Vestibular Schwannoma Presenting with Bilateral Papilledema Without Hydrocephalus: Case Study

Candanedo, Carlos; Moscovici, Samuel; Kruger, Joshua M.; Mizrachi, Cezar J; Eliahou, Ruth; Spektor, Sergey

doi:10.7759/cureus.1862

Cited by 3 publications

(2 citation statements)

References 9 publications

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“… 21 A giant tumor may present with papilloedema and visual impairment without hydrocephalus. 22 These reports suggest that hydrocephalus is not mandatory for the development of papilloedema in vestibular schwannoma. As long as any cerebrospinal fluid (CSF) cleft persists inside the fourth ventricle, CSF circulation remains intact.…”

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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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Papilledema secondary to vestibular schwannoma: An atypical case without intracranial hypertension

et al. 2022

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Vestibular Schwannoma Presenting with Bilateral Papilledema Without Hydrocephalus: Case Study

Cited by 3 publications

References 9 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

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

Papilledema secondary to vestibular schwannoma: An atypical case without intracranial hypertension

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