids the operation. Patients with randomly detected by CT or MRI with a nevinoma without clinical symptomatics, patients with long-term hearing disorders and elderly patients with weak symptomatics showed expectant tactics with constant control of education and dynamics clinical symptoms.

Forecast

The outcome of the neurine largely depends on the timeliness of the diagnosis and size of the tumor. The forecast is favorable with adequate treatment of vestibular shwannoma in the I and II stages. During the radiosurgical removal in the early stages of 95%, the cessation of growth and the complete restoration of the patient's working capacity is noted. In surgical intervention, the risk of hearing loss and damage to the facial nerve is high. IN III Stages The prediction is unfavorable: the patient can die during the surrender of vital cerebral structures increasing the tumor.

Nevnoma auditory nerve is also called Shwannoy vestibular nerve And accompanied by the emergence of a benign tumor in the region of the eighth cranial nerve (predver-snelled) in the area of \u200b\u200bmyelin shell.

A similar pathological process of primary intracranial neoplase is not metastasive.

Despite the positive forecast, the tumor may increase, leading to a loss of hearing and other negative consequences.

According to statistical data, a similar tumor is about 10% of all brain tumors and is found mainly in people of 30-40-year-old age. In children, before the beginning of puberty, there was no such disease.

Causes and factors of development

Today, the reasons for the development of the neuromy of the auditory nerve and the risk factors for the appearance of this disease are not yet established.

It is a genetic predisposition and is the main, and perhaps even the only reason for the appearance of Svannya vestibular nerve.

Children inherit abnormal genes from parents, which in the future is manifested by the development of such a tumor.

In complicated cases, this disease is a sign of a second type neurofibromatosis. Such pathology is the main cause predisposing to the formation of tumors in the body.

In the presence of neurofibromatosis of the second type, most often the neurinoma is developing on both sides.

Signs and symptoms of the neuromy of a hearing nerve

Depending on the size and direction of tumor growth, a squeezing process may appear, negatively affecting the cerebellum, facial and triple face nerve, the bridge, 9-11 pairs of cranial nerves (wandering, languagehilic, sublard).

Similar pathological changes in the body are manifested. Reduced hearing, To which the squeezing of the ulobal area of \u200b\u200bthe nerve is tumor. When influencing the brain, respiratory and vascular centers may be disturbed, which can be dangerous even for life.

The symptoms of the neurinoma of the auditory nerve may not manifest themselves throughout the year or several years with an increase in the size of the tumor.

In some people tumor education remains small And does not make itself felt. In this case, the treatment should not be carried out, it is recommended only to undergo regular medical examinations.

In accordance with the fact that for the nurses of the auditory nerve, squeezing is characterized, the symptoms of the neuromy of the auditory nerve can be divided into the main groups for which the following are characteristic manifestations:

• the defeat of the cranial brain nerves;
• squeezing the brain barrel;
• cerebellum disorders.

The severity of symptoms depends not only on the region of localization of the neoplasm, but also from its size.

But not for each case of the course of the neuromy is characterized by a similar fact, because sometimes even when the symptoms appear, symptoms may be absent. Even a small tumor can deliver a large discomfort to a patient, which depends on which fabrics and organs it squeezes.

To the earliest manifestations of the neuromy of the auditory nerve can be attributed defeating auditory nerveWhat is observed in almost 95% of patients and is accompanied by a ringing in the ears, a decrease in hearing.

In 60% of cases observed symptoms lesion vestibular nerve, which is expressed in periodic instability or dizziness with sharp movements of the head or body.

Thus, the main symptoms of the nevinoma of the auditory nerve can be attribute

• reducing the hearing functions by the localization of the tumor, which may occur suddenly;
• the appearance of characteristic noise in the ear on the side of the defeat;
• periodic dizziness and disability;
• when squeezing the facial nerve, the appearance of tingling and numbness of the part of the face is possible.

