El neurinoma del acústico (NA) es una neoplasia benigna que se origina de la rama vestibular del VIII par craneal en el conducto auditivo interno (CAI) y en el ángulo pontocerebeloso (APC). Constituye el 8 al 9% de las tumoraciones intracraneales y el 80 al 90% de las tumoraciones del APC. Los estudios epidemiológicos demuestran que la incidencia clínica anual de NA varía de entre el 0.7 a 1 por cada 100,000 habitantes. El crecimiento de estas tumoraciones es impredecible por lo que el tratamiento quirúrgico es requerido en la mayoría de los casos. Los reportes de la literatura señalan la importancia de diagnosticar a las tumoraciones tempranamente, debido a la relación existente entre el menor tamaño tumoral y una mejor evolución postoperatoria.Consideramos que el desarrollo de los NA en el trayecto del VIII par craneal (desde el fondo del CAI hasta el APC) estará relacionado con los síntomas de presentación y los síntomas al momento del diagnóstico, y que estas tumoraciones producirán alteraciones específicas durante la realización de las exploraciones neurotológicas que harán sospechar al clínico de la existencia del NA, con lo cual se podrá realizar un diagnóstico temprano de la tumoración. Para estudiar las características de los NA en diferentes estadios incluimos a 133 pacientes, los cuales fueron divididos en tres grupos en relación al tamaño de los neurinomas del acústico confirmados a través de la resonancia magnética nuclear (RMN):- Grupo I: Tumores intracanaliculares puros- Grupo II: Tumores - Grupo III: Tumores > a 2.5 cm en APC o tamaño grande en APCTodos los pacientes fueron sometidos a las siguientes exploraciones neurotológicas:- Audiometría tonal y vocal- Potenciales evocados auditivos de tronco cerebral- Videonistagmografía y pruebas calóricas- Electroneuronografía facialEn esta tesis estudiamos los síntomas que refirieron los pacientes durante su evolución hasta el momento del diagnóstico según el grupo tumoral y realizamos una revisión bibliográfica de cada síntoma en su relación con los NA. Así mismo, estudiamos las bases fisiológicas y anatómicas en las que las exploraciones neurotológicas están fundadas para determinar la relación existente entre las alteraciones encontradas durante la realización de los estudios y los diferentes grupos tumorales, con el fin de diagnosticar a los NA en una fase más temprana, con la consiguiente reducción de la morbilidad, la preservación del nervio facial y la conservación de la audición útil. / Acoustic neuromas (AN) are benign tumors that arise form the vestibular bundle of the eighth cranial nerve in the internal auditory canal (IAC) and cerebellopontine angle (CPA). Represent eight to nine percent of intracranial tumors and account for 80% to 90% of tumors of the CPA. The epidemiologic studies show a yearly clinical incidence of diagnosed acoustic neuroma 0,7 to 1 per 100,000 habitants. The growth great of these tumors are unpredictable, thus surgical resection is required in most cases of AN. The literature shows the importance of make an early diagnosis due the relation between the smaller tumor size and the better postoperative evolution.We have considered that the developed of the AN in the eighth cranial nerve (from fundus of the IAC to CPA) is related with the evolution of the symptoms, and these tumors will produce specifics alterations in the neurotologic explorations that could be suspect the existence of AN, made possible an early diagnosis of the tumor.For the study of the characteristics of the AN tumor in different stages, we included 133 patients. These patients were divided in three groups according to the size of the tumor in the magnetic resonance imaging (MRI):- Grupo I: intracanalicular tumors (exclusively)- Grupo II: Tumor < 2.5 cm in CPA o medium size in CPA - Grupo III: Tumor > 2.5 cm in CPAC o large size in CPAAll patients underwent thorough neurotologic evaluation, wich included:- Pure-tone audiometry and speech audiometry- Auditory brainstem response- Videonystagmography- Facial electroneuronography- Magnetic resonance imaging (MRI)The aim of this thesis is to study the symptoms referred by the patients during their evolution until the diagnosis of AN could be done and make a bibliographic revision of each symptom and its relation with the tumor. Likewise, we study the anatomical and physiological basis of the neurotologic explorations to determine the relationship among the pathological findings discovered during the realization of the procedure and the tumoral gorup, with the aim of an early detection of the AN tumor, in order to reduce morbidity with the preservation of the facial nerve and conservation of the serviceable hearing.

