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Neil Shah, Francis Cocjin, Willliam Gange, David Yoo, Ian Kirchner; Ocular Complications Following Acoustic Neuroma Treatment: Resection versus Radiosurgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4307.
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© ARVO (1962-2015); The Authors (2016-present)
Evaluate the incidence of post-operative ocular sequelae following acoustic neuroma repair (ANR) with traditional resection versus stereotactic radiosurgery (SRS).
Retrospective chart review was conducted between 2005 and 2015 at Loyola University Medical Center following institutional review board approval. Data up to two years following the procedures was collected. Patient demographics, tumor size, tumor characteristics, surgical approach, radiation therapy approach, ocular complications, and ocular treatment were recorded.
Between 2005 and 2015, 260 patients underwent acoustic neuroma resection via retrosigmoid, translabyrinthine, or combined approach, while 26 patients underwent stereotactic radiosurgery for tumor control. Median tumor size was 2.2cm. In the surgical resection group, 37% of patients overall had ocular complications: 24% experienced nystagmus, 22% experienced lagophthalmos, 15% experienced dry eye, 7% experienced keratitis, and 5% experienced ptosis and epiphora, respectively. In the SRS group, 26% of patients overall had complications: 12% experienced lagophthalmos, 12% experienced dry eye, 8% experienced keratitis. Every 1-cm increase in tumor size was associated with a 32% increase (OR = 1.32, 95% CI: 1.06 – 1.65) in the odds of experiencing a postoperative ocular complication (p =.012) among both groups. Treatment rates for ocular complications differed significantly (p=.049) between the surgery (35.0%) and SRS (15.4%) groups. 8% of patients in the surgical group required an ophthalmic surgical intervention while only 4% in the SRS group required a similar intervention.
Large tumor size is predictive of ocular complications for both the traditional resection and radiosurgery groups. Patients with preoperative exposure keratopathy had a trend towards experiencing exacerbation of symptoms after repair. SRS for the treatment of acoustic neuroma had statistically significant fewer postoperative treatment rates in our cohort. Further clinical trial is necessary to support these findings.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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