Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from dam...Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.展开更多
Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function ...Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.展开更多
Traumatic painful neuroma is an intractable clinical disease characterized by improper extracellular matrix(ECM)deposition around the injury site.Studies have shown that the microstructure of natural nerves provides a...Traumatic painful neuroma is an intractable clinical disease characterized by improper extracellular matrix(ECM)deposition around the injury site.Studies have shown that the microstructure of natural nerves provides a suitable microenvironment for the nerve end to avoid abnormal hyperplasia and neuroma formation.In this study,we used a decellularized nerve matrix scaffold(DNM-S)to prevent against the formation of painful neuroma after sciatic nerve transection in rats.Our results showed that the DNM-S effectively reduced abnormal deposition of ECM,guided the regeneration and orderly arrangement of axon,and decreased the density of regenerated axons.The epineurium-perilemma barrier prevented the invasion of vascular muscular scar tissue,greatly reduced the invasion ofα-smooth muscle actin-positive myofibroblasts into nerve stumps,effectively inhibited scar formation,which guided nerve stumps to gradually transform into a benign tissue and reduced pain and autotomy behaviors in animals.These findings suggest that DNM-S-optimized neuroma microenvironment by ECM remodeling may be a promising strategy to prevent painful traumatic neuromas.展开更多
Neuroma formation after peripheral nerve transection often leads to severe neuropathic pain.Regenerative peripheral nerve interface has been shown to reduce painful neuroma in the clinic.However,no reports have invest...Neuroma formation after peripheral nerve transection often leads to severe neuropathic pain.Regenerative peripheral nerve interface has been shown to reduce painful neuroma in the clinic.However,no reports have investigated the underlying mechanisms,and no comparative animal studies on regenerative peripheral nerve interface and other means of neuroma prevention have been conducted to date.In this study,we established a rat model of left sciatic nerve transfection,and subsequently interfered with the model using the regenerative peripheral nerve interface or proximal nerve stump implantation inside a fully innervated muscle.Results showed that,compared with rats subjected to nerve stump implantation inside the muscle,rats subjected to regenerative peripheral nerve interface intervention showed greater inhibition of the proliferation of collagenous fibers and irregular regenerated axons,lower expressions of the fibrosis markerα-smooth muscle actin and the inflammatory marker sigma-1 receptor in the proximal nerve stump,lower autophagy behaviors,lower expressions of c-fos and substance P,higher expression of glial cell line-derived neurotrophic factor in the ipsilateral dorsal root ganglia.These findings suggested that regenerative peripheral nerve interface inhibits peripheral nerve injury-induced neuroma formation and neuropathic pain possibly via the upregulation of the expression of glial cell line-derived neurotrophic factor in the dorsal root ganglia and reducing neuroinflammation in the nerve stump.展开更多
Objective To report the authors' experiences in hearing preservation during acoustic neuroma (AN) resection procedures. Methods Two cases of AN removal via retrosigmoid approach were reviewed. Hearing preservation...Objective To report the authors' experiences in hearing preservation during acoustic neuroma (AN) resection procedures. Methods Two cases of AN removal via retrosigmoid approach were reviewed. Hearing preservation was attempted in the aid of endoscopic technique along with continuous monitoring of the compound action potential (CAP) and auditory brainstem response(ABR) during the surgery. Results The tumor in Case 1 was 1.5 cm in diameter. The average pure-tone hearing threshold was 30 dB HL and ABR was normal. Waves I, III and V of ABR were present following tumor removal. At 7th month follow-up, audiometric thresholds and ABR inter-peak intervals had recovered to pre-operative levels, with normal facial nerve function. The patient in Case 2 had bilateral AN. The tumors measured 4.0 cm(left) and 5.0 cm (right) on MRI scans. The AN on the right side was removed first, followed by removal of the left AN four months later. Intraoperative CAP monitoring was employed during removal of the left AN. While efforts to preserve the cochlear nerve were not successful, CAPs were still present after tumor removal. Conclusions Intraoperatively recorded CAPs are not reliable in predicting postoperative hearing outcomes. In contrast, ABRs are an indicator of function of the peripheral auditory pathway. Presence of waves I, III and V following tumor removal may represent preservation of useful hearing.展开更多
BACKGROUND Gastrointestinal subepithelial tumors(GSTs),incidentally detected during upper gastrointestinal(GI)endoscopy,may be lesions derived from the GI wall or may be caused by compression from external organs.In g...BACKGROUND Gastrointestinal subepithelial tumors(GSTs),incidentally detected during upper gastrointestinal(GI)endoscopy,may be lesions derived from the GI wall or may be caused by compression from external organs.In general,traumatic neuroma is a benign nerve tumor that results from postoperative nerve injury,occurring in the bile duct as one of the complications after cholecystectomy.This is the first case report demonstrating that neuroma of the cystic duct can be incorrectly perceived as a duodenal subepithelial tumor by compressing the duodenal wall.CASE SUMMARY We report the case of a 72-year-old man with traumatic neuroma of the cystic duct after cholecystectomy.This tumor was mistaken for a duodenal subepithelial tumor on preoperative upper GI endoscopy and endoscopic ultrasonography due to external compression of the GI wall.The patient had no symptoms,and his laboratory test results were normal.However,in a series of follow-up endoscopies,the tumor was found to have grown in size,so it was surgically resected.The lesion was completely removed by laparoscopic endoscopic cooperative surgery.The patient was discharged on postoperative day 7 without complications.CONCLUSION Traumatic neuroma of the cystic duct can be mistaken for GSTs in GI endoscopy.展开更多