PURPOSE: To develop an algorithm in order to establish a consensus on how oculomotor nerve schwannomas should be treated by reviewing results from reported cases in the literature. Given the rarity of oculomotor nerve schwannomas, there is no agreed upon criteria for when a surgical or a nonsurgical intervention would be indicated. By reviewing former cases of oculomotor nerve schwannomas, our study proposes a flowchart for physicians to follow for optimal management. METHODS: The review of reported oculomotor nerve schwannoma cases involved 51 cases. From the 51 cases, data was tabulated including age, patient symptoms, symptom duration, tumor size, tumor location, treatment, post operative results, and follow up time. The cases were then divided in to surgical subgroup and a nonsurgical subgroup. Each case was also grouped based on post operative oculomotor function into improved, no change, and worsened groups. Our collaboration with Tufts Medical center also yielded 4 unreported cases of oculomotor nerve schwannoma that are described and compared to the previous 51 cases from the literature review. RESULTS: The review of the 51 reported cases yielded a few statistically significance differences between the surgical and nonsurgical subgroups. The surgical subgroup was older with a mean age of 35 years than the nonsurgical subgroup with a mean age of 15.8 years. The surgical group also had larger tumors with a mean tumor diameter of 29.5 mm versus the nonsurgical subgroup's 4.5 mm mean tumor diameter. The surgical subgroup also experienced shorter symptom durations as well. The mean duration of symptoms in the surgical subgroup was 17.8 months versus the 140 month mean symptom duration for the nonsurgical cases. Finally, the majority of surgically treated cases experienced a worsening of residual oculomotor function (20/38), while the majority of nonsurgically treated cases experienced little to no change in oculomotor function (11/13). CONCLUSION: Given the high likelihood of complete third nerve palsy after surgery, this study advocates a conservative approach to oculomotor nerve schwannomas that do not present with any life threatening symptoms or acutely deteriorating symptoms. The cases that are presented in this study also corroborate previous studies' findings on the efficacy of stereotactic radiosurgery in managing schwannoma size without resorting to more invasive interventions.

Abstract The findings on depression and anxiety among brain tumor patients have so far been based on case series and case samples. In Finland, psychiatric research in relation to psychiatric symptoms among patients with different types of brain tumors is lacking. The study population of this thesis consisted of 101 patients (39 males and 62 females) aged between 20 and 82 years with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery, Oulu University Hospital between February 1990 and March 1992. The major histological subgroup consisted of gliomas (40%), and the rest were meningiomas (33%), acoustic neurinomas (13%), pituitary adenomas (8%) and other types (6%). The psychiatric symptoms of the patients were assessed at three time points, namely before tumor operation as well as at three months and at one year after operation by two valid measurement instruments, the Beck Depression Inventory and the Crown Crisp Experiential Index. In addition, the patients' functional state was evaluated by the Karnofsky Performance Scale and their quality of life according to Sintonen 15 D. Prevalence of at least mild depression before tumor operation was 30% for males and 38% for females. The mean depressive scores decreased significantly for up to one-year during follow-up for both males and females, but they remained notably high in all patients. Decreased functional status (KPS under 70) in the patients was significantly associated with high depressive scores at all measurement points. The decrease in the mean depressive scores was significant among patients with an anterior tumor and those with a pituitary adenoma. Five-year survival of the brain tumor patients was found to be mainly associated with the histology of the tumor. Survival time in months (SD) of the patients with high-grade (III–IV) gliomas was shown to be 22.5 (21.4), while it was 50.2 (19.9) for the patients with low-grade (I–II) gliomas, and 58.2 (9.4) for the rest of the patients. Depression among low-grade glioma patients was significantly associated with worse survival at five years follow-up. The level of anxiety was shown to be significantly higher among patients with a primary brain tumor in the right hemisphere compared to the anxiety scores among patients with left hemispheric tumors. A significant increase was found in the level of obsessionality over time in the female patients with a brain tumor in the left anterior location of the brain at three months after operation. The level of quality of life (QOL) was significantly worse among female brain tumor patients compared to males. Depressive females had significantly lower quality of life compared to that of non-depressive females up to one-year follow-up after surgical operation of the tumor. Depression, anxiety and obsessive-compulsive symptoms have to be recognized and be treated by psychotherapy and pharmacotherapy as soon as possible at every unit where brain tumor patients are followed and encountered.

Introduction: Takotsubo cardiomyopathy is an apical ballooning syndrome, which can be triggeredby stress. Only few case reports describe the onset of Takotsubo as a complication of neurosurgery procedures. Clinical presentation: A case of a 53 year-old female with a spinal neurinoma and surgery-associated Takotsubo cardiomyopathy is demonstrated. The patient developed typical signs of a myocardial infarction with circulation depression and ST elevation, but normal cardiac enzymes at the end of surgery. Cardiac catheterization and levocardiography confirmed the absence of any critical coronary disease but the presence of a typical apical ballooning and midventricular hypokinesis. The patient recovered completely under supportive conservative and cardiological therapy, showing regular left ventricular pumpfunction. Conclusion: Interventions in neurosurgery and perioperative care should be kept as stress free as possible. Due to the possibility of neurogenic mechanisms related to cardiomyopathy, Takotsubo cardiomyopathy as an entity of stress-induced complications should be taken into consideration.

Introduction: Takotsubo cardiomyopathy is an apical ballooning syndrome, which can be triggeredby stress. Only few case reports describe the onset of Takotsubo as a complication of neurosurgery procedures. Clinical presentation: A case of a 53 year-old female with a spinal neurinoma and surgery-associated Takotsubo cardiomyopathy is demonstrated. The patient developed typical signs of a myocardial infarction with circulation depression and ST elevation, but normal cardiac enzymes at the end of surgery. Cardiac catheterization and levocardiography confirmed the absence of any critical coronary disease but the presence of a typical apical ballooning and midventricular hypokinesis. The patient recovered completely under supportive conservative and cardiological therapy, showing regular left ventricular pumpfunction. Conclusion: Interventions in neurosurgery and perioperative care should be kept as stress free as possible. Due to the possibility of neurogenic mechanisms related to cardiomyopathy, Takotsubo cardiomyopathy as an entity of stress-induced complications should be taken into consideration.