Stages of the disease

Today, only three stages of the neuromy of the auditory nerve are known:

1. The first stage - The tumor does not exceed 2 cm in diameter and is accompanied by a characteristic disruption of hearing functions and the vestibular apparatus. It is possible to appear problems in the work of taste receptors or slight injury to the facial nerve;
2. Second stage - the tumor increases to the size of the walnut and may be accompanied by a violation of coordination of movements and the appearance of sharp movements of the eyeballs;
3. Third stage - Education reaches sizes chicken egg and is accompanied by symptomatics of squeezing of the brain: the development of nystagma, hydrocephalus and impairment of vision.

Most often, the neuromance of the auditory nerve is manifested in the early stages of development, so the third stage is very rarely diagnosed. That is why mortality from this pathology is practically absent, inferior to a positive outcome of the disease.

Diagnostics

The diagnosis of the neuromy of the auditory nerve begins with the analysis of the anamnesis of the disease.

The ear surveys and nervous system.

All patients in the presence of suspicion on the unwitting auditory nerve it is recommended to go through the following research:

1. Audiogram of pure tone - Effective diagnostic procedure with initial screening, which allows you to determine functional state hearing and get data necessary for further comparison;
2. Electronistgmography - The study is effective only with a pronounced nevinoma, since when the tumor is localized in the lower domain of the vestibular apparatus gives normal results. The functions of the vestibular nerve are preserved until almost all fibers are affected;
3. Radiological diagnosticsa (MRI, CT, thanks) - make it possible to visualize even small neoplasms.

Healing procedures

There is no single approach for effective treatment Nevnomes of auditory nerve, as each way of exposure to the disease has certain advantages and risks.

Specialists from almost all patients suffering from this disease are recommended to pass radiosurgical intervention Before starting which it is carefully studied possible benefit other methods of impact on the tumor.

Among the possible treatment options for the neuromy of auditory nerve can be noted Next:

1. Expectant tactic - control of symptoms and hearing (audiometry). Observation of changes in the tumor (MRI and CT) first once every six months (for 2 years), and after once a year (under the condition of stable tumor state). The operation is assigned only when progressing the neoplasm.
2. To facilitate the state of the patient, it is recommended to take package, anti-inflammatory and diuretic Preparations.
3. Radiation therapy - used as independent treatment or in addition to surgical intervention.
4. External irradiation.
5. SRH - stereotactic radiosurgery.

Surgery

It is also possible to remove the neurine hearing nerve with the help of the operation - possible accessories:

1. Rectosigmoid (Subocital) - provides the ability to save hearing.
2. TransLabrinth - It is carried out in various modifications and most often accompanied by damage to hearing. This version of surgical intervention makes it possible to maintain the functionality of the seventh nerve.
3. Extradural ilossochny - It is performed through the score exclusively for small lateral neuro auditory nerve.

Caution, video operations! Click to open

Consequences of the disease

Operational interference with small tumors - in 95% of cases helps to completely get rid of the tumor.

Mortality in this case does not exceed 1%. Surgery At the initial stages of the development of the neurine, it allows you to maintain auditory functions.

Surgical operation for large neoplasms - virtually 2/3 patients The face paralysis develops due to the lesion of the facial nerve.

Such pathology threatens a characteristic violation of the functioning of mimic muscles controlling blinking and chewing.

Radiation therapy (radiosurgery) - this technique of exposure to the tumor can accompanied by late development side Effects which are in the loss of hearing, nerve damage and facial paralysis.

The consequences of the neurinoma of the auditory nerve will be the less than the treatment began.

Preventive measures

Due to the fact that the reasons for the appearance of the nurses of the auditory nerve were not studied to the end, uniform preventive Mer Also not provided.

The article considers the tumor under the name of a neurinoma (or shwannoma), which comes from the cells of nerve shells. You will learn what features a benign and malignant shape of the neuro, as the tumor is manifested in different parts Body (spine, brain, limbs), how is the treatment and what are the predictions for patients?

Symptoms and neurinoma treatment

Nevninoma or Svannya (C47 ICD) is a rare soft tissue tumor that amazes the shell of the nerves, namely, Schwann's cells. In most cases, it is benign, but there are also malignant options. Malignant Schwann is called a neurosarcoma.