Studies have shown that myelin-associated glycoprotein(MAG)can inhibit axon regeneration after nerve injury.However,the effects of MAG on neuroma formation after peripheral nerve injury remain poorly understood.In thi...Studies have shown that myelin-associated glycoprotein(MAG)can inhibit axon regeneration after nerve injury.However,the effects of MAG on neuroma formation after peripheral nerve injury remain poorly understood.In this study,local injection of MAG combined with nerve cap made of chitin conduit was used to intervene with the formation of painful neuroma after sciatic nerve transfection in rats.After 8 weeks of combined treatment,the autotomy behaviors were reduced in rats subjected to sciatic nerve transfection,the mRNA expression of nerve growth factor,a pain marker,in the proximal nerve stump was decreased,the density of regenerated axons was decreased,the thickness of the myelin sheath was increased,and the ratio of unmyelinated to myelinated axons was reduced.Moereover,the percentage of collagen fiber area and the percentage of fibrosis marker alpha-smooth muscle actin positive staining area in the proximal nerve stump were decreased.The combined treatment exhibited superior effects in these measures to chitin conduit treatment alone.These findings suggest that MAG combined with chitin conduit synergistically inhibits the formation of painful neuroma after sciatic nerve transection and alleviates neuropathic pain.This study was approved by the Animal Ethics Committee of Peking University People’s Hospital(approval No.2019PHE027)on December 5,2019.展开更多
Acoustic Neuroma (AN) arises from the eighth cranial nerve. It primarily involves the vestibular branch of the nerve and is therefore also called vestibular schwannoma(VS). To the date, diagnosis and surgical treatmen...Acoustic Neuroma (AN) arises from the eighth cranial nerve. It primarily involves the vestibular branch of the nerve and is therefore also called vestibular schwannoma(VS). To the date, diagnosis and surgical treatment of AN have advanced significantly. Along with advances in audiology and imaging technologies, cases of diagnosed AN have been increasing, making it a common展开更多
文摘Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.
文摘Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.
基金supported by the National Natural Science Foundation of China,No.82171650(to CBZ)Guangdong Province Key Research and Development Project,No.2020B1111150003(to DPQ)Guangdong Basic and Applied Basic Research Foundation,No.2020A1515011143(to CBZ)。
文摘Traumatic painful neuroma is an intractable clinical disease characterized by improper extracellular matrix(ECM)deposition around the injury site.Studies have shown that the microstructure of natural nerves provides a suitable microenvironment for the nerve end to avoid abnormal hyperplasia and neuroma formation.In this study,we used a decellularized nerve matrix scaffold(DNM-S)to prevent against the formation of painful neuroma after sciatic nerve transection in rats.Our results showed that the DNM-S effectively reduced abnormal deposition of ECM,guided the regeneration and orderly arrangement of axon,and decreased the density of regenerated axons.The epineurium-perilemma barrier prevented the invasion of vascular muscular scar tissue,greatly reduced the invasion ofα-smooth muscle actin-positive myofibroblasts into nerve stumps,effectively inhibited scar formation,which guided nerve stumps to gradually transform into a benign tissue and reduced pain and autotomy behaviors in animals.These findings suggest that DNM-S-optimized neuroma microenvironment by ECM remodeling may be a promising strategy to prevent painful traumatic neuromas.
基金supported by the Health Commission of Hubei Province Medical Leading Talent Project,No.LJ20200405(to AXY)。
文摘Neuroma formation after peripheral nerve transection often leads to severe neuropathic pain.Regenerative peripheral nerve interface has been shown to reduce painful neuroma in the clinic.However,no reports have investigated the underlying mechanisms,and no comparative animal studies on regenerative peripheral nerve interface and other means of neuroma prevention have been conducted to date.In this study,we established a rat model of left sciatic nerve transfection,and subsequently interfered with the model using the regenerative peripheral nerve interface or proximal nerve stump implantation inside a fully innervated muscle.Results showed that,compared with rats subjected to nerve stump implantation inside the muscle,rats subjected to regenerative peripheral nerve interface intervention showed greater inhibition of the proliferation of collagenous fibers and irregular regenerated axons,lower expressions of the fibrosis markerα-smooth muscle actin and the inflammatory marker sigma-1 receptor in the proximal nerve stump,lower autophagy behaviors,lower expressions of c-fos and substance P,higher expression of glial cell line-derived neurotrophic factor in the ipsilateral dorsal root ganglia.These findings suggested that regenerative peripheral nerve interface inhibits peripheral nerve injury-induced neuroma formation and neuropathic pain possibly via the upregulation of the expression of glial cell line-derived neurotrophic factor in the dorsal root ganglia and reducing neuroinflammation in the nerve stump.
