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Skew deviation following vestibular nerve surgery

P Riordan-Eva1, J P Harcourt, M Faldon

  • 1Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, London, UK.

Annals of Neurology
|January 1, 1997
PubMed
Summary

Vestibular nerve surgery can cause skew deviation, an eye misalignment. This condition is linked to significant changes in ocular torsion and subjective visual vertical following the procedure.

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Area of Science:

  • Ophthalmology
  • Neurology
  • Vestibular System

Background:

  • Vestibular nerve surgery aims to treat vestibular disorders.
  • Ocular motility disturbances can occur postoperatively.
  • Skew deviation is a vertical misalignment of the eyes.

Purpose of the Study:

  • To investigate the occurrence and characteristics of skew deviation after vestibular nerve surgery.
  • To identify factors associated with the development of skew deviation.

Main Methods:

  • Pre- and postoperative ocular motility examinations were performed on 18 patients.
  • Ocular alignment, binocular function, ocular torsion, and subjective visual vertical were assessed.
  • Caloric testing was used to evaluate vestibular function.

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Main Results:

  • Five patients (28%) developed skew deviation post-surgery, with the lower eye on the operated side.
  • Skew deviation was incomitant in all affected patients.
  • Associated findings included diplopia in 3 patients and large changes in ocular torsion and subjective visual vertical.
  • Skew deviation correlated with lesser degrees of preoperative canal paresis on the operated side.

Conclusions:

  • Skew deviation is a potential complication of vestibular nerve surgery.
  • The development of skew deviation is associated with significant alterations in ocular torsion and subjective visual vertical.
  • A gradation of responses to vestibular deafferentation exists, with skew deviation occurring in cases of marked vestibular system changes.