Frequency of diplopia after intraoperative nerve disturbance in trochlear nerve schwannoma: A case report and systematic review

Eiji Fujiwara, Kazuhide Adachi, Shinichiro Tateyama, Mitsuhiro Hasegawa, Yuichi Hirose

Research output: Contribution to journalArticlepeer-review

Abstract

Schwannomas of the trochlear nerve are relatively rare, and most patients present with preoperative diplopia because of trochlear nerve palsy. We describe the case of a 61-year-old male patient with a trochlear nerve schwannoma and no pre-and postoperative diplopia, despite his troch-lear nerve being cut during the operation. We aimed to investigate the frequency of postoperative diplopia associated with intraoperative trochlear nerve disturbance by reviewing previous case reports, wherein postoperative diplopia did not occur after the trochlear nerve was cut intraop-eratively. We recorded the frequency of diplopia because of intraoperative trochlear nerve distur-bance, such as the trochlear nerve being cut, in cases without pre-and postoperative diplopia. We searched the PubMed, Medline, and Google Scholar databases for works published from 1976 to 2020 and followed the preferred reporting items for systematic reviews and meta-analyses guidelines. We reviewed 36 publications and found 92 cases of trochlear nerve schwannoma. Surgical resection was performed for 43 patients, of whom 40 were kept under observation and 9 were treated with radiation therapy. Of the 43 cases, 9 without preoperative diplopia underwent gross total resection. We analyzed ten cases (including ours) without preoperative diplopia to check for postoperative diplopia. In total, four cases, including ours, did not display postoperative diplopia despite the trochlear nerve being cut. This may be attributed to the preoperatively acquired motor and sensory fusion in the patient’s vision because of tumor progression. Our findings may benefit neurosurgeons who treat patients with schwannomas and help them predict patients’ outcomes.

Original languageEnglish
Pages (from-to)591-597
Number of pages7
Journalneurologia medico-chirurgica
Volume61
Issue number10
DOIs
Publication statusPublished - 2021

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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