The Real Story of the Fifth Nerve Neurinoma: A Review of Our Learning Curve about Surgical Approaches and Associated Shortcomings

from an abstractive to a more meaningful and conductive state. In cases of fifth nerve neurinoma, pre-operativeanatomopathologic diagnosis could lead us to a pre-planned program during and after the surgery to get the safesurgical result.Case Presentation: Representation of two complex fifth nerve neurinoma cases, untoward happenings and the way tomanage patient safety. Review of literature to find a wise approach for maximum benefi t is included here.Conclusion: Both of our patients have developed iatrogenic unilateral corneal anesthesia, one of them warned of itand the second one not. We have had more problems in the way of preservation of the cornea in the warned case. Wehave reviewed the factors influencing safe corneal preservation after the operation of fifth nerve neurinoma which areincluded following items: surgical approach, Anatomopathologic location of the tumor (pre-ganglionic, ganglionic orpost-ganglionic), simultaneous damage of V and VII nerve including vidian nerve, preserved corneal sensation, anycombination of injury to physiologic and mechanical protectors. The cornerstones to have a safe cornea followingsuch surgeries are pre-operative exam of fifth and 7th nerve in all aspects and also early post-operative evaluation ofthem including the state of the tear secretion. We encounter corneal anesthesia and epithelial defect. Iatrogenic damageof vidian nerve depending to approach selected seems to be considerable. Simultaneous damage of V and VII nerveduring the surgery of large neurinoma are expected and noteworthy.

Keywords:

Corneal anesthesia , Iatrogenic , Combined approach , Cerebello Pontine Angle tumor , Vidian nerve , Painless corneal perforation , Herpes ophthalmicus , Neurinoma , Interdurall location