Bilateral Blindness in a Patient With Vestibular Schwannoma and Empty Sella Syndrome: A Case Report.

We report a rare clinical presentation of a T4b vestibular schwannoma causing severe compression of the brainstem and fourth ventricle, associated with obstructive hydrocephalus and empty sella syndrome, in a patient presenting with profound neurological and ophthalmological deficits, most notably complete bilateral blindness. Radical microsurgical resection was achieved via a lateral suboccipital (retromastoid) approach, resulting in gross-total tumor removal with preservation of most cranial nerves. Postoperatively, the patient developed House-Brackmann grade III facial palsy. Hydrocephalus resolved without the need for cerebrospinal fluid diversion, gait instability improved, and visual deficits persisted. This case highlights the exceptional association of vestibular schwannoma with bilateral blindness and empty sella syndrome, emphasizing the importance of early recognition and timely surgical intervention in advanced tumors to minimize morbidity and optimize outcomes.