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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(03): 448-454
DOI: 10.1055/s-0042-1756633
Original Article

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

Sanjeev Kumar
1   Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
,
Debabrata Sahana
1   Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
,
Amit Jain
1   Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
,
Lavlesh Rathore
1   Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
,
Manish Tawari
1   Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
,
Jatinder Mittal
1   Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
,
Rajiv Sahu
1   Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
› Author Affiliations Funding None.
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Abstract

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.

Keywords

vestibular schwannoma - acoustic neuroma - visual impairment

List of Abbreviations

DOS, duration of symptoms; BPL, below poverty line; APL, above poverty line; WHO, World Health Organization; CT, computed tomography scan; MRI, magnetic resonance imaging; CSF, cerebro-spinal fluid; VP, ventriculo-peritoneal; HCP, hydrocephalus.


Ethical Approval

The ethical approval was not needed and waived. The patient consented to participation.


Informed Consent

Written informed consent was obtained from the patient to publish this manuscript and any accompanying images.


Authors' Contributions

SK, DS, and AJ were operating surgeons; SK, DS, AJ, and MT conducted the literature search; SK, DS, and JM prepared the manuscript; SK, DS, and RS edited the final manuscript; MT, AJ, and JM performed the follow-up of the patient. All the authors have read and approved the manuscript.




Publication History

Article published online:
08 October 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Babu R, Sharma R, Bagley JH, Hatef J, Friedman AH, Adamson C. Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management. J Neurosurg 2013; 119 (01) 121-130
    CrossrefPubMedGoogle Scholar
  • 2 Tos M, Stangerup SE, Cayé-Thomasen P, Tos T, Thomsen J. What is the real incidence of vestibular schwannoma?. Arch Otolaryngol Head Neck Surg 2004; 130 (02) 216-220
    CrossrefPubMedGoogle Scholar
  • 3 Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg 2010; 112 (04) 860-867
    Google Scholar
  • 4 Jain VK, Mehrotra N, Sahu RN, Behari S, Banerji D, Chhabra DK. Surgery of vestibular schwannomas: an institutional experience. Neurol India 2005; 53 (01) 41-45 , discussion 45
    Google Scholar
  • 5 Kumar B, Behari S, Jaiswal AK, Jha VK, Bettaswamy G, Singh U. Large and giant vestibular schwannomas: does cisterna magna hyperproteinorrachia influence visual status?. Acta Neurochir (Wien) 2013; 155 (01) 63-69
    CrossrefPubMedGoogle Scholar
  • 6 Nair S, Baldawa SS, Gopalakrishnan CV, Menon G, Vikas V, Sudhir JB. Surgical outcome in cystic vestibular schwannomas. Asian J Neurosurg 2016; 11 (03) 219-225
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Turel MK, D'Souza WP, Chacko AG, Rajshekhar V. Giant vestibular schwannomas: surgical nuances influencing outcome in 179 patients. Neurol India 2016; 64 (03) 478-484
    Google Scholar
  • 8 van Meter WS, Younge BR, Harner SG. Ophthalmic manifestations of acoustic neurinoma. Ophthalmology 1983; 90 (08) 917-922
    CrossrefPubMedGoogle Scholar
  • 9 Matthies C, Samii M. Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery 1997; 40 (01) 1-9 , discussion 9–10
    PubMedGoogle Scholar
  • 10 Huang X, Xu J, Xu M. et al. Clinical features of intracranial vestibular schwannomas. Oncol Lett 2013; 5 (01) 57-62
    CrossrefPubMedGoogle Scholar
  • 11 Stangerup SE, Tos M, Thomsen J, Caye-Thomasen P. True incidence of vestibular schwannoma?. Neurosurgery 2010; 67 (05) 1335-1340 , discussion 1340
    CrossrefPubMedGoogle Scholar
  • 12 Ben Ammar M, Piccirillo E, Topsakal V, Taibah A, Sanna M. Surgical results and technical refinements in translabyrinthine excision of vestibular schwannomas: the Gruppo Otologico experience. Neurosurgery 2012; 70 (06) 1481-1491 , discussion 1491
    CrossrefPubMedGoogle Scholar
  • 13 Ramamurthi B. The continuing challenge of acoustic neurinomas (1949-1993). Br J Neurosurg 1995; 9 (03) 361-366
    CrossrefPubMedGoogle Scholar
  • 14 The World Bank. Rural population (% of total population) – India. Accessed June 14, 2022 from: https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?locations=IN
    Google Scholar
  • 15 Ambett R, Rupa V, Rajshekhar V. Analysis of causes for late presentation of Indian patients with vestibular schwannoma. J Laryngol Otol 2009; 123 (05) 502-508
    CrossrefPubMedGoogle Scholar
  • 16 Financial Express. Available from: https://www.financialexpress.com/economy/around-22-indians-live-below-poverty-line-chattisgarh-jharkhand-fare-worst/1713365/
