Neuro-Ophthalmic Complications of Vestibular Schwannoma Resection: Current Perspectives

Abstract

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.

Surgical Management of Cerbellopontine Angle Tumors - Experience from a Tertiary Care Hospital of Peshawar

“…. The abducent nerve (VI) is affected by large vestibular shwannoma followed by an increased intracranial pressure with damge to CN-VI intra-operatively or due to trauma causing exposure keratitis 16 . Studies haves reported to have managed 45% of such cases conservatively with use of eye lubricant and eye shield only while 40-45% required surgeries to manage 17. We recorded CP Angle Meningioma 8 (16.7%) cases with Two cases had Brainstem contusion with hemeperisis (posttraumatic).…”

“…The abducent nerve (VI) is affected by large vestibular shwannoma followed by an increased intracranial pressure with damge to CN-VI intraoperatively or due to trauma causing exposure keratitis 8,16 . Studies haves reported to have managed such cases conservatively while 40-45% of the comlications required surgeries to manage, 9,16 Vestibular Schwannoma with Hydrocephalus are managed with Ventriculo-Peritoneal Shunt. Obstructive hydrocephalus with acoustic neuroma as result of compression of 4 th ventricle by the CP anlgle tumor.…”

Platelet-Covered Nanocarriers for Targeted Delivery of Hirudin to Eliminate Thrombotic Complication in Tumor Therapy

“…The treatment of malignant cancers is vigorously pursued with precision, while the possible complications of thrombi are often ignored. , The occurrence and development of thrombi are closely related to the tumor . Many clinical and biological risk factors make tumor patients vulnerable to thrombi, including intravenous drug injection, surgical excision, laser irradiation, etc .…”