Oncology can occur in nerves in any part of the body. The neurinoma is preferably a single character, but there are also multiple lesions.

The most common places localization of these tumors are:

• legs (in particular, sedlicated nerve);
• hands (shoulder plexus);
• back (spinal nevinoma or spinal cordoriginating from nerve roots);
• head and neck (brain-brain nerves).

Extremely widespread scuman auditory nerve. Rare variants include tumors of mediastinal nerves and retroperitoneal space.

The peripheral nervous system transmits signals from the head and spinal cord (central nervous system) to the muscles and body tissues. Onko-tube can compress and damage the nerve, causing various violations, even if it is benign.

Lymphatic metastasis of malignant Swannoma is rare. Hematogenic metastasis is usually found at a late stage in lungs or bones in 33-55% of patients. Also, the tumor spreads through the direct invasion of the surrounding tissues.

Classification of neuro

As noted earlier, the scums of the nerve can be:

1. Benign. They are a clearly delimited node that grows very slowly and may not cause any violations. Benign neuromans more often affect the fabrics of the neck, head, face, spine.
2. Malignant. A malignant nerve sarcoma may appear de Novo or as a result of the illicitality of a benign tumor. It is distinguished by the lack of clear boundaries, a soft-elastic consistency, a faster growth rate and the ability to form metastases in other organs. Malignant neoplasm reaches large sizes and it is harder to treat it. Typical location places - distal departments limbs (brushes, feet, forearm).

Interesting fact! Malignant Svanny soft tissues are predominantly young people aged 20-40 years old, while benign - older men and women aged 50-60 years.

Benign and malignant neuromans similar to clinical symptoms. Therefore, sometimes they are very difficult to distinguish. For the diagnosis, morphological verification is required.

When the tumor is discharged, its degree of differentiation changes:

• initially, it has the first (high) degree of differentiation. Its cells are practically no different from ordinary Schwann cells and are practically benign;
• for 2 degrees (moderate) there are more notable changes in the structure of tissues and accelerate the growth rate;
• 3 (Low) Differentiation degree indicates the most aggressive neurogenic sarcoma.

There are also 4 degrees that are assigned to non-differency neoplasms. Their histogenesis is very difficult to determine. Most neurosaric refer to 3 degrees of differentiation.

Causes of Schwannoma

Most of the causes of the occurrence of the neurine remain unknown, as tumors are usually developing in healthy people.

The causes of nerve tumors in some cases are such genetic diseases:

• neurofibromatosis 1 and 2 types;
• shvannomatosis;
• syndrome Gorlyn Golts.

Cases of oncology in the family, ionizing radiation and injury are also counted towards risk factors.

Symptoms of malignant shwannoma

General symptoms of the neuromy is:

1. the appearance of palpable formation under the skin;
2. soreness in this area (especially with pressing).

Oncooochoors in their arms and legs look like small formation of dense consistency, protruding over the skin. An apparent sign may not be if the nerve is damaged, which is deep in soft tissues.

Important!Nerves tumors can grow slowly for months or years without causing symptoms.

The remaining symptoms of Swannomes are specific, they depend on the location of the pathology:

I. Nevnoma of the brain or brain-brain nerves(It accounts for 10-13% of the skull cavity tumors).

The manifestations of the neurine brain nerves can be the most diverse, depending on which area will be damaged.

When the nerves arranged in the front of the skull, there are symptoms in the form of one-sided obstruction of the nose, hyposhythmia, nasal bleeding, atypical pain, localized swelling of the face.

When influencing the orbital department, exophthalm, nystagm, impairment of vision are present.

Long-catching nerve damage causes problems with speech and swallowing, dysphagia, lantern.

Nevnoma of auditory nerve (vestibular shwannoma) causes:

• worsening hearing or deafness;
• tinnitus;
• problems with equilibrium;
• dizziness when turning the head;
• spontaneous Nistagm.

