Our Summary

This research paper discusses two unique cases of patients experiencing unusual visual symptoms triggered by chewing due to defects in the bony outer wall of their eye sockets. One 57-year-old man reported temporary double vision and a shaky visual perception after undergoing a complex surgery for a tumor in his pituitary gland. His right eye protruded only when he was chewing. A CT scan revealed a defect in the right outer wall of his eye socket. The second case involved a 48-year-old man who experienced temporary double vision and blind spots in his right eye when chewing. Both a CT scan and an MRI showed a two-part lesion (abnormal tissue) that connected the temporal fossa (an anatomical term for the temple region on the side of the skull) to the eye socket through a defect in the right outer wall of the eye socket. The paper also discusses the relevant neuroanatomy and pathophysiology (the study of how disease processes affect the body’s function) related to these cases.

FAQs

  1. What are the symptoms of lateral orbital wall defects as described in the article?
  2. What types of imaging are used to diagnose lateral orbital wall defects?
  3. What is a right fronto-temporal-orbito-zygomatic craniotomy?

Doctor’s Tip

A doctor might tell a patient who has undergone a craniotomy to be aware of any new or unusual symptoms, such as visual disturbances during mastication, and to report them promptly for further evaluation. Additionally, they may advise the patient to avoid activities that exacerbate their symptoms until a proper diagnosis and treatment plan can be established.

Suitable For

Patients who are typically recommended for craniotomy include those with complex invasive pituitary adenomas, skull base tumors, traumatic brain injuries, vascular malformations, epilepsy, and other conditions that require surgical intervention to access and treat lesions within the brain or skull. Additionally, patients with visual symptoms or other neurological deficits related to orbital wall defects may also be candidates for craniotomy to repair the defect and alleviate symptoms.

Timeline

Before the craniotomy:

  • Patients may experience symptoms related to the underlying condition requiring surgery, such as headaches, vision problems, or other neurological symptoms.
  • Diagnostic tests, such as CT scans or MRIs, may be performed to assess the condition and plan the surgery.
  • Preoperative consultations with the surgical team and anesthesia team will take place to discuss the procedure and address any concerns.

After the craniotomy:

  • Patients will undergo the craniotomy procedure, during which a portion of the skull is removed to access the brain.
  • Postoperatively, patients will be monitored in the recovery room and then transferred to a hospital room for further observation.
  • Patients may experience pain, swelling, and discomfort at the surgical site, which can be managed with medication.
  • Physical therapy and rehabilitation may be recommended to help patients regain strength and function.
  • Follow-up appointments with the surgical team will be scheduled to monitor healing and address any complications or concerns.

What to Ask Your Doctor

  1. What specific risks are associated with a craniotomy procedure?
  2. How long is the recovery process expected to take after a craniotomy?
  3. What symptoms should I be aware of following the procedure that may indicate a complication?
  4. Are there any specific activities or movements I should avoid during the recovery period?
  5. Will I need any additional imaging or follow-up appointments after the craniotomy?
  6. How will the craniotomy affect my vision and eye function?
  7. Are there any potential long-term effects on my vision or eye health following a craniotomy?
  8. What post-operative care measures should I take to ensure optimal healing and recovery?
  9. Are there any specific medications I should be taking or avoiding after the craniotomy?
  10. How soon after the craniotomy can I expect to resume normal activities and work?

Reference

Authors: Mettu P, Bhatti MT, El-Dairi MA, Price EB, Lin AY, Alaraj A, Setabutr P, Moss HE. Journal: J Neuroophthalmol. 2016 Sep;36(3):308-12. doi: 10.1097/WNO.0000000000000354. PMID: 26919071