Neuro-Ophthalmic Complications of Vestibular Schwannoma Resection: Current Perspectives

Upper thoracic spinal schwannoma leading to intracranial hypertension and hydrocephalus: A case report and literature review

RATIONALE

Hydrocephalus is predominantly caused by intracranial hemorrhage, infections, tumors, genetic metabolic disorders, and congenital malformations. Hydrocephalus secondary to spinal cord tumors is exceedingly rare; these tumors are predominantly located in the upper cervical spinal region or near the conus medullaris. Hydrocephalus and elevated intracranial pressure caused by upper thoracic spinal schwannomas have not previously been reported.

PATIENT CONCERNS

We report the first case in a 71-year-old female patient who presented with bilateral lower limb weakness for 6 months, accompanied by headache, dizziness, and urinary incontinence for 1 month.

DIAGNOSES

This patient was diagnosed with schwannomas located in the upper cervical spinal region.

INTERVENTIONS

Based on preoperative examination results, it was difficult to distinguish a schwannoma from a spinal meningioma. Subsequently, a microsurgical operation was performed, and the whole tumor was removed via a posterior approach. Tumor tissue histopathological results revealed a whole capsule; under a light microscope, the tumor mainly consisted of sheath cells, which were arranged in a palisade or swirl shape. Antoni A and Antoni B regions constituted a large part of the whole tumor. Moreover, cytologic atypia and necrosis or mitosis were absent. Immunohistochemical staining revealed strong positivity staining for S-100 and SOX 10. Hence, a histopathological diagnosis of schwannomas was finally confirmed. The patient's symptoms of intracranial hypertension, hydrocephalus, and spinal cord dysfunction were significantly alleviated after the operation.

OUTCOMES

Follow-up magnetic resonance image (1 month after being discharged from the hospital) of the thoracic spine and brain revealed complete resection of the upper thoracic spinal schwannoma, a significant reduction in the size of ventricles, and marked alleviation of periventricular interstitial edema.

LESSONS

The findings emphasize the importance of considering spinal tumors in cases of unexplained hydrocephalus and may guide early microsurgical intervention.

The importance of simultaneous oculoplastic surgery in quality of life related to vision in surgical resection of large vestibular schwannomas

OBJECTIVES

Facial nerve palsy is one of the most important complications of vestibular schwannoma resection. When VII cranial nerve is damaged, ocular complications might appear, impacting patient´s quality of life. Therefore, standardized eye care must be a priority. This involves three key treatments: topical treatment, rehabilitation and oculoplastic surgery. The aim of this work is to review the results of oculoplastic surgery performed simultaneously with vestibular schwannoma resection in terms of vision-related quality of life, compared to deferred surgery.

DESIGN

The study involved 177 patients who underwent vestibular schwannoma resection between 2015 and 2022. The incidence of facial palsy was registered. Of those patients who had the palsy, we selected 35 who also had oculoplastic surgery. 5 of them declined participating in the study. The final sample (n = 30) was divided in two groups depending on the timing of oculoplastic surgery: simultaneously- first group (n = 15) and deferred-second group (n = 15). The vision-related quality of life was measured using the NEI VFQ-25 test.

RESULTS

26.56% patients developed an immediate postoperative facial dysfunction, decreasing to 18.08% after one year of follow-up. Timing of oculoplastic surgery was associated with better results in quality of life; the first group of patients had a better quality of life (70.27/100) compared to the second group (53.73/100; p = 0.006). Moreover, worse results in quality of life were also associated with long-term postoperative facial palsy (p = 0.042). Current criteria for selecting patients were reliable, proving adequacy as we found worse long-term facial functions in patients who underwent simultaneous surgery (p = 0.01).

CONCLUSIONS

Our current criteria for selecting candidates for simultaneous oculoplastic surgery are effective. When long-term facial nerve dysfunction is expected during vestibular schwannoma resection, oculoplastic surgery should be performed simultaneously to preserve the q vision-related quality of life. Long-term severe facial palsy is associated with poor vision-related quality of life.

Post-Operative Outcome Predictions in Vestibular Schwannoma Using Machine Learning Algorithms

Background/Objectives: This study aimed to develop a machine learning (ML) algorithm that can predict unplanned reoperations and surgical/medical complications after vestibular schwannoma (VS) surgery. Methods: All pre- and peri-operative variables available in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (n = 110), except those directly related to our outcome variables, were used as input variables. A deep neural network model consisting of seven layers was developed using the Keras open-source library, with a 70:30 breakdown for training and testing. The feature importance of input variables was measured to elucidate their relative permutation effect in the ML model. Results: Of the 1783 patients with VS undergoing surgery, unplanned reoperation, surgical complications, and medical complications were seen in 8.5%, 5.2%, and 6.2% of patients, respectively. The deep neural network model had area under the curve of receiver operating characteristics (ROC-AUC) of 0.6315 (reoperation), 0.7939 (medical complications), and 0.719 (surgical complications). Accuracy, specificity, and negative predictive values of the model for all outcome variables ranged from 82.1 to 96.6%, while positive predictive values and sensitivity ranged from 16.7 to 51.5%. Variables such as the length of stay post-operation until discharge, days from operation to discharge, and the total hospital length of stay had the highest permutation importance. Conclusions: We developed an effective ML algorithm predicting unplanned reoperation and surgical/medical complications post-VS surgery. This may offer physicians guidance into potential post-surgical outcomes to allow for personalized medical care plans for VS patients.

Platelet-Covered Nanocarriers for Targeted Delivery of Hirudin to Eliminate Thrombotic Complication in Tumor Therapy

Most patients are at high risk of thrombosis during cancer treatment. However, the major discrepancy in the therapeutic mechanisms and microenvironment between tumors and thrombosis makes it challenging for a panacea to treat cancer while being able to eliminate the risk of thrombosis. Herein, we developed a biomimetic MnOx/Ag₂S nanoflower platform with platelet membrane modification (MnOx@Ag₂S@hirudin@platelet membrane: MAHP) for the long-term release of anticoagulant drugs to treat thrombosis together with tumor therapy. This MAHP platform could achieve the targeted delivery of hirudin to the thrombus site and perform the controlled release under the irradiation of near-infrared light, demonstrating effective removal of the thrombus. Moreover, MAHP could inhibit tumor progression and prolong the survival time of mice with thromboembolic complications.