The attacks may be accompanied by nausea and vomiting. In progression of the disease, pain in the part of the person where the tumor is located, as well as numbness. The neurinoma may affect the discharge nerve, causing a symptom of diplopia.

Damage to the trigeminal nerve and its branches is accompanied by:

• severe pain (burning);
• numbness of certain areas of the skin of the face (limited to the movement of eyebrows, lips, chin, etc.);
• atrophy of chewing muscles;
• loss of taste, increased salivation.

Musculatory dysfunction occurs late when the third division of a trigeminal nerve is involved in the process. Height inside the cavernous sine can lead to dysfunction of cranial nerves.

At the later stages in the patient, various neurological syndromes and intracranial pressure, accompanied by headache and nausea, are observed.

In severe cases, when the tumor squeezes the cerebellum or brain barrel, arise:

• convulsions;
• psyche disorders;
• intellectual disorders;
• disruption of breathing and cardiac activity;
• ataxia;
• hypotension of hands and leg muscles;
• change of vision fields.

II. The nerve tumor of the spine (is 20% of all tumors of this localization).

Symptoms of the spinal cord savanno may be back pain, numbness of legs or hands, weakness in limbs or paralysis. A common neurinoma of a horse-tail causes paralysis lower extremities, Pain in the lower back, giving up legs and buttocks, violation of functions bladder (incontinence, urine delay) and intestines.

III. Soft soft hand or feet - Problems with movement, weakness.

IV. Svanny mediastia- The manifestations of the malignant Schwannoe mediastum include pain in the chest or the thoracic spine, numbness in the hands, the skin of the body or neck, the change in the voice (belligence), difficulty breathing and swallowing, an increase in vessels on the chest, swelling and face formation.

V. Nevnoma Light- cough, shortness of breath, breathing pain.

Vi. China neuroma - Communion on the neck, problems with swallowing, numbness of the tongue, pain in the neck and shoulder.

VII. Nevnoma Morton - This tumor is localized in the foot, so people complain about pain in the foot or fingers. There may also be felt the presence of a foreign body.

In each case, a combination of various symptoms can be observed. At first they are not so pronounced, but as the disease progressing is becoming more and more.

Diagnosis of tumor

The diagnosis of malignant Schwannoma is difficult, since this tumor is rare, and the symptoms that it causes are similar to other more common diseases. To identify neurological disorders, special tests are carried out on sensitivity, reflexes, coordination of movements, etc. So the doctor will be able to understand how the nerve is damaged.

To eliminate other (non-cancer) ailments and confirm the diagnosis of such methods:

1. Radiography. The classic signs of malignant shwannomes on an x-ray are well limited mass, which displaces adjacent structures without direct invasion of them. It is characterized by cystic degeneration, but hemorrhage and calcification are very rare. Using radiography also examine organs chest, mediastinum and spine.
2. Computer tomography. CT is not so sensitive in the diagnosis of neurine, as MRI, but often it is the first study. CT is especially useful in assessing bone changes and search for metastases in the lungs.
3. MRI. It will help determine the exact location of the neoplasm, its connection with the nerve and surrounding tissues.
4. Biopsy. The tumor sample takes using a special needle and examine in the laboratory to establish its origin and malignant. The biopsy is not required if the doctors are confident in the benignness of the neurinoma (it grows slowly, it has clear boundaries).

Depending on the location of the neoplasm, additional research may be needed. For example, to study the spinal cord and its structures (including nerve roots), myelography is used, and when the audit nerve is defeated, an audiometry is prescribed, that is, a hearing study.

Treatment of neurinoma (Svannoma): benign and malignant

The treatment of Svannya depends on the location of the tumor, the severity of the symptoms, and whether the tumor is benign or malignant (cancer).

Operational treatment

With benign formations of small size, which do not cause pain and other symptoms, can apply expectant tactics: the patient is not treated, but only regularly check with MRI. When accelerating the growth of the tumor or the occurrence of some complaints, surgical removal is carried out.

