ArticleMedicine2025
Nursing care of a giant acoustic neuroma patient complicated with tonsillar herniation in the postoperative period: A CARE-compliant case report.
Article in Medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
rationaleGiant Aacoustic neuroma resection has high risks of postoperative vital sign changes and consciousness disturbances. Brain edema or delayed hemorrhage may cause life-threatening tonsillar herniation, but systematic nursing reports are lacking for high-risk cases, especially giant acoustic neuroma patients with tonsillar herniation after partial resection. This study aimed to summarize comprehensive nursing strategies for such patients to provide clinical references for improving prognosis, with "Internet + extended care" as a unique post-discharge measure to promote recovery. PATIENT CONCERNS: A 36-year-old male was admitted for half-month unsteady gait with no family history or comorbidities. Examinations showed persistent needle-like headache, right ear hearing loss, conjunctival congestion, horizontal nystagmus, right eye abduction limitation, incomplete eyelid closure, hoarseness and positive Romberg sign. DIAGNOSES: Preoperative clinical examination and enhanced cranial MRI confirmed a right cerebellopontine angle occupying lesion.
interventionsNursing included a multidisciplinary team with feedforward control, early tonsillar herniation identification, refined eye care, whole-process swallowing assessment and rehabilitation, tidal-style psychological support. Post-discharge "Internet + extended care" (online health education, self-management monitoring, home services, psychological therapy) was used to improve motor, mental, cognitive and language functions. OUTCOMES: The patient regained consciousness 2 days after the second emergency surgery with glasgow coma scale score 4 + T + 6, muscle strength grade 5 and normal pupil size and light reflex. Functional oral intake scale grade was 3 on postoperative day 13, 5 on day 20 (nasogastric tube removed), and 6 2 days before discharge (full oral intake without aspiration). He was discharged ambulatorily on postoperative day 30 with no keratitis or corneal ulceration. Hamilton anxiety rating scale score decreased from 31 to 18, Hamilton depression rating scale from 25 to 16. One month after discharge, ADL score increased from 70 to 95 with no falls, and he reintegrated into family and social life and completed 3-month postoperative follow-up. LESSONS: This study provides a guarantee for the comprehensive nursing of patients with tonsillar herniation after posterior fossa surgery and has important clinical reference value.
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