The Imaging of Large Nerve Perineural Spread

Gandhi, Mitesh; Sommerville, Jennifer

doi:10.1055/s-0036-1571836

Cited by 28 publications

(10 citation statements)

References 13 publications

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“…10 In the absence of symptoms such as pain, burning sensation, or paresthesias, which have been reported to be present in up to 60% of patients with PNS, PNS is less likely. 8 MRI has been shown to have a detection rate in large nerve PNS of greater than 95%, 11 and in our patient, it showed no enlargement or enhancement of nerves or other findings suggestive of PNS. However, absence of MRI findings does not definitively rule out PNS.…”

Section: Discussionsupporting

confidence: 54%

Isolated Abducens Nerve Palsy Following Pembrolizumab

Jaben

Francis

Shoushtari

et al. 2019

Neuro-Ophthalmology

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Pembrolizumab is a checkpoint inhibitor targeting the programmed cell death 1 receptor of lymphocytes and is used in the treatment of solid tumours including melanoma. The authors report a 64-yearold man treated with pembrolizumab for stage IV cutaneous melanoma (primary cutaneous melanoma of the right lower back) with liver metastases. The patient developed a horizontal binocular diplopia due to an isolated unilateral cranial nerve VI palsy. Following 1 week of high dose oral steroid therapy and cessation of the drug, the patient's nerve palsy and associated diplopic symptoms improved dramatically, and after 6 weeks of oral steroid taper and drug cessation, the palsy resolved completely. Few reports of checkpoint inhibitor autoimmune-induced isolated cranial nerve palsies have been described, and this is the first report of drug-induced isolated cranial nerve VI palsy.

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Section: Discussionsupporting

confidence: 54%

Isolated Abducens Nerve Palsy Following Pembrolizumab

Jaben

Francis

Shoushtari

et al. 2019

Neuro-Ophthalmology

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“…Sommerville et al described a sensitivity of 95–100% using this broader definition of neurography. 9 Steady state precession sequences, more commonly known by trade names such as FIESTA (Fast Imaging Employing Steady-state Acquisition) or CISS (Constructive Interference Steady State), are another promising tool, though data is limited. 10 These sequences derive signal intensity from the tissue ratio of T2 to T1 signal, again offering improved resolution between cerebrospinal fluid and nerve tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, some authors and sites use the term more broadly to describe high resolution, focused cranial nerve MRI. Sommerville et al described a sensitivity of 95–100% using this broader definition of neurography 9 . Steady state precession sequences, more commonly known by trade names such as FIESTA (Fast Imaging Employing Steady-state Acquisition) or CISS (Constructive Interference Steady State), are another promising tool, though data is limited 10 .…”

Section: Discussionmentioning

confidence: 99%

Mixed cranial neuropathies due to occult perineural invasion of basal cell carcinoma

Ashraf

Kalin-Hajdu

Levin

et al. 2019

American Journal of Ophthalmology Case Reports

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PurposeTo report a diagnostically challenging case of cranial neuropathy due to perineural invasion by a basal cell carcinoma presenting 7.5 years after treatment of the primary tumor with Mohs micrographic surgery.ObservationsA 62-year-old male with a history of Mohs micrographic surgery for basal cell carcinoma (BCC) of the left brow presented with insidious onset of diplopia and paresthesia localizing to the ipsilateral cranial nerves V1, V2, and VI. He had no evidence of recurrent cutaneous BCC. Magnetic resonance imaging of the orbits and skull base identified equivocal, subtle abnormalities in the ipsilateral superior orbital fissure and cavernous sinus, with normal appearance of the clinically involved nerve branches. A radiographically normal branch of cranial nerve V was biopsied and histopathology identified perineural invasion by recurrent basal cell carcinoma.Conclusions and importanceThe diagnosis of perineural invasion by BCC can pose several challenges, including subtle to absent imaging findings of clinically involved nerves and a lengthy latent period following primary tumor treatment. This case represents, to our knowledge, the longest reported interval between primary treatment and biopsy-proven recurrence with perineural invasion by BCC.

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“…One such metastasis, perineural spread of malignancy along the trigeminal (V) and facial nerves (VII), is a complication of head and neck tumours which is becoming more frequently recognised and results in a poor prognosis for the patient [ 2 , 3 ]. Diagnosis of perineural spread involves a variety of imaging techniques, particularly MRI, but is often delayed due to the slow development of clinical symptoms [ 4 , 5 ]. Successful imaging of the tumour is important in determining therapeutic options which include surgical resection and/or radiation treatment [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Elevated frequencies of CD8 T cells expressing PD-1, CTLA-4 and Tim-3 within tumour from perineural squamous cell carcinoma patients

et al. 2017

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Perineural spread of tumour cells along cranial nerves is a severe complication of primary cutaneous squamous cell carcinomas of the head and neck region. While surgical excision of the tumour is the treatment of choice, removal of all the tumour is often complicated by the neural location and recurrence is frequent. Non-invasive immune treatments such as checkpoint inhibitor blockade may be useful in this set of tumours although little is understood about the immune response to perineural spread of squamous cell carcinomas. Immunohistochemistry studies suggest that perineural tumour contains a lymphocyte infiltrate but it is difficult to quantitate the different proportions of immune cell subsets and expression of checkpoint molecules such as PD-1, Tim-3 and CTLA-4. Using flow cytometry of excised perineural tumour tissue, we show that a T cell infiltrate is prominent in addition to less frequent B cell, NK cell and NKT cell infiltrates. CD8 T cells are more frequent than other T cells in the tumour tissue. Amongst CD8 T cells, the frequency of Tim-3, CTLA-4 and PD-1 expressing cells was significantly greater in the tumour relative to the blood, a pattern that was repeated for Tim-3, CTLA-4 and PD-1 amongst non-CD8 T cells. Using immunohistochemistry, PD-1 and PD-L1-expression could be detected in close proximity amongst perineural tumour tissue. The data suggest that perineural SCC contains a mixture of immune cells with a predominant T cell infiltrate containing CD8 T cells. Elevated frequencies of tumour-associated Tim-3+, CTLA-4+ and PD-1+ CD8 T cells suggests that a subset of patients may benefit from local antibody blockade of these checkpoint inhibitors.

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The Imaging of Large Nerve Perineural Spread

Cited by 28 publications

References 13 publications

Isolated Abducens Nerve Palsy Following Pembrolizumab

Isolated Abducens Nerve Palsy Following Pembrolizumab

Mixed cranial neuropathies due to occult perineural invasion of basal cell carcinoma

Elevated frequencies of CD8 T cells expressing PD-1, CTLA-4 and Tim-3 within tumour from perineural squamous cell carcinoma patients

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