To describe and characterize diplopia resulting from skew deviation after cerebellopontine angle (CPA) surgery and labyrinthectomy.
Retrospective case series of 4 patients who developed vertical diplopia from skew deviation after resection of tumors in the CPA or labyrinthectomy
Complete neuro-opthalmologic examination including opticokinetic testing, confrontational visual field assessment, color plate, pupillary reflex, slit lamp examination, and head tilt test.
Four patients with residual hearing preoperatively developed skew deviation immediately after surgical intervention, including translabyrinthine (n = 1) and retrosigmoid (n = 2) approaches to the CPA and labyrinthectomy (n = 1). Neuro-ophthalmologic examination demonstrated intact extraocular movements, and 2- to 14-mm prism diopter hypertropia on both primary gaze and head tilt testing. In all cases, skew deviation resolved spontaneously with normalization of the neuro-ophthalmologic examination within 10 weeks.
Patients undergoing CPA surgery or labyrinthectomy can develop postoperative diplopia due to skew deviation as a consequence of acute vestibular deafferentation. Patients with significant hearing preoperatively, a probable marker for residual vestibular function, may be especially at risk for developing skew deviation postoperatively.
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 07/2012; 33(5):840-2. DOI:10.1097/MAO.0b013e3182595269 · 1.60 Impact Factor
Clinical neurology and neurosurgery 01/2012; 114(6):812-5. DOI:10.1016/j.clineuro.2012.01.001 · 1.25 Impact Factor
Intratympanic gentamicin therapy for the treatment of episodic vertigo associated with Ménière's disease is generally well tolerated. Although auditory and vestibular symptoms following intratympanic gentamicin are well known, visual disturbance has not been previously described. In this report, we describe two patients with Ménière's disease who developed sudden onset of binocular vertical diplopia due to skew deviation after intratympanic gentamicin therapy. The skew deviation and diplopia resolved spontaneously and completely within 6 to 8 weeks without therapy. Development of diplopia due to skew deviation should be discussed as a potential complication in patients undergoing intratympanic gentamicin therapy.
The Laryngoscope 03/2011; 121(3):492-4. DOI:10.1002/lary.21279 · 2.03 Impact Factor