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Cranial Nerve Lesion Acoustic Neuroma

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

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Cranial Nerve Lesion Acoustic Neuroma

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  1. Cranial Nerve Lesion Acoustic Neuroma Presented By: Emma Morales Gigi Sanchez Christine Achenbach Josefina Delgado

  2. Introduction of Cranial Nerve Eight: Vestibulocochlear Nerve • Arises in the inner ear and goes to the pons • Two anatomically and functional parts: • Cochlear Nerve • Vestibular Nerve • Cranial Nerve XIII functions in hearing and balance

  3. Vestibulocochlear Nerve VIII

  4. Clinical Case of Acoustic Neuroma (Vestibular Shwannoma) • Robin • European-American woman • 51 years old • Professional Executive • Maintained reasonable diet • Overall in perfectly good health

  5. Robin’s Symptoms • Symptoms started 2 years ago • telephone communication distorted -right ear • tinnitus-right ear • dizzy spells at work • bumping into things everywhere

  6. Robin’s visit to General Physician • First General Physician • diagnosed her with inner ear imbalance from her last plane trip • Antivert medication was prescribed • no change in symptoms • Second Physician • MRI scan • found small 0.9cm Acoustic Neuroma

  7. Background: What is Acoustic Neuroma? • Non-cancerous tumor of the eighth cranial Nerve leading from brain to inner ear • Usually grow slowly over a period of years • Not Hereditary: Occur spontaneously without any evidence of inheritable patterns

  8. Common Symptoms • Major symptom: Hearing Loss 95% of those with tumor • Tinnitus • Vertigo • Headaches • Unsteadiness-poor coordination • Facial numbness, tingling, twitching

  9. Signs of Acoustic Neuroma • Decreased speech discrimination • Nystagmus • Abnormal facial electromyogram

  10. Statistical Information • Found in autopsy in less than one in one-hundred of the general population • Hearing loss and symptoms occur in about one person in 100, 000 • Diagnosed in patients between the ages of 30-60 • Cause unknown

  11. ENG (Electronystagmography test) Caloric Test MRI scan Clinical Findings: Test

  12. MRI Classification for AN • Entirely Intracanicular • Intercranial extension without brainstem distortion • Intracranial extension with brainstem distortion

  13. Diagnosis: Findings on Clinical Case • Detected small .9cm Acoustic Neuroma • affected hearing loss and balance

  14. Treatment Options • Observation • Surgery- Microsurgical tumor removal • Partial tumor removal • Total tumor removal • Radiation • Gamma Knife • FSR

  15. Clinical Case Plan • Patient Robin decided on RADIATION • FSR treatment • 5 treatments a week • for 5 weeks • Robin’s Follow-up • 1 year - improved hearing • 2 years – tumor reduced and 92% hearing back • no significant side effects

  16. Neurobiology of Acoustic Neuroma: Structures Involved • Eighth Cranial nerve • Vestibular & Cochlear Divisions

  17. Auditory Canal

  18. Internal Auditory Canal

  19. Stage 1 Stage 2 Stage 3 Growth patterns

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