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Ian Kirchner, Srinivas Sai A Kondapalli, David K Yoo, Charles S Bouchard; Ocular Complications Following Acoustic Neuroma Resection. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2779.
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To evaluate ophthalmic complications following acoustic neuroma resection (ANR) and determine if tumor size and/or surgical approach are predictive for developing ocular complications post-operatively.
The medical records of 302 patients undergoing acoustic neuroma resection between 1988 and 2012 at Loyola University Medical Center were retrospectively reviewed. Data up to one year following the procedures was collected from operative and post-operative progress notes. Patients who received stereotactic radiotherapy, underwent multiple ANR surgeries, or presented with pre-operative ocular symptoms were excluded. Demographic data included patient age, sex, race, and ethnicity. Surgical data included surgeon, surgical approach, tumor location, and tumor size. Post-operative complications included dry eye, pain/irritation, dryness, lagophthalmos, diplopia, epiphora, ectropion, eyebrow droop, ptosis, periorbital edema, corneal hypoesthesia, changes in visual acuity, and corneal ulceration, scarring, or perforation. Facial nerve function was determined by the House-Brackmann score assigned to each case.
302 patient records were reviewed. 152 of these patients (43%) had ocular complications, the most common of which were lagophthalmos, epiphora, and dry eye. Fifty-seven patients (16%) had trigeminal nerve palsy manifesting predominantly as corneal hypoesthesia. The combined translabyrintine / transcochlear surgical approach in ANR had the highest complication rate of 67%. Tumors > 2.0 cm resulted in greater facial nerve paresis (P < .001).
Many patients develop ocular complications following acoustic neuroma resection. The effected patients present symptoms ranging from mild, transient complications to severe ocular problems requiring lifelong treatment. Risk factors for ocular complications include exposure keratopathy and corneal hypoesthesia, as the majority of symptoms stem from injury to the corneal surface secondary to a dysfunctional facial or trigeminal nerve. In our series of patients, surgical approach and tumor size were predictive of trigeminal and/or facial nerve involvement. Thus, pre-operative knowledge of these factors may predict the post-operative course. This is the largest series of patients with a resected acoustic neuroma evaluated for ocular complications. Our findings differ from prior studies in that a smaller percentage of patients needed surgical treatment for ocular symptoms.
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