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Der Ophthalmologe : Zeitschrift Der... Nov 2021To demonstrate the technique and effectiveness of the bridle operation for oculomotor nerve paralysis with maintained elevation. (Review)
Review
PURPOSE
To demonstrate the technique and effectiveness of the bridle operation for oculomotor nerve paralysis with maintained elevation.
METHOD
The bridle operation includes transposition of the lateral rectus muscle (passing behind inferior oblique and rectus muscles) and the superior rectus muscle (behind superior oblique tendon and medial rectus muscle) to the nasal inferior surface of the globe.
RESULTS
In the reported case, this procedure corrected exo-hypertropia of 30-40°/20-30° without inducing cyclotropia.
CONCLUSION
The bridle operation expands the surgical arsenal for paralytic strabismus.
Topics: Humans; Oculomotor Muscles; Oculomotor Nerve Diseases; Strabismus; Tendons
PubMed: 33649921
DOI: 10.1007/s00347-021-01339-y -
Medicine Aug 2022to investigate the efficacy and long-term outcomes of endovascular embolization and surgical clipping for patients with posterior communicating artery unruptured...
Efficacy and long-term results of endovascular embolization and surgical clipping for posterior communicating artery unruptured aneurysms complicated with oculomotor nerve palsy.
to investigate the efficacy and long-term outcomes of endovascular embolization and surgical clipping for patients with posterior communicating artery unruptured aneurysms (PcomAs) concomitant with oculomotor nerve palsy (ONP). No significant (P > .05) difference existed in the age, gender, proportion of complete ONP, and size of eye fissure and pupil before treatment between 2 groups. After compared with before treatment, the eye fissure was widened significantly (P < .05) and the pupil narrowed significantly (P < .05), but no significant (P > .05) differences existed between the 2 groups. Complete ONP recovery was observed in 32 (80%) patients in the embolization group and 31 (77.5%) in the microsurgical group, partial ONP recovery occurred in 6 (15%) in the embolization group and 8 (20%) in the microsurgical group. The recovery rate was 95% in the embolization group and 97.5% in the microsurgical group, with no significant (P > .05) difference between 2 groups. The recovery rate of the ONP was significantly (P < .01) greater in the microsurgical group than that in the embolization group at follow-up of 1 month, 3 months, six and 12 months, respectively. At 18 months, the ONP recovery rate was not significantly different between 2 groups (95% vs 97.5%) Surgical clipping may have a faster effect on the recovery of oculomotor nerve palsy than endovascular embolization for patients with posterior communicating artery unruptured aneurysms complicated with oculomotor nerve palsy, but both approaches may result in a similar effect on the nerve recovery in the long run.Eighty patients treated with endovascular embolization or surgical clipping were retrospectively enrolled into the endovascular embolization group or surgical clipping and analyzed.
Topics: Arteries; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Oculomotor Nerve Diseases; Recovery of Function; Retrospective Studies; Treatment Outcome
PubMed: 36042618
DOI: 10.1097/MD.0000000000030421 -
Folia Morphologica 2021This study aims to revisit the anatomy of orbital segment of the third cranial nerve (CN III). The study also involved morphometric measurements of CN III muscular...
BACKGROUND
This study aims to revisit the anatomy of orbital segment of the third cranial nerve (CN III). The study also involved morphometric measurements of CN III muscular branches. Detailed description of observed anatomical variations and their incidence was also included. The study supplements earlier findings with detailed observations of the neuromuscular relations.
MATERIALS AND METHODS
The study was conducted on 52 orbits taken from 26 cadaveric heads (10 males and 16 females; Central European population).
RESULTS
Anatomical variations of the orbital segment of the CN III observed on the examined material involved both the superior and inferior branch of this nerve. The muscular branch innervating the levator palpebrae superioris muscle occasionally pierces the superior rectus muscle. The nerve to the inferior oblique muscle may pierce and innervate the inferior rectus muscle. In rare instances, duplication of the parasympathetic root of the ciliary ganglion may also occur. Among the muscular branches, the smallest diameter reached the branch to the levator palpebrae superioris muscle. Among the three muscular branches derived from the inferior branch of the CN III, the nerve to the inferior oblique was the longest one. Its length varied from 28.9 mm to 37.4 mm. The shortest was the muscular branch to the inferior rectus muscle. Its length varied from 0 mm (when muscular sub-branches arose directly from the nerve to the inferior oblique muscle) to 7.58 mm.
