Diagnosis and treatment of acoustic neuromas presenting with ocular symptoms:report of 16 cases and literature review
QIN Han
HU Jun-ming
QIN Hai-lin
HUANG Cheng
Abstract：Objective To explore the causes of visual changes in patients with acoustic neuromas presenting with ocular symptoms and the clinical characteristics,diagnostic and therapeutic methods of these patients.Methods The clinical data of 16 patients with acoustic neuroma presenting with ocular symptoms admitted from January 2014 to April 2023 were retrospectively analyzed.Results All 16 patients had preoperative hydrocephalus.Nine patients were under 40 years old.Large or giant tumors accounted for 81.25%.All 16 patients underwent tumor resection via the retrosigmoid approach.Preoperatively,5 cases underwent ventricular puncture and external drainage,3 cases underwent Omaya cyst implantation,and 1 case underwent lateral ventricle-cisterna magna shunt during the operation.Postoperatively,2 cases with aggravated hydrocephalus underwent ventricular puncture and external drainage,and 2 cases with unrelieved hydrocephalus underwent ventriculoperitoneal shunt.Total tumor resection was achieved in 13 cases,and subtotal resection in 3 who were followed by gamma knife therapy.The facial nerve was anatomically preserved in all 16 cases.The reexamination 2 weeks after the operation revealed that vision improved in 8 cases,remained unchanged in 3 cases,and deteriorated in 5 cases(3 blind in both eyes,2 light perception).During the 6-month postoperative follow-up,none of the 13 cases with total tumor resection had recurrence,and the 3 cases with subtotal resection showed no progression.The vision returned to normal in the 8 cases with improved vision 2 weeks after the operation.The vision improved in the 3 cases with unchanged vision 2 weeks after the operation.There was no improvement in the 5 cases with deteriorated vision 2 weeks after the operation.Conclusions Young and middle-aged patients with large acoustic neuromas associated with hydrocephalus are prone to visual changes and are easily misdiagnosed.After diagnosis,hydrocephalus should be relieved by surgery as soon as possible to salvage vision,and the remission rate of hydrocephalus after the operation is high.For patients with preoperative optic nerve atrophy,the recovery of vision after the operation is poor.
Keywords：Acoustic neuromasHydrocephalusVision impairmentMicrosurgery
Publication Date：2024-05-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 268-270,273 )