Operation under malignant neuromans is mandatory. The neoplasm resectrates together with a small part of the surrounding tissue to increase the chance of radical removal. In severe cases, the limb amputation is required, but they are rare. Schwannomes in the early stages, as a rule, can be removed without nerve damage. Operations at the newarm in the hands and legs are considered fairly simple. Some patients can return home on the same day.

Complete surgical resection may be impossible due to the extensive nature of the tumor and its location (for example, in the neuromy of the brain or cranial nerves).

Radioshurgery

In the treatment of Svannya, the spine has certain difficulties associated with the possibility of damage. nervous root or spinal cord, so instead of surgery can use stereotactic radiosurgery. This is a non-invasive technique based on the effects of radioactive radiation (as in radiation therapy). The procedure is carried out using a special device "", which creates powerful radiation and sends it to the tumor. At the same time, the human body is fixed in a specially manufactured stereotactic frame, and the direction of the beam calculates the CT device to eliminate the error.

For 1-3, painless procedures, a duration of 30-60 minutes, it is possible to completely destroy a small neoplasm, but the result will be visible only in a few weeks. The tumor decreases in size and becomes inactive, and the surrounding healthy tissue practically does not suffer. Radiosurgery is also used to treat the scums of the brain, which is in hard-to-reach areas.

Chemistry and radiation therapy for malignant Swannoe

For the treatment of malignant Schwann, it is advisable to use adjudent or.

Postoperative antitumor therapy is necessarily assigned under the condition:

• incomplete removal of shwannoma;
• large tumor size;
• availability of regional or remote metastases.

Additional radiation impact and / or chemotherapy presumably help to destroy cancer residues, stop the growth of metastases, reduce the risk of relapse and extend the life of the patient, but their effectiveness has not been proven due to the lack of a large-scale study. In case of non-melectual irradiation neoplasms, they are the main method of treating the neuromy.

There is no standard chemotherapy scheme for nerve tumors, but some studies have noted a positive result from the use of high doses and. The number of courses varies from 4 to 6.

Unnunoid anti-inflammatory drugs can be prescribed as symptomatic treatment of neurine drugs, painkillers. For brain tumors, which cause hydrocephalus, the method of choice is shunting.

Recurious treatment

A few years after the operation, 50-55% of patients occur a recurrence of malignant Swannomes. If the tumor returns in the same place, then it means that it was not completely removed for the first time. Perhaps the microscopic oncocletes remained. This is enough to turn into a new sarcoma. Also, the recurrence may become metastasis (secondary tumor) in another organ or nerve.

Complications and consequences of nerve tumors

Surgical treatment of malignant Swannomes usually quickly removes symptoms associated with nerve damage. But in the launched cases, such unpleasant consequences may remain as:

• muscular weakness (if the muscle cannot return to the initial state);
• persistent violations of the function of the pelvic organs;
• hearing loss;
• irreversible paralysis.

The brain oncology is also dangerous in such phenomena as epilepsy, loss of vision, violation of movement coordination, respiratory or heart failure.

Svannya Malignant: Forecast

Benign tumors of nerve shells do not lead to death, therefore a 5-year life expectancy for such patients is 100%.

Even the malignant Swannomes grow slowly, compared to other sarcomas, so the forecast for them is very comforting. 5-year survival ranges from 37.6% to 65.7%. If the operation is impossible, the forecast will be worse. Also on the numbers affects the localization of the tumor. Thus, for neurogenic sarkes of the head and neck 5-year survival forecast below everything, it ranges from 15 to 35%.

A disease that is more known as a neuromy of an auditory nerve, there are alternative names: vestibular (or acoustic) shwannoma and acoustic neurinoma. Symptoms in 95% of cases begin to manifest itself in the form of a progressive deterioration of hearing, which is 60% accompanied by noise or ringing in the ears. The complexity of the detection of the symptoms of the neuromet of the auditory nerve and the treatment of the disease is that the slow growth of the tumor causes the presence of a long asymptomatic period, as well as the gradual occurrence of clinical manifestations.

