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

Matos, Rui; Gil, Pedro; Pires, J.M.; Lopes, Nádia

doi:10.1080/01658107.2016.1183133

Cited by 9 publications

(3 citation statements)

References 7 publications

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“…Matos et al reported a case of optic disc edema without hydrocephalus in a 3 cm tumor. 19 Papilledema without hydrocephalus is also described in an NF 2 case. 20 Similar observations were reported in other studies.…”

Section: Discussionmentioning

confidence: 90%

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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Section: Discussionmentioning

confidence: 90%

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

et al. 2022

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“…More recently, Grainger and Dias [ 9 ] and Matos, et al [ 10 ] suggested that protein secretion into the CSF by vestibular schwannomas may cause an impaired reabsorption of CSF, albeit intermittently, resulting in a type of communicating hydrocephalus. The same mechanism was proposed in patients with spinal schwannomas and normal pressure hydrocephalus [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Vestibular Schwannoma Presenting with Bilateral Papilledema Without Hydrocephalus: Case Study

Candanedo

Moscovici

Kruger

et al. 2017

Cureus

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Bilateral papilledema secondary to obstructive or communicating hydrocephalus in patients with vestibular schwannomas is a known presentation; however, papilledema in the absence of hydrocephalus is rarely reported and its mechanism is poorly understood. We report a case of a 20-year-old woman presenting with visual deterioration and bilateral papilledema on fundoscopy. Magnetic resonance imaging (MRI) revealed a giant vestibular schwannoma with no sign of hydrocephalus. The only imaging evidence of increased pressure on preoperative imaging studies was seen on a T2-weighted MRI, where there was subtle dilatation of the arachnoid space of the optic sleeve. We presume that this patient developed papilledema by some mechanism not connected to hydrocephalus. In a young patient, papilledema may be a sign preceding hydrocephalus, or she may have had pseudotumor cerebri concomitant with her vestibular schwannoma. In either case, removal of the vestibular schwannoma solved the problem. She had complete visual recovery, irrespective of the mechanism.

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“…Further, it is even more rare to identify patients with papilledema without hydrocephalus, although there are isolated cases reported. [14][15][16]…”

Section: Introductionmentioning

confidence: 99%

Vision Deterioration and Hydrocephalus: Rare Presentations of Vestibular Schwannoma and Evolution of Management

Keulen

Pace

Penn

et al. 2021

J Neurol Surg B Skull Base

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Introduction The incidence of vestibular schwannoma is reported as 12 to 54 new cases per million per year, increasing over time. These patients usually present with unilateral sensorineural hearing loss, tinnitus, or vertigo. Rarely, these patients present with symptoms of hydrocephalus or vision changes. Objective The study aimed to evaluate the surgical management of vestibular schwannoma at a single institution and to identify factors that may contribute to hydrocephalus, papilledema, and the need for pre-resection diversion of cerebrospinal fluid. Patients and Methods A retrospective review examining the data of 203 patients with vestibular schwannoma managed with surgical resection from May 2008 to May 2020. We stratified patients into five different groups to analyze: tumors with a diameter of ≥40 mm, clinical evidence of hydrocephalus, and of papilledema, and patients who underwent pre-resection cerebrospinal fluid (CSF) diversion. Results From May 2008 to May 2020, 203 patients were treated with surgical resection. Patients with tumors ≥40 mm were more likely to present with visual symptoms (p < 0.001). Presentation with hydrocephalus was associated with larger tumor size (p < 0.001) as well as concomitant visual symptoms and papilledema (p < 0.001). Patients with visual symptoms presented at a younger age (p = 0.002) and with larger tumors (p < 0.001). Conclusion This case series highlights the rare presentation of vision changes and hydrocephalus in patients with vestibular schwannoma. We recommend urgent CSF diversion for patients with visual symptoms and hydrocephalus, followed by definitive resection. Further, vision may still deteriorate even after CSF diversion and tumor resection.

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

Cited by 9 publications

References 7 publications

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

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

Vestibular Schwannoma Presenting with Bilateral Papilledema Without Hydrocephalus: Case Study

Vision Deterioration and Hydrocephalus: Rare Presentations of Vestibular Schwannoma and Evolution of Management

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