Large and giant vestibular schwannomas: does cisterna magna hyperproteinorrhachia influence visual status?

Kumar, Brijesh; Behari, Sanjay; Jaiswal, Awadhesh Kumar; Jha, Vikas Kumar; Bettaswamy, Guruprasadh; Singh, Uttam

doi:10.1007/s00701-012-1529-4

Cited by 9 publications

(4 citation statements)

References 20 publications

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“…They also can produce problems with CSF absorption from protein leaking into the CSF. 6,7 In the present case, disc oedema was present in the absence of obstructive hydrocephalus. A strong possibility is the role of hyperproteinorrhachia in causing CSF stasis.…”

Section: Discussionmentioning

confidence: 72%

Advanced Vestibular Schwannoma: A Case of Optic Disc Oedema without Hydrocephalus

Matos¹,

Gil²,

Pires³

et al. 2016

Neuro-Ophthalmology

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A wide range of pathologies can cause papilloedema. Vestibular schwannoma is a benign and slow-growing tumour that causes symptoms and findings on ophthalmic examination when the diagnostic is delayed. The authors report a case of a 64-year-old male who presented with bilateral disc oedema secondary to a vestibular schwannoma grade 4. Obstructive hydrocephalus was not evident. The authors suggest that cerebrospinal fluid protein may have a role in the formation of optic disc oedema. A right suboccipital craniectomy was performed to remove the tumour, leading to secondary facial palsy. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 72%

Advanced Vestibular Schwannoma: A Case of Optic Disc Oedema without Hydrocephalus

Matos¹,

Gil²,

Pires³

et al. 2016

Neuro-Ophthalmology

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“…Among the western series, the incidence ranges from 1 to 10%, while in developing world series, it varies from 6.2 to 57.5% ( Table 5 ). 3 4 5 6 7 8 9 10 Actual incidences may differ due to underreporting. In the Western world, patients seek medical attention early at the onset of symptoms; therefore, small tumors are detected early.…”

Section: Discussionmentioning

confidence: 99%

“…In logistic regression analysis, duration of symptoms, papilloedema, hydrocephalus, and tumor volume was not significant for visual loss. 5 Shedding of protein through the tumor capsule was the probable cause. Protein concentration in ventricular CSF was also higher in their study.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Visual Impairment in Vestibular Schwannoma Patients: An Overlooked Entity of Developing World

et al. 2022

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Objective Visual impairment in vestibular schwannomas is an underreported entity. The plethora of literature focuses primarily on facial and hearing preservation. This study aims to describe our experience and find the possible reasons for visual impairment. Materials and Methods This is a retrospective observational study. We evaluated 114 patients with vestibular schwannoma, operated during 2015 to 2020. Eight parameters were studied—age, gender, maximum tumor size, hydrocephalus, economic status, duration of symptoms, visual loss, and ease of access to the tertiary neurosurgical facility. JASP software (version 0.14.1, Amsterdam) was used for statistical analysis. Results A total of 42/114 (36.84%) patients had a varying degree of impairment. Patients with impaired vision had significantly larger tumors (4.31 vs. 4.12 cm, p = 0.02), longer duration of symptoms (19.14 vs. 16.45 months, p = 0.02), hydrocephalus (p = 0.03), and were from remote areas (p = 0.009). In stepwise logistic regression analysis, longer duration of symptoms and difficult access to neurosurgical facility stand out as decisive factors for visual impairment. The follow-up data were available for 35/42 (83.33%) cases of visual impairment. Vision improved in 14/35 (40%) of cases. Vision improved in a significantly higher number of patients when a preoperative ventriculoperitoneal shunt was placed (p = 0.03). Conclusion The visual handicap occurs in a significant number of patients with vestibular schwannoma. Delayed arrival at the neurosurgical facility due to difficult access appears to be the primary factor leading to blindness. Strengthening our healthcare systems in rural areas would go a long way in the timely detection and prevention of blindness in such cases.

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“…While the incidence of hydrocephalus was comparable between the two groups, it is likely that raised intracranial pressure was greater in the group with tumors ≥5 cm in size, as evidenced by the increased incidence of papilledema at earlier presentation. Kumar et al, [14] have shown that independent of the tumor volume, elevated cisternal CSF proteins may play an important role in determining the presence of papilledema and visual outcome in giant VSs. The presence of an increased incidence of diplopia due to a unilateral sixth nerve paresis in this group with tumors ≥5 cm in size also may be attributed to the size of the tumor and direct compression of the abducens nerve rather than a generalized raised intracranial pressure, which causes a bilateral lateral rectus paresis.…”

Section: Clinical Presentationmentioning

confidence: 99%

Giant vestibular schwannomas: Surgical nuances influencing outcome in 179 patients

et al. 2016

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Large and giant vestibular schwannomas: does cisterna magna hyperproteinorrhachia influence visual status?

Cited by 9 publications

References 20 publications

Advanced Vestibular Schwannoma: A Case of Optic Disc Oedema without Hydrocephalus

Advanced Vestibular Schwannoma: A Case of Optic Disc Oedema without Hydrocephalus

Preoperative Visual Impairment in Vestibular Schwannoma Patients: An Overlooked Entity of Developing World

Giant vestibular schwannomas: Surgical nuances influencing outcome in 179 patients

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