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Cranial Nerve Lesion Acoustic Neuroma. Presented By: Emma Morales Gigi Sanchez Christine Achenbach Josefina Delgado. Introduction of Cranial Nerve Eight: Vestibulocochlear Nerve. Arises in the inner ear and goes to the pons Two anatomically and functional parts: Cochlear Nerve - PowerPoint PPT Presentation
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Cranial Nerve LesionCranial Nerve Lesion Acoustic Neuroma Acoustic Neuroma
Presented By:Emma MoralesGigi Sanchez
Christine AchenbachJosefina Delgado
Introduction of Cranial Introduction of Cranial Nerve Eight: Nerve Eight: Vestibulocochlear NerveVestibulocochlear Nerve
Arises in the inner ear and goes to the Arises in the inner ear and goes to the ponspons
Two anatomically and functional parts:Two anatomically and functional parts:Cochlear NerveCochlear Nerve Vestibular NerveVestibular Nerve
Cranial Nerve XIII functions in hearing Cranial Nerve XIII functions in hearing and balanceand balance
Vestibulocochlear Nerve Vestibulocochlear Nerve VIIIVIII
Clinical Case of Acoustic Clinical Case of Acoustic Neuroma Neuroma (Vestibular (Vestibular Shwannoma)Shwannoma)
RobinRobin•European-American womanEuropean-American woman•51 years old51 years old•Professional ExecutiveProfessional Executive•Maintained reasonable dietMaintained reasonable diet•Overall in perfectly good Overall in perfectly good
healthhealth
Robin’s SymptomsRobin’s Symptoms
•Symptoms started 2 years agoSymptoms started 2 years ago–telephone communication telephone communication distorted -right eardistorted -right ear
–tinnitus-right eartinnitus-right ear–dizzy spells at workdizzy spells at work–bumping into things bumping into things everywhereeverywhere
Robin’s visit to General Robin’s visit to General PhysicianPhysician
•First General PhysicianFirst General Physician•diagnosed her with inner ear diagnosed her with inner ear imbalance from her last plane trip imbalance from her last plane trip
• Antivert medication was prescribedAntivert medication was prescribed•no change in symptomsno change in symptoms
•Second Physician Second Physician •MRI scanMRI scan•found small 0.9cm Acoustic found small 0.9cm Acoustic NeuromaNeuroma
Background: Background: What is Acoustic What is Acoustic Neuroma?Neuroma?
Non-cancerous tumor of the eighth Non-cancerous tumor of the eighth cranial Nerve leading from brain to cranial Nerve leading from brain to inner earinner ear
Usually grow slowly over a period Usually grow slowly over a period of yearsof years
Not Hereditary: Occur Not Hereditary: Occur spontaneously without any spontaneously without any evidence of inheritable patternsevidence of inheritable patterns
Common SymptomsCommon Symptoms
Major symptom: Hearing Loss Major symptom: Hearing Loss 95% of those with tumor95% of those with tumor
TinnitusTinnitus VertigoVertigo HeadachesHeadaches Unsteadiness-poor coordinationUnsteadiness-poor coordination Facial numbness, tingling, Facial numbness, tingling,
twitchingtwitching
Signs of Acoustic Signs of Acoustic NeuromaNeuroma
Decreased speech Decreased speech discrimination discrimination
NystagmusNystagmusAbnormal facial Abnormal facial
electromyogramelectromyogram
Statistical InformationStatistical Information
Found in autopsy in less than one Found in autopsy in less than one in one-hundred of the general in one-hundred of the general populationpopulation
Hearing loss and symptoms occur Hearing loss and symptoms occur in about one person in 100, 000in about one person in 100, 000
Diagnosed in patients between Diagnosed in patients between the ages of 30-60 the ages of 30-60
Cause unknownCause unknown
Clinical Findings: TestClinical Findings: Test
ENGENG(Electronystagmogr(Electronystagmogr
aphy test)aphy test)
Caloric TestCaloric Test
MRI scanMRI scan
MRI Classification for ANMRI Classification for AN
Entirely IntracanicularEntirely Intracanicular Intercranial extension without Intercranial extension without
brainstem distortionbrainstem distortion Intracranial extension with Intracranial extension with
brainstem distortionbrainstem distortion
Diagnosis: Findings on Diagnosis: Findings on Clinical CaseClinical Case
Detected small .9cm Acoustic Neuromaaffected hearing loss and balance
Treatment OptionsTreatment Options
ObservationObservation Surgery- Microsurgical tumor Surgery- Microsurgical tumor
removalremoval• Partial tumor removalPartial tumor removal• Total tumor removalTotal tumor removal
RadiationRadiation• Gamma KnifeGamma Knife• FSRFSR
Clinical Case PlanClinical Case Plan
Patient Robin decided on RADIATIONPatient Robin decided on RADIATION FSR treatment FSR treatment
• 5 treatments a week5 treatments a week• for 5 weeksfor 5 weeks
Robin’s Follow-upRobin’s Follow-up• 1 year - improved hearing1 year - improved hearing• 2 years – tumor reduced and 92% 2 years – tumor reduced and 92%
hearing backhearing back• no significant side effectsno significant side effects
Neurobiology of Acoustic Neurobiology of Acoustic Neuroma: Structures Neuroma: Structures InvolvedInvolved
Eighth Cranial nerve Eighth Cranial nerve • Vestibular & Cochlear DivisionsVestibular & Cochlear Divisions
Auditory Canal Auditory Canal
Internal Auditory Canal Internal Auditory Canal
Growth patternsGrowth patterns
Stage 1Stage 1
Stage 2Stage 2
Stage 3Stage 3