History of detection and study

In 1777, Sandyphort conducted an autopsy, the result of which was the description of a dense benign tumor of the auditory nerve, which turned out to be fascinated at the site of the exit of the sentence-snelled and facial nerves with a brain trunk and was distributed in a hearing pass temporal bone. The researcher concluded that this formation was the cause of the deafness of the patient during life.

In 1830, Charles Bella was first raised by the patient a lifetime diagnosis that was confirmed after the death of the patient. Bell focused on frequent headaches, deafness, loss of taste sensitivity, trigeminal neuralgia and some other signs and complaints of the patient who died a year after the survey.

The first surgical surgery to remove the encapsulated formation of a bridge of the axle corner was produced in 1894 by Charles Ballas. Despite the fact that during the operation, triple and facial nerve structures were damaged and due to the complication, an enucleation of the eye was required, medical intervention could be called successful, since after it the patient has lived for more than 12 years.

The sophisticated way to reduce postoperative mortality did the founder of neurosurgery in the US Harvey Kushing. After the first operation in 1906, which ended in the death of the patient, the neurosurgeon first refused to completely remove the neurine, which made it possible to reduce mortality up to 40%. And later, with the improvement of the technique, postoperative mortality was reduced to 7.7%. However, out of 176 dismantled church, only 13 cases were a total removal.

Since 1917, the follower of Cushing Walter Dandy improved the methodology by using a subocital access to the rear cranial fossa, which became possible due to penetration through a part of the occipital bone. As a result, the mortality rate decreased to 2.4%. However, to this day, surgical interference with acoustic Swannomes is associated with serious risks associated with the health of patients.

Therefore, the introduction of radiosurgery Lars Lexelle made it possible to sharply improve the quality of treatment for a neuro dimension of up to 3 cm.

Morphology, causes and mechanisms for the occurrence of acoustic disease

The neoplasm is described as a rounded (or irregular shape) a buggy dense node, which has a connecting capsule outside, and inside - diffuse or local cystic cavities with a brown liquid. Depending on the blood supply, the color of the neoplasm may be:

• pale pink with red sections (most often),
• blue (with a venous stitch),
• brown-brown (with hemorrhages).

A benign formation of cells forming the structure by type of palfolds, between the elements of which areas are present, which consist of fibers. In the process of the growth of the tissue, the pigment consisting of iron oxide (hemosiderin) occurs.

VIII Course CHMN includes a vestibular part (carrying information into cerebral centers from vestibular receptors) and auditory. In most cases, the neurinoma occurs in the vestibular part, as it grows outwardly adjacent departments. Since there are still a number of others (a threefold, distinguishing, wandering, language petition, facial) next to the predvevnogo-snitvy nerve, their squeezing is also reflected by characteristic features.

The reasons for the occurrence of this benign formation are not fully defined.

The direct connection of one-sided neurine with etientifactors is not traced. The two-sided form is steadily fixed in patients with genetically determined neurofibromatosis of type II. There is a 50% risk of disaster disease if there are pathological genes from parents.

Three stage stages of the vestibular scums are distinguished:

1. For the first characteristic of the size of formation up to 2-2.5 cm, entailing the hearing loss and vestibular disorders.
2. For the second - expanding to sizes of 3-3.5 cm (" walnut") With a pressure on the brain stem. This contributes to the emergence of Nystagma and equilibrium impairment.
3. The third stage occurs during the growth of education to the size of a chicken egg with the symptoms of the compression of cerebral structures, swallowing disorders and salivation, visual function. At this stage, irreversible changes in the tissues of the brain occur, and due to the fact that Swannoma becomes inoperable, the fatal outcome occurs.

In the typical development of the disease, a hearing impairment is recorded as the first signs (95% of the sick) and dizziness (less often). Most often (in 60% of cases) acoustic effects in the form of noise, a stall or a hum on the side of the neoplasm becomes the only symptom of the initial stages of the disease. It happens that the reduction of hearing occurs markedly and sharply. However, the deterioration of hearing can manifest itself almost imperceptibly for the patient, and the noises to come with the advent of other symptoms.

