Author/Authors :
Bahrami, Eshagh University of Medical Sciences, Tehran, Iran , Rahatlou, Hessam University of Medical Sciences, Tehran, Iran , Fattahi, Arash University of Medical Sciences, Tehran, Iran , Astaraki, Shahrzad University of Medical Sciences, Tehran, Iran , Khani, Mohammad-Reza Milad Hospital, Tehran, Iran , Shirvani, Massood Milad Hospital, Tehran, Iran , Ghaempanah, Mohammad-Jafar University of Medical Sciences, Tehran, Iran
Abstract :
Background and Importance: Our learning curve during two decades of neurosurgical practice has been changed
from an abstractive to a more meaningful and conductive state. In cases of fifth nerve neurinoma, pre-operative
anatomopathologic diagnosis could lead us to a pre-planned program during and after the surgery to get the safe
surgical result.
Case Presentation: Representation of two complex fifth nerve neurinoma cases, untoward happenings and the way to
manage patient safety. Review of literature to find a wise approach for maximum benefi t is included here.
Conclusion: Both of our patients have developed iatrogenic unilateral corneal anesthesia, one of them warned of it
and the second one not. We have had more problems in the way of preservation of the cornea in the warned case. We
have reviewed the factors influencing safe corneal preservation after the operation of fifth nerve neurinoma which are
included following items: surgical approach, Anatomopathologic location of the tumor (pre-ganglionic, ganglionic or
post-ganglionic), simultaneous damage of V and VII nerve including vidian nerve, preserved corneal sensation, any
combination of injury to physiologic and mechanical protectors. The cornerstones to have a safe cornea following
such surgeries are pre-operative exam of fifth and 7th nerve in all aspects and also early post-operative evaluation of
them including the state of the tear secretion. We encounter corneal anesthesia and epithelial defect. Iatrogenic damage
of vidian nerve depending to approach selected seems to be considerable. Simultaneous damage of V and VII nerve
during the surgery of large neurinoma are expected and noteworthy.
Keywords :
Corneal anesthesia , Iatrogenic , Combined approach , Cerebello Pontine Angle tumor , Vidian nerve , Painless corneal perforation , Herpes ophthalmicus , Interdurall location , Neurinoma