Postoperative reversal of complete (monocular) blindness in skull base meningioma: case report

Ophthalmic and orbital considerations in the evaluation of skull base malignancies

INTRODUCTION

The orbital contents, afferent and efferent visual pathways, and the cranial nerves involved in eye movement, corneal sensation and eyelid closure traverse the skull base, a region bounded by the intracranial cavity, the paranasal sinuses, and the deep spaces of the face and head. As such, tumors from above or below have potential to affect some aspect of the visual system.

METHODS

We discuss here the clinical ophthalmologic and orbital considerations in the evaluation of patients with these tumors, as well as the ophthalmic sequelae of treatment with radiation or surgery (or both). And for the surgeon, we discuss the ophthalmic and orbital considerations in surgical planning, the role of the orbital surgeon in skull base surgery, and briefly discuss transorbital approaches to the skull base.

RESULTS AND CONCLUSION

Ophthalmic and orbital dysfunction may be the main source of disability in patients with skull base malignancy; it is thus incumbent on those who manage patients with tumors of this region to be aware of the ophthalmic, neuro-ophthalmic and orbital manifestations, so as to best tailor therapy and monitor treatment outcomes.

Neurostimulation in resistant depression

Drugs and psychotherapy are inadequate for relieving depressive symptoms in a substantial portion of severely depressed patients. In that patient group, neurostimulation techniques such as electroconvulsive therapy, transcranial magnetic stimulation, magnetic seizure therapy, vagus nerve stimulation and deep brain stimulation could be lifesaving therapies. Neurostimulation is a physical intervention that utilizes application of either electric current or a magnetic field to directly stimulate the brain or central nervous system. This article presents an overview of currently available neurostimulatory techniques for depression, including a review of their efficacy and safety. Further development and evaluation of non-pharmacological antidepressant therapies are needed, with the hope of improving treatment of refactory depression.