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Primary Paraganglioma of the Facial Canal: An Evidence-Based Approach.

原发性面管副神经节瘤: 循证方法。

  • 影响因子:2.23
  • DOI:10.1177/0194599820907303
  • 作者列表:"Yuhan BT","Trang A","Hutz MJ","Leonetti JP
  • 发表时间:2020-04-01
Abstract

OBJECTIVES:To perform an evidence-based review evaluating presenting symptoms, imaging, and management for primary paragangliomas of the facial canal (PPFCs). DATA SOURCES:PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science. REVIEW METHODS:Studies were assessed for quality of evidence and bias with the Cochrane bias tool, GRADE, and MINORS criteria. Demographic data, imaging modalities, management strategies, and status at last follow-up were obtained. RESULTS:Sixteen studies met inclusion criteria. In total, 21 patients with PPFCs were identified, 19 of which were histologically confirmed. Most common presenting symptoms included unilateral facial nerve dysfunction (n = 14, 73.7%) and pulsatile tinnitus (n = 8, 42.1%). Mean time from reported onset of facial dysfunction was 17.8 months. Computed tomography findings included an expanded descending facial nerve canal (n = 13, 76.5%). All cases with magnetic resonance imaging reported enhancement with contrast. Of the 18 patients who had surgery, 16 (88.9%) underwent full tumor resection while 1 (5.6%) had partial tumor debulking with adjuvant radiotherapy. Overall improvement in facial weakness was documented in 5 of 9 patients (55.6%) with initial facial nerve dysfunction and >6-month follow-up. No evidence of tumor recurrence was reported. CONCLUSIONS:PPFCs are extraordinarily rare vascular neoplasms of the temporal bone. Early imaging with both computed tomography and magnetic resonance imaging is essential for narrowing the differential diagnosis, assessing the extent of tumor invasion, and accurate surgical planning. Surgical tumor resection with subsequent facial nerve reconstruction is recommended for patients with facial nerve dysfunction, while tumor biopsy or debulking may be indicated when normal facial movement in present.

摘要

目的: 对原发性面管副神经节瘤 (PPFCs) 的症状、影像学表现和治疗进行循证评价。 数据来源: PubMed/MEDLINE、Embase、Cochrane Library和Web of Science。 综述方法: 采用Cochrane偏倚工具、分级和未成年人标准评估研究的证据质量和偏倚。获得了人口统计学数据、成像方式、管理策略和最后随访时的状态。 结果: 16 项研究符合纳入标准。共鉴定出 21 例PPFCs患者,其中 19 例经组织学证实。最常见的症状包括单侧面神经功能障碍 (n = 73.7%) 和搏动性耳鸣 (n = 42.1%)。从报告的面部功能障碍开始的平均时间为 17.8 个月。计算机断层扫描结果包括扩大的面神经下行管 (n = 13,76.5%)。所有磁共振成像病例均报告增强与对比。18 例接受手术的患者中,16 例 (88.9%) 接受了肿瘤全切除,1 例 (5.6%) 在辅助放疗下部分肿瘤减瘤。9 例初始面部神经功能障碍且> 6 个月随访的患者中有 5 例 (55.6%) 记录了面部无力的总体改善。未报告肿瘤复发的证据。 结论: PPFCs是非常罕见的颞骨血管肿瘤。计算机断层扫描和磁共振成像的早期成像对于缩小鉴别诊断疾病、评估肿瘤浸润程度和准确的手术计划至关重要。对于面神经功能障碍的患者,建议手术切除肿瘤并进行后续面神经重建,而当存在正常的面部运动时,可能会提示肿瘤活检或减瘤。

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发表时间:2020-03-01
DOI:10.1177/1078155219842277
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METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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