Diplopia Due to Skew Deviation Following Neurotologic Procedures

作者：Cosetti Maura K; Tawfik Kareem; Fouladvand Mohammad; Roland J Thomas Jr; Lalwani Anil K^*

来源：Otology & Neurotology, 2012, 33(5): 840-842.

DOI：10.1097/MAO.0b013e3182595269

• Cerebellopontine angle
• Diplopia
• Labyrinthectomy
• Skew deviation

Objective: To describe and characterize diplopia resulting from skew deviation after cerebellopontine angle (CPA) surgery and labyrinthectomy.
Patients and Interventions: Retrospective case series of 4 patients who developed vertical diplopia from skew deviation after resection of tumors in the CPA or labyrinthectomy
Main Outcome Measure: Complete neuro-opthalmologic examination including opticokinetic testing, confrontational visual field assessment, color plate, pupillary reflex, slit lamp examination, and head tilt test.
Results: 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). Neuroophthalmologic 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.
Conclusion: 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.

• 出版日期2012-7