Neurophysiological intraoperative monitoring during an optic nerve schwannoma removal.

This paper reports the case of a patient with optic nerve schwannoma and the first use of neurophysiological intraoperative monitoring of visual evoked potentials during the removal of such tumor with no postoperative visual damage. Schwannomas are benign neoplasms of the peripheral nervous system arising from the neural crest-derived Schwann cells, these tumors are rarely located in the optic nerve and the treatment consists on surgical removal leading to high risk of damage to the visual pathway. Case report of a thirty-year-old woman with an optic nerve schwannoma. The patient underwent surgery for tumor removal on the left optic nerve through a left orbitozygomatic approach with intraoperative monitoring of left II and III cranial nerves. We used Nicolet Endeavour CR IOM (Carefusion, Middleton WI, USA) to performed visual evoked potentials stimulating binocularly with LED flash goggles with the patient´s eyes closed and direct epidural optic nerve stimulation delivering rostral to the tumor a rectangular current pulse. At follow up examinations 7 months later, the left eye visual acuity was 20/60; Ishihara score was 8/8 in both eyes; the right eye photomotor reflex was normal and left eye was mydriatic and arreflectic; optokinetic reflex and ocular conjugate movements were normal. In this case, the epidural direct electrical stimulation of optic nerve provided stable waveforms during optic nerve schwannoma resection without visual loss.

[Unilateral tucking of the inferior rectus muscle for dissociated vertical deviation]. / Plegamiento del recto inferior unilateral para el tratamiento de la desviación vertical disociada.

BACKGROUND: There are several options for the treatment of dissociated vertical deviation (DVD). The most discouraging results are those cases of poor vision. The fold of the inferior rectus is presented as a therapeutic option for poor vision. METHODS: Patients with spontaneous DVD and monocular poor vision were included. A maximum folding of the inferior rectus was performed only in the eye with poor vision. Evaluation of the spontaneity and magnitude of the DVD was done in the pre- and postoperatively with a minimum 6-month follow up. RESULTS: Nineteen patients were included, finding a decrease in the spontaneity (p = 0.05) and the magnitude of the DVD (p = 0.01) at the maximum follow-up time. Limitation of the elevation of 2+ was observed in the immediate postoperative period in all cases. The limitation remained in 16 patients. In two patients, hypotropia of 5 DP was observed in the primary position. No cases of alteration of the lower palpebral position were observed. CONCLUSIONS: Unilateral maximum tucking of the inferior rectus muscle decreases the magnitude and spontaneity of DVD.