CONCLUSIONS
This study presented the characteristic of orbital segment of the CN III, including anatomical variations and morphometric measurements relevant to intraorbital procedures.
Topics: Female; Head; Humans; Male; Oculomotor Muscles; Oculomotor Nerve; Orbit
PubMed: 32073135
DOI: 10.5603/FM.a2020.0017 -
Survey of Ophthalmology 2024A 63-year-old man with diabetes presented with unilateral ptosis and an exotropia. A diagnosis of isolated diabetic III nerve palsy was made. Subsequent...
A 63-year-old man with diabetes presented with unilateral ptosis and an exotropia. A diagnosis of isolated diabetic III nerve palsy was made. Subsequent neuro-ophthalmologic evaluation showed multiple cranial nerves involvement consistent with a diagnosis of orbital apex syndrome. Review of past medical history was significant for a previous nasopharyngeal carcinoma, and biopsy of the involved site was consistent with tumor recurrence. This case highlights the importance of correct medical history taking and anatomo-clinical correlation in neuro-ophthalmology.
Topics: Humans; Male; Middle Aged; Blepharoptosis; Exotropia; Nasopharyngeal Neoplasms; Oculomotor Nerve Diseases; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Carcinoma; Nasopharyngeal Carcinoma
PubMed: 38007200
DOI: 10.1016/j.survophthal.2023.11.007 -
Obstetrics and Gynecology Apr 2021We summarize a case of transient oculomotor nerve palsy in a pregnant woman with a cavernous sinus meningioma. When pregnant women present with acute ophthalmic signs...
BACKGROUND
We summarize a case of transient oculomotor nerve palsy in a pregnant woman with a cavernous sinus meningioma. When pregnant women present with acute ophthalmic signs and symptoms, meningioma should be considered during diagnostic workup given the common proximity of growing meningiomas to visual pathways and ocular motor nerves within the parasellar region.
CASE
A 32-year-old woman, gravida 2 para 1, at 37 weeks of gestation, presented with 2 weeks of diplopia, left-sided ptosis, and left periocular headache. There were no signs of preeclampsia. Examination revealed a left mydriatic pupil, complete left-sided ptosis, and motility deficits consistent with a left pupil-involving oculomotor nerve palsy. Magnetic resonance imaging of the brain revealed a cavernous sinus meningioma. Five days after cesarean birth, the ptosis significantly improved; 2 weeks later, the diplopia resolved.
CONCLUSION
Pregnancy is associated with increased likelihood of intracranial meningioma growth, particularly in the parasellar region. We highlight a rare case of a transient cranial nerve III palsy in a pregnant patient due to cavernous sinus meningioma and review prior published reports.
Topics: Adult; Diagnosis, Differential; Female; Headache; Humans; Meningeal Neoplasms; Oculomotor Nerve Diseases; Pregnancy; Pregnancy Complications, Neoplastic; Prenatal Diagnosis
PubMed: 33706360
DOI: 10.1097/AOG.0000000000004330 -
Journal of Clinical Medicine Jun 2020To investigate the morphometric characteristics of the oculomotor nerve and its association with horizontal rectus muscle volume in patients with Duane's retraction...
OBJECTIVE
To investigate the morphometric characteristics of the oculomotor nerve and its association with horizontal rectus muscle volume in patients with Duane's retraction syndrome (DRS) according to the presence of the abducens nerve.
METHODS
Fifty patients diagnosed with unilateral DRS were divided into two groups according to high-resolution magnetic resonance imaging (MRI) findings; DRS without an abducens nerve on the affected side (absent group, = 41), and DRS with symmetric abducens nerves on both sides (present group, = 9). Oculomotor nerve diameter was measured on high-resolution MRI in the middle of the cisternal space. The medial rectus muscle (MR) and lateral rectus muscle (LR) volumes were measured on T2-weighted coronal MRI of the orbit. Associations of oculomotor nerve diameter and horizontal rectus muscle volumes were performed according to the presence and absence of the abducens nerve.
RESULTS
Oculomotor nerve diameter on the affected side was thicker than that of the non-affected side in the absent group ( < 0.001), but not in the present group ( = 0.623). In the absent group, there was a positive correlation between oculomotor nerve diameter and MR volume ( = 0.779, < 0.001), as well as the LR volume ( = 668, = 0.023) of the affected eye.