文摘Objective To report the authors' experiences in hearing preservation during acoustic neuroma (AN) resection procedures. Methods Two cases of AN removal via retrosigmoid approach were reviewed. Hearing preservation was attempted in the aid of endoscopic technique along with continuous monitoring of the compound action potential (CAP) and auditory brainstem response(ABR) during the surgery. Results The tumor in Case 1 was 1.5 cm in diameter. The average pure-tone hearing threshold was 30 dB HL and ABR was normal. Waves I, III and V of ABR were present following tumor removal. At 7th month follow-up, audiometric thresholds and ABR inter-peak intervals had recovered to pre-operative levels, with normal facial nerve function. The patient in Case 2 had bilateral AN. The tumors measured 4.0 cm(left) and 5.0 cm (right) on MRI scans. The AN on the right side was removed first, followed by removal of the left AN four months later. Intraoperative CAP monitoring was employed during removal of the left AN. While efforts to preserve the cochlear nerve were not successful, CAPs were still present after tumor removal. Conclusions Intraoperatively recorded CAPs are not reliable in predicting postoperative hearing outcomes. In contrast, ABRs are an indicator of function of the peripheral auditory pathway. Presence of waves I, III and V following tumor removal may represent preservation of useful hearing.
文摘BACKGROUND Gastrointestinal subepithelial tumors(GSTs),incidentally detected during upper gastrointestinal(GI)endoscopy,may be lesions derived from the GI wall or may be caused by compression from external organs.In general,traumatic neuroma is a benign nerve tumor that results from postoperative nerve injury,occurring in the bile duct as one of the complications after cholecystectomy.This is the first case report demonstrating that neuroma of the cystic duct can be incorrectly perceived as a duodenal subepithelial tumor by compressing the duodenal wall.CASE SUMMARY We report the case of a 72-year-old man with traumatic neuroma of the cystic duct after cholecystectomy.This tumor was mistaken for a duodenal subepithelial tumor on preoperative upper GI endoscopy and endoscopic ultrasonography due to external compression of the GI wall.The patient had no symptoms,and his laboratory test results were normal.However,in a series of follow-up endoscopies,the tumor was found to have grown in size,so it was surgically resected.The lesion was completely removed by laparoscopic endoscopic cooperative surgery.The patient was discharged on postoperative day 7 without complications.CONCLUSION Traumatic neuroma of the cystic duct can be mistaken for GSTs in GI endoscopy.
基金the National Natural Science Foundation of China,No.31771322Major R&D Program of National Ministry of Science and Technology of China,No.2018YFB1105504+1 种基金Beijing Natural Science Foundation of China,No.7212121and Shenzhen Science and Technology Plan Project of China,No.JCYJ20190806162205278(all to PXZ).
文摘Studies have shown that myelin-associated glycoprotein(MAG)can inhibit axon regeneration after nerve injury.However,the effects of MAG on neuroma formation after peripheral nerve injury remain poorly understood.In this study,local injection of MAG combined with nerve cap made of chitin conduit was used to intervene with the formation of painful neuroma after sciatic nerve transfection in rats.After 8 weeks of combined treatment,the autotomy behaviors were reduced in rats subjected to sciatic nerve transfection,the mRNA expression of nerve growth factor,a pain marker,in the proximal nerve stump was decreased,the density of regenerated axons was decreased,the thickness of the myelin sheath was increased,and the ratio of unmyelinated to myelinated axons was reduced.Moereover,the percentage of collagen fiber area and the percentage of fibrosis marker alpha-smooth muscle actin positive staining area in the proximal nerve stump were decreased.The combined treatment exhibited superior effects in these measures to chitin conduit treatment alone.These findings suggest that MAG combined with chitin conduit synergistically inhibits the formation of painful neuroma after sciatic nerve transection and alleviates neuropathic pain.This study was approved by the Animal Ethics Committee of Peking University People’s Hospital(approval No.2019PHE027)on December 5,2019.
文摘Acoustic Neuroma (AN) arises from the eighth cranial nerve. It primarily involves the vestibular branch of the nerve and is therefore also called vestibular schwannoma(VS). To the date, diagnosis and surgical treatment of AN have advanced significantly. Along with advances in audiology and imaging technologies, cases of diagnosed AN have been increasing, making it a common
