Neuroma

Neuroma is a tumor in the spinal, peripheral and cranial nerves. Other names for this tumor are schwannoma or neurilemma. It is a capsule-shaped benign neoplasm. The probability of developing a schwannoma ranges from 9–14%, depending on the location.

Most often appears in the auditory or vestibulocochlear nerve. Rarely develops into a malignant neoplasm.

Varieties

The most common types of neuroma are:

• Morton's neuroma. Appears on the sole of one foot. As a rule, it is formed in the space between the middle and ring fingers, less often between the middle and index fingers;
• Acoustic neuroma. Otherwise known as acoustic or vestibular schwannoma. The disease develops so slowly that people may not realize that they are sick for a very long time. Elderly people most often suffer from cerebral neuromas. Appears in the abducens, facial and trigeminal nerves. If a cerebral neuroma is detected in time, the patient’s life prognosis appears positive;
• schwannoma of the spine. It most often occurs in the thoracic and cervical regions, less often in the lumbar region. It is able to grow through the intervertebral foramina.

Causes

Factors causing the occurrence of the disease may be:

• radiation exposure;
• chemical exposure over a long period of time;
• neurofibromatosis in the patient or his relatives;
• heredity;
• the presence of other benign neoplasms.

If a patient is diagnosed with a neuroma, it should not be argued that this is a consequence of the above factors. The reasons can be completely unpredictable.

Symptoms

This disease manifests itself in various ways. Symptoms depend directly on the size and location of the tumor.

With an acoustic neuroma, the following symptoms appear in exact sequence:

• ringing in the ears. Appears on the side of the affected nerve;
• hearing impairment. The first warning sign may be the inability to recognize voices on the phone. Observed in 95% of cases;
• loss of coordination, loss of balance, nausea and frequent dizziness due to damage to the vestibular part of the auditory nerve.

Spinal neuroma manifests itself:

• with radicular pain syndrome, muscle paralysis, impaired sensitivity of the skin, numbness, weakness in the limbs or pain;
• with the syndrome of autonomic disorders, digestion, the functioning of the pelvic organs, cardiac activity deteriorate and the color of the skin changes;
• with the syndrome of damage to the diameter of the spinal cord, spastic paralysis occurs and sensitivity is impaired.

With neuroma of any peripheral nerves, a sharp and shooting pain occurs at the site of occurrence when pressed.

Diagnosis of neuroma

The method for diagnosing a schwannoma depends on its location. After examining the patient, the therapist prescribes further research.

1. Examination by a neurologist. The examination includes testing the reflexes of various nerves and identifying symptoms.

Symptoms that occur when cranial nerves are damaged are:

• nystagmus. These are involuntary twitching eye movements. It is detected by monitoring the reaction of the pupils to the movement of the hammer in the doctor’s hands;
• loss of balance and altered gait. Determined by passing the Romberg test (the patient stands up with outstretched arms and closes his eyes). If the nerves are damaged, the patient deviates to one side and cannot maintain balance. The patient also experiences dizziness and nausea when turning the head;

• damage to the hearing aid. To identify a lesion, a tuning fork (a special instrument for producing sound) is used. Squeezing the legs of the device, the doctor one by one brings it to the patient’s ears. Then the doctor places a tuning fork on the mastoid process of the temporal bone and asks the patient to report the moment when he stops feeling the vibration of the device. With a neuroma, the sound and vibration of the instrument in both ears sounds different;
• double vision (diplopia). It is observed with large tumors that press on the abducens nerve;
• poor skin sensitivity on the face. When diagnosing, the doctor touches the patient’s face with a special needle. Normally, a person should feel all these touches clearly;
• deterioration or complete disappearance of the corneal (a sign of trigeminal neuroma) or swallowing reflex. The first reflex should appear when the cotton swab touches the cornea of ​​the eye. If a patient has a trigeminal schwannoma, then most likely the eye will not respond to the stimulus by blinking. The swallowing reflex should occur in response to the touch of any object to the patient’s throat. Damage to the glossopharyngeal nerve is observed in cases of large tumors that press on the brain stem;
• facial nerve paresis. It manifests itself in disturbances in the sense of taste and salivation, and also leads to facial asymmetry (when frowning, smiling, and when trying to completely close the eyes).

Symptoms that a doctor should pay attention to, and which indicate damage to the spinal nerve:

• weakness in muscle tissue. The doctor will ask the patient to squeeze two of his fingers as tightly as possible and will be able to determine whether both hands are equally strong. Then you need to alternately raise the lower limbs while the neurologist provides resistance and thus evaluates it on a 5-point scale;
• rigidity (stiffness of movements). The patient is asked to completely relax his arm and watch how it works in the joints. A healthy person will involuntarily offer little resistance when shaking his arm too much;
• pain and cold sensitivity. The cold room is checked with test tubes of different temperatures, and the pain zone is checked with an algesimeter - a special device;
• increased tendon reflex. First, the doctor strikes the knees with a hammer, while the lower leg should be extended. And then he hits the Achilles tendon with a hammer, which should entail extension of the ankle joints. Reflexes are also rated on a scale from 0 to 4.

1. Audiogram. This study reveals the degree of hearing impairment in acoustic schwannoma.
2. Computed tomography and nuclear magnetic resonance. Prescribed for the diagnosis of cerebral neuroma. Their task is to study brain tissue layer by layer.
3. Ultrasound. A safe and fairly informative research method that shows changes in tissues near the tumor.
4. X-ray. Detects changes in bone structures located near the tumor.
5. Biopsy. Taking a fragment of tumor tissue for histological examination.

Treatment of neuroma

Contraindications to surgery are cardiovascular diseases, old age and serious condition of the patient.

Removal of a neuroma occurs microsurgically (acoustic schwannoma), partially when the tumor grows with nerve fibers, and stereotactically (local irradiation). Radiosurgical treatment is prescribed for contraindications to surgery. Reviews for this treatment method are only good, because it has virtually no side effects.

A conservative treatment method consists of taking medications and monitoring water-electrolyte balance and diuresis. In addition to basic medications, drugs that improve brain activity are also prescribed.

Timely ways to detect symptoms and diagnose neuroma will help avoid the unpleasant consequences of this disease. A well-performed operation will allow you to forget forever about the existence of such a pathology in the past.