At the initial stage in two of three cases, vestibular disorders are recorded. They manifest themselves:

• dizziness, which, with this disease, is manifested gradually with increasing intensity,
• instability at the turns of the head and body,
• nistagm, which is expressed stronger when looking towards the location of the neoplasm.

Most often, parts of auditory and vestibular nerve structures are amazed at the same time. However, in some cases, only one of the parts can be tested.

Sometimes vestibular crises are recorded, characterized by nausea and vomiting against the background of dizziness.

With an increase in the formation and damage to them, the signs of this lesion are added to symptoms. However, the magnitude of the neoplasm does not always correspond to the severity of the signs. In addition to the magnitude, the degree depends on the direction of growth and localization of Svanoma. So at large sizes of Svannoma, it can demonstrate more dim symptoms than a small one, and vice versa.

The squeezing of trigeminal nerve structures causes pain character on the face and feelings of numbness and tingling from the neoplasm. Such pains can fond or enhance, and then become permanent. Sometimes this pain is confused with a dental or take a trigeminal nerve for neuralgia. It happens that pain occurs in the occipital part of the formation.

In parallel with these processes (sometimes a little later), symptoms associated with the peripheral lesion of the facial and discharge nerves appear:

• facial asymmetry due to the pack of mimic muscles,
• loss of taste on 2/3 front of the language,
• violation of salivation,
• condensed squint
• double vision with displacement (diplopy).

If a benign education grow up in the inner hearing pass, the symptoms of squeezing can appear in the first stages of the disease.

A further increase in education leads to a violation of the gentle functions, a swallowing disorder and pharyngeal reflex, loss of sensitivity on the rest of the tongue.

The late symptoms of the disease include an increase in intracranial pressure, the result of which the visual function becomes the total character of the headache with the concentration in the occipital and frontal regions. There is a systematic vomiting.

On the initial stage Its disease should be separated from similar on the manifestations of Maze, Meniere disease, cochlear neuritis, otosclerosis. Diagnosis of the disease is carried out with a deretererology or on joint admission from a neurologist and a otolaryngologist. As required, the survey is connected by a vestibular, an ophthalmologist and sometimes a dentist.

The survey begins with the inspection of the nervous system and hearing, and during suspicion of Svanny, a number of diagnostic procedures are appointed, which make it possible to confirm suspicion with a high probability:

Treatment with medical and folk methods

The outcome of treatment depends on the timely detection and size of the tumor. When diagnosing the neurine at the first two stages, the forecast is favorable. Radiosurgical tumor removal stops resuming growth in 95% of cases. At the same time restoring the ability of the patient, it returns to the previous lifestyle. Open surgical intervention has a less favorable prognosis associated with the risk of damage to various nervous structures and / or hearing loss. In the third stage of the disease, the prognosis is unfavorable. The risk of squeezing is subject to vital cerebral structures. In the treatment of a nute hearing nerve folk remedies Forecasts are not done, due to the unprotence of the effectiveness of people's techniques.

Since each of the treatment techniques has both advantages and risks, they are not talking about the only possible approach, but about possible tactics medical control and interventions.

The solution on surgical removal is made on the basis of a set of accounting factors, including: the size of the tumor, the age of the patient, the quality of hearing, the degree of skills of the surgeon. Depending on the access paths, the following types are distinguished:

• Suboccipient. The operation is carried out with high chances of keeping the hearing.
• Translaubinal. There is a few options, while all of them are associated with a high risk of hearing damage.
• The advantage is applied by removing small nevin through the middle cranial fossa (scaly).

