Ophthalmic Complications Following Acoustic Neuroma Resection

Gange, William S.; Kirchner, Ian D; Thompson, James T.; Hill, Jacquelyn P.; Grahnke, Kurt; Ibrahim, Tarik F.; Leonetti, John; Anderson, Douglas E.; Bouchard, Charles S.

doi:10.1093/ons/opx071

Cited by 8 publications

(15 citation statements)

References 17 publications

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“…However, the direct impact of VII nerve monitoring on post-operative VII function is yet to be elucidated. 16 , 27 Stereotactic radiosurgery has lower rates of post-treatment VII nerve weakness with less than 1% of patients in our own neurosurgical unit having persistent VII nerve weakness following Gamma knife radiosurgery. 29 Whilst traditionally reserved for smaller tumor sizes, stereotactic radiosurgery can achieve reasonable tumor control even for larger volume VSs of greater than 10cm 3 .…”

Section: Facial (Vii) Nerve Weaknessmentioning

confidence: 91%

“… 78 One series reported two cases (1.1%) of peri-orbital cellulitis following VS resection. 16 Finally, Roland et al reported one case of a persistent Horner’s syndrome following resection of a VS. 54 This was, however, associated with a severe sialadenitis (salivary gland inflammation) and a large neck phlegmon, which also caused a temporary palsy of the lower cranial nerves and the brachial plexus.…”

Section: Miscellaneousmentioning

confidence: 99%

“…In the presence of a desensate cornea, the risk of severe ocular complications is significantly greater. 16 , 31 , 34 , 35 …”

Section: Facial (Vii) Nerve Weaknessmentioning

confidence: 99%

“…When reported, the rates of corneal or facial hypoesthesia after VS resection vary widely between 2% and 40%. 16 , 22 , 34 , 46 , 48 It is difficult to determine whether V nerve damage in these reports arose from the effects of the tumor or the effect of surgery. Whilst VII nerve function is clearly adversely affected by VS surgery, V nerve function may be more affected by the tumor itself over and above the surgery.…”

Section: Trigeminal (V) Nerve Damagementioning

confidence: 99%

“… 50 In combination with exposure of the eye and reduced lacrimation as a result of VII nerve palsy, the desensate cornea is particularly at risk. 8 , 10 , 15 , 16 , 22 , 31 , 33–35 , 46 …”

Section: Trigeminal (V) Nerve Damagementioning

confidence: 99%

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Neuro-Ophthalmic Complications of Vestibular Schwannoma Resection: Current Perspectives

Chiu¹,

Hickman²,

Pepper³

et al. 2021

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Vestibular schwannomas (VSs), also called acoustic neuromas, are benign intracranial neoplasms of the vestibulocochlear (VIII) cranial nerve. Management options include “wait-and-scan,” stereotactic radiosurgery and surgical resection. Due to the proximity of the VIII nerve to the facial (VII) nerve in the cerebello-pontine angle, the VII nerve is particularly vulnerable to the effects of surgical resection. This can result in poor eye closure, lagophthalmos and resultant corneal exposure post VS resection. Additionally, compression from the tumor or resection can cause trigeminal (V) nerve damage and a desensate cornea. The combination of an exposed and desensate cornea puts the eye at risk of serious ocular complications including persistent epithelial defects, corneal ulceration, corneal vascularization, corneal melting and potential perforation. The abducens (VI) nerve can be affected by a large intracranial VS causing raised intracranial pressure (a false localizing sign) or as a result of damage to the VI nerve at the time of resection. Other types of neurogenic strabismus are rare and typically transient. Contralaterally beating nystagmus as a consequence of vestibular dysfunction is common post-operatively. This generally settles to pre-operative levels as central compensation occurs. Ipsilaterally beating nystagmus post-operatively should prompt investigation for post-operative cerebrovascular complications. Papilledema (and subsequent optic atrophy) can occur as a result of a large VS causing raised intracranial pressure. Where papilledema follows surgical resection of a VS, it can indicate that cerebral venous sinus thrombosis has occurred. Poor visual function following VS resection can result as a combination of all these potential complications and is more likely with larger tumors.

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Section: Facial (Vii) Nerve Weaknessmentioning

confidence: 91%