Neurinoma

General characteristic of a disease

The neurinoma (or a shvannoma) is the benign tumor which is formed in schwannian cells of spinal, cranial and peripheral nerves. Thus, the neurinoma is a new growth in cells which cover nerves. They present themselves roundish, sometimes lobular formations in the form of the capsule. Appear most often in a root of an acoustical nerve (a vestibular portion), progress in a mosto-cerebellar corner (facial and acoustical nerves), is more rare – in a root of the V nerve (maxillary and mandibular, orbital nerves). And extremely seldom neurinoma arise in roots of the glossopalatine and wandering nerves.

The percent of a disease of a neurinoma – rather small also makes about 8% of all intracranial new growths and about 20% of all primary spinal educations. People of middle and advanced age are subject to this disease, at the same time women are ill more often. Since the neurinoma is high-quality with slow-growing new growths, it develops into a malignant tumor very seldom.

The following types of a neurinoma are the most widespread:

1. Morton's neurinoma. This benign tumor is formed in a zone of a bottom nerve of foot. In most cases arises in the place of passing of a nerve of the third and fourth fingers of foot, sometimes between the second and third fingers. Generally strikes one foot, it is very rare - both.

2. A neurinoma of an acoustical nerve (carries also the name a vestibular shvannoma). In most cases such tumor arises in a vestibular branch of an acoustical nerve, and its growth continues in a cerebellar and bridge corner. The neurinoma increases in the volume therefore there is pressure upon a cerebellum and a brainstem. The direct contact of education with facial nerves sometimes even affects lower cranial and trigeminal nerves.

Distinguish a unilateral neurinoma of an acoustical nerve (about 95%) and bilateral (5%). The last is usually caused by a neurofibromatosis, and its first manifestations are possible on the second decade of life, unlike unilateral to which, most often, aged people of 40-50 years are subject.

3. Backbone neurinoma. It is caused by a tumor of roots of spinal nerves, and in most cases arises in chest and cervical department, is more rare in lumbar. It is considered the most widespread disease from primary new growths on a spinal cord. Develops as an extramedullary and intradural tumor in schwannian cells.

Neurinoma of roots of a spinal cord can extend through an intervertebral foramen ekstraduralno. Such form of a neurinoma belongs to type of "hourglasses" and is characteristic of cervical department of a backbone. Effects of a neurinoma of a backbone are bone changes which are diagnosed by a usual spondilografiya.

The neurinoma trigeminal and other nerves is a consequence of a tumor of an acoustical nerve, and such look as a sredostreniye neurinoma – tumor subspecies on a backbone.

Neurinoma reasons

Histologically the neurinoma is a result of high-quality reproduction of Schwannian cells (from here and the second name of a disease of Shvannom) which form a myelin cover of nerves and that influences this process – is up to the end not studied.

Neurinoma symptoms

The first notable symptoms of a neurinoma of an acoustical nerve the ring in ears is considered, about 60% of all patients, and also the decrease in hearing especially noticeable at telephone conversation complain of it. In most cases work of acoustical function changes gradually, but in 10-20% there is an instant decrease in hearing. Damages of a vestibular nerve can be shown at sharp turn of the head or body, at the same time there is an unpleasant feeling of instability or loss of balance. In case education has quite big sizes, hydrocephaly can be shown (liquid accumulation a brain). At the same time, as the accompanying sign is possible scarcely noticeable front paralysis.

The main symptom of a neurinoma of a backbone is the radicular pain caused by development of a disease in back sensitive roots. Neurinoma of a backbone develop slowly. Therefore the right diagnosis is established only after several years of pains if localization is noticed in wide lumbosacral department. The narrow cervical department allows to reveal a disease at an early stage because signs of pressure upon a spinal cord appear. In the presence of a tumor in a side triangle of a neck and in a supraclavicular zone (which, as a rule, arise in roots of a cervical or brachial plexus) pain in necks or a shoulder girdle is possible.

Because peripheral neurinoma proceed is long and asymptomatically, the tumor is found as hypodermic volume education without painful signs.

Treatment of a neurinoma

Treatment of a neurinoma can take place in several ways, irrespective of the place of formation of a tumor.

1. The conservative method of treatment in this case means purpose of such drugs as: Mannitolum in combination with glucocorticoids, and also control of water and electrolytic balance and a diuresis. Also appoint drugs which improve cerebral circulation.

2. The most widespread method is a surgical removal of a neurinoma.

This method consists in radical removal. Treatment of a neurinoma at an early stage is possible with microsurgical intervention. During such removal of a neurinoma of an acoustical nerve function of a facial nerve remains, and it is possible, hearing. In such cases translabyrinth approach to treatment is used, but hearing preservation – is real if the sizes of a tumor do not exceed 2 cm.

3. The method of stereotaxic radio surgery is some alternative to removal of a neurinoma because control of growth of the tumor is in that case provided, at the same time negative results have low indicators.

Radio surgical treatment is shown for elderly people, in the presence of somatic pathology which does not allow to carry out operational treatment of a neurinoma, and in case of refusal the patient from an operative measure. The tumor no more than 30 mm is subject to such method;

4. In case of the slow growth of education that is especially characteristic of elderly people or with serious associated diseases, it is necessary to apply waiting tactics which provides carrying out KT or MPT and constant observation of a state. Here the palliative method of treatment of a neurinoma, i.e. the shunting operation allowing to eliminate hydrocephaly is applied.

The neurinoma is not a malignant tumor, but if in time not to pay attention to symptoms, then it can be very hazardous to health of the person, and its treatment will not bring positive takes.