  • 17 Bartek Jr J, Förander P, Thurin E. et al. Short-term surgical outcome for vestibular schwannoma in Sweden: a nation-wide registry study. Front Neurol 2019; 10: 43
    CrossrefPubMedGoogle Scholar
  • 18 Miyakoshi A, Kohno M, Nagata O, Sora S, Sato H. Hydrocephalus associated with vestibular schwannomas: perioperative changes in cerebrospinal fluid. Acta Neurochir (Wien) 2013; 155 (07) 1271-1276
    CrossrefPubMedGoogle Scholar
  • 19 Matos RJ, Gil PN, Pires JM, Lopes N. Advanced vestibular schwannoma: a case of optic disc oedema without hydrocephalus. Neuroophthalmology 2016; 40 (05) 222-224
    CrossrefPubMedGoogle Scholar
  • 20 Harada T, Sawamura Y, Ohashi T. et al. Severe optic disc edema without hydrocephalus in neurofibromatosis 2. Jpn J Ophthalmol 1998; 42 (05) 381-384
    CrossrefPubMedGoogle Scholar
  • 21 Grainger J, Dias PS. Case report: optic disc edema without hydrocephalus in acoustic neuroma. Skull Base 2005; 15 (01) 83-86 , discussion 86–88
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Candanedo C, Moscovici S, Kruger JM, Mizrachi CJ, Eliahou R, Spektor S. Vestibular schwannoma presenting with bilateral papilledema without hydrocephalus: case study. Cureus 2017; 9 (11) e1862
    PubMedGoogle Scholar
  • 23 Bloch J, Vernet O, Aubé M, Villemure JG. Non-obstructive hydrocephalus associated with intracranial schwannomas: hyperproteinorrachia as an etiopathological factor?. Acta Neurochir (Wien) 2003; 145 (01) 73-78
    CrossrefPubMedGoogle Scholar
  • 24 Kwon SK, Kim MW. Pseudo-Froin's syndrome, xanthochromia with high protein level of cerebrospinal fluid. Korean J Anesthesiol 2014; 67 (Suppl): S58-S59
    CrossrefPubMedGoogle Scholar
  • 25 Garispe A, Naji H, Dong F, Arabian S, Neeki M. Froin's syndrome secondary to traumatic and infectious etiology. Cureus 2019; 11 (12) e6313
    PubMedGoogle Scholar
  • 26 Fukuda M, Oishi M, Kawaguchi T. et al. Etiopathological factors related to hydrocephalus associated with vestibular schwannoma. Neurosurgery 2007; 61 (06) 1186-1192 , discussion 1192–1193
    CrossrefPubMedGoogle Scholar
  • 27 Wang X, Xu P, Li P. et al. Alterations in gray matter volume due to unilateral hearing loss. Sci Rep 2016; 6: 25811
    CrossrefPubMedGoogle Scholar
  • 28 Zhang Y, Mao Z, Feng S, Liu X, Zhang J, Yu X. Monaural-driven functional changes within and beyond the auditory cortical network: evidence from long-term unilateral hearing impairment. Neuroscience 2018; 371: 296-308
    CrossrefPubMedGoogle Scholar
  • 29 Chen J, Hu B, Qin P. et al. Altered brain activity and functional connectivity in unilateral sudden sensorineural hearing loss. Neural Plast 2020; 2020: 9460364
    CrossrefPubMedGoogle Scholar
  • 30 Jefferis JM, Raoof N, Carroll T, Salvi SM. Optic nerve sheath fenestration in patients with visual failure associated with vestibular schwannoma. Br J Neurosurg 2019; 33 (04) 402-408
    CrossrefPubMedGoogle Scholar
  • 31 Gauden A, Weir P, Hawthorne G, Kaye A. Systematic review of quality of life in the management of vestibular schwannoma. J Clin Neurosci 2011; 18 (12) 1573-1584
    CrossrefPubMedGoogle Scholar
  • 32 Carlson ML, Tveiten OV, Driscoll CL. et al. Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. J Neurosurg 2015; 122 (04) 833-842
    CrossrefPubMedGoogle Scholar
  • 33 Inoue Y, Ogawa K, Kanzaki J. Quality of life of vestibular schwannoma patients after surgery. Acta Otolaryngol 2001; 121 (01) 59-61
    CrossrefPubMedGoogle Scholar
  • 34 Soulier G, van Leeuwen BM, Putter H. et al. Quality of life in 807 patients with vestibular schwannoma: comparing treatment modalities. Otolaryngol Head Neck Surg 2017; 157 (01) 92-98
    CrossrefPubMedGoogle Scholar
  • 35 Wagner JN, Glaser M, Wowra B. et al. Vestibular function and quality of life in vestibular schwannoma: does size matter?. Front Neurol 2011; 2: 55
    CrossrefPubMedGoogle Scholar
  • 36 Cheng S, Naidoo Y, da Cruz M, Dexter M. Quality of life in postoperative vestibular schwannoma patients. Laryngoscope 2009; 119 (11) 2252-2257
    CrossrefPubMedGoogle Scholar
  • 37 Lloyd SK, Kasbekar AV, Baguley DM, Moffat DA. Audiovestibular factors influencing quality of life in patients with conservatively managed sporadic vestibular schwannoma. Otol Neurotol 2010; 31 (06) 968-976
    CrossrefPubMedGoogle Scholar
  • 38 Starnoni D, Giammattei L, Cossu G. et al. Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 2020; 162 (11) 2595-2617
    CrossrefPubMedGoogle Scholar
  • 39 Schüz J, Steding-Jessen M, Hansen S, Stangerup SE, Cayé-Thomasen P, Johansen C. Sociodemographic factors and vestibular schwannoma: a Danish nationwide cohort study. Neuro-oncol 2010; 12 (12) 1291-1299
    Google Scholar
  • 40 Rupa V, Job A, George M, Rajshekhar V. Cost-effective initial screening for vestibular schwannoma: auditory brainstem response or magnetic resonance imaging?. Otolaryngol Head Neck Surg 2003; 128 (06) 823-828
    CrossrefPubMedGoogle Scholar