Folk Methods

In cases where there is no possibility to carry out an operation in order to brake the tumor growth and its decrease in its size uses grass therapy, which, however, cannot replace medical methods:

1. Infusion of mistletoe white. The shoots of the plant are crushed, 2 teaspoons (with a slide) poured 2 glasses of boiling water and insist during the night in the thermos. Drinks three times a day for 2 tablespoons with small sips before meals. The duration of the course is 23 days. A week later, you can spend the following course. (Maximum number of courses with a weekly break - four).
2. Alcohol tincture of Japanese sofa. The liter of alcohol is taken by 100 g of the ribbed plant. Inspection occurs within 40 days with daily shaking (stirring). Further, the alcohol is fastened, and the cake is pressed. It takes 10 g three times a day before eating for 40 days. Break between courses - half months.
3. Vodka with horse chestnut. The proportions and procedures are the same as in the previous case, but the composition insists only 10 days and in a dark place. Drinking together with a small amount of water 10 drops three times a day. The 14-day course can be repeated for three months with a weekly interruption.
4. The infusion of the Prince of Siberian. A teaspoon of a ground dried plant is insistant on boiling water (2 cups) and, after the filping, it is accepted three times a day on a tablespoon for two months.
5. Welding Morder Ordinary. For brewing, we need chopped seeds from the calculation of a teaspoon on 300 ml of water. The composition of 15 minutes is boiled on a slow fire and is insistant to push 2 hours. It is consumed four times a day for 2 tablespoons.
6. Silver from the socket of ordinary. Grinding in powder roots of the plant in proportions 1: 5 are mixed with swine fat. This mixture is 5 hours languishing in a heated to 70c oven. Without giving a mixture to cool, it needs to be strain and decompose on glass banks, tightly clogging them, and then twice a day, a layer of ointments, applied to the parchment paper, to use as local lines (30 minutes / procedure). The monthly treatment course alternates with a two-week pause.

Sources: medcape.com,

Vestibular shwannomes (Nevnomes of auditory nerve) - the most common tumors of neural shells. Typically, the initial tumor growth is the shell of one of the predestless nerves in the inner hearing aisle. The neurinoma is characterized by slow growth and often flows asymptomatic. The first and long one is the only manifestation, the ringing in the ear (tinnit), more often than a highly contacious nature. Later, a slowly progressive rumor reduction is joined, which is usually revealed by chance. Upon reaching a large sizes (up to 3-4 cm in diameter), coordinator disorders are developed associated with coarse deformation of the brain barrel, as well as signs of moderate deformity from the facial and triple nerves, although these nerves also undergo pronounced changes (stretching, thinning, wave ). The rumor is usually completely lost. Stagnation on the fundus develops late. The rapid progression of the reduction in hearing with vestibular disorders is observed with the growth of the tumor mainly in the channel of the internal auditory passage, which leads to early squeezing of all the nerves in the channel (predominary, auditory, facial) and the labyrinth artery.
Bilateral vestibular shwannomes are manifestations of type neurofibromatosis (hereditary disease, characterized in addition to Schwann, also with multi-grade meningiomas, glyoms, etc.). In these cases, tumors are growing faster and more aggressive.
The diagnosis of CT, MRI usually does not cause difficulties when the tumor is detected by a rounded form, adjacent to the rear surface of the temporal bone pyramid, with signs of expanding the internal auditory pass.
Microsurgical treatment. The close connection of the tumor with surrounding nerves, cerebellar arteries, stem structures requires only pofragmental removal of tumor mass. Sometimes the leaving of it is a forced measure with the occurrence of critical hesitation of blood pressure even with minimal tumor traction, which is associated with irritation of both the brain barrel and the roots of the Langulic and wandering nervesbonding tumor from below. When preserving the vessels that feed the brain barrel, the operation is successful, the face nerve dysfunction is highly likely. In case of incomplete removal, repeated interventions are usually in a few years. The expectant tactic is admissible in the asymptomatic flow of small nevin. It is also possible to use radiosurgery.
In the cavity of the skull there are shwnnomes of a trigeminal nerve (in the area of \u200b\u200bthe top of the pyramid of the temporal bone), extremely rarely - the neuromy of the facial nerve. Among the extracepantic swann, there should be parafaring tumors of the language inheritant nerve. Treatment only surgical.