CONCLUSIONS
In DRS patients with an absent abducens nerve, the oculomotor nerve diameter was thicker in the affected eye compared to the non-affected eye. Oculomotor nerve diameter was associated with MR and LR volumes in the absent group. This study provides structural correlates of aberrant innervation of the oculomotor nerve in DRS patients.
PubMed: 32599889
DOI: 10.3390/jcm9061983 -
JAMA Ophthalmology Aug 2023
Topics: Female; Humans; Mydriasis; Magnetic Resonance Imaging
PubMed: 37382931
DOI: 10.1001/jamaophthalmol.2023.2585 -
BMJ Neurology Open 2023Post-thrombectomy subarachnoid haemorrhage (SAH) can result in oculomotor palsy and drowsiness, which may falsely suggest transtentorial herniation.
INTRODUCTION
Post-thrombectomy subarachnoid haemorrhage (SAH) can result in oculomotor palsy and drowsiness, which may falsely suggest transtentorial herniation.
CASE PRESENTATION
We present a case of right oculomotor nerve palsy presenting after endovascular thrombectomy (EVT) for a right middle cerebral artery (MCA) stroke. The patient presented with a significant right MCA syndrome and a National Institutes of Health Stroke Scale (NIHSS) score of 10 with CT perfusion demonstrating a large penumbral lesion and a CT angiogram confirming a right MCA M1 occlusion. After thrombectomy, the patient developed a 9mm dilated non-reactive right pupil, and a new ipsilateral near-complete oculomotor nerve palsy. Repeat code stroke imaging demonstrated perimesencephalic SAH). The patient was managed expectantly and her conscious state and oculomotor palsy gradually resolved with an excellent neurological recovery.
CONCLUSION
This case underscores the potential for post-thrombectomy perimesencephalic SAH as a rare mimic of symptomatic intracranial haemorrhage with mass effect manifesting as sudden-onset oculomotor nerve palsy.
PubMed: 37808515
DOI: 10.1136/bmjno-2023-000500 -
Cureus Mar 2022Unilateral Isolated oculomotor nerve palsy is a rare neurological complication after cardiac catheterization. Concomitant thalamus and midbrain infarction secondary to...
Unilateral Isolated oculomotor nerve palsy is a rare neurological complication after cardiac catheterization. Concomitant thalamus and midbrain infarction secondary to embolic events involving the artery of Percheron after cardiac catheterization have been reported in the literature. However, isolated midbrain infarction is a rare neurological deficit. Here, we present the case of a patient who presented with mild left-sided ptosis, binocular diplopia, and partially impaired left eye adduction two hours after cardiac catheterization. Brain magnetic resonance imaging revealed a focal area of restricted diffusion within the midbrain tegmentum, confirming this rare brainstem stroke.
PubMed: 35411266
DOI: 10.7759/cureus.22948 -
Radiology Case Reports Apr 2022Gliosarcoma is a rare malignant brain tumor, characterized by a biphasic tissue pattern with alternating areas displaying glial and mesenchymal differentiation. We first...
Gliosarcoma is a rare malignant brain tumor, characterized by a biphasic tissue pattern with alternating areas displaying glial and mesenchymal differentiation. We first report a case of temporo-mesial gliosarcoma, extended to the crural and ambient cisterns, with direct involvement of the ipsilateral third cranial nerve and encasement of anterior choroidal, posterior communicant and posterior cerebral arteries, presenting without symptoms of peripheral neuropathy. A 61-year-old woman with 1-month history of intense bilateral frontal-temporal headache resistant to pharmacological therapy and paresis of the left lower midface underwent surgical resection, through pterional trans-sylvian approach, of a right temporo-mesial gliosarcoma which directly involved the ipsilateral oculomotor nerve. Reported cases of gliomas with direct involvement of a cranial nerve, from the third to the twelfth, are very rare, whit no cases of gliosarcoma described. Because of its rarity, sometimes this entity is not considered as diagnostic hypothesis and is misdiagnosed, both during preoperative diagnostic evaluation and during the surgery. Gliosarcoma is a strong challenge for neurosurgeons and neurooncologists because of low incidence, poor prognosis and limited reported cases on literature. This case shows unique features for localization, pattern of growth and clinical presentation.
PubMed: 35169418
DOI: 10.1016/j.radcr.2022.01.018