Symptomatic Oculomotor Nerve Cyst in a 3-Year-Old Child: Case Report With Emphasis on Surgical Management

Abstract BACKGROUND AND IMPORTANCE Third nerve palsies in the pediatric population are most commonly caused by trauma, tumors, or vascular abnormalities. Cystic oculomotor nerve neuropathies, however, are rare. We report the case of a symptomatic cyst along and within the oculomotor nerve, which has not been described previously. CLINICAL PRESENTATION Here, we report a case of a 3-yr-old girl presenting with a progressive painless oculomotor nerve palsy. A magnetic resonance imaging revealed a cystic formation along the cisternal and cavernous course of the nerve. Due to lack of alternative treatment options, surgery was offered. Intraoperative direct nerve stimulation allowed for identification of a non-functional part of the cyst wall and open fenestration and biopsy were executed. Histopathology revealed neuritis. Serology was negative for various pathogens. The oculomotor palsy rapidly resolved. At a follow-up 5 yr after surgery, the girl is asymptomatic and the cisternal part of the cyst remains collapsed. CONCLUSION This is the first report of a symptomatic cyst along and within the oculomotor nerve treated effectively with open fenestration and decompression highlighting the importance of intraoperative neuromonitoring in cranial nerve surgery. Uncertainty remains regarding the etiology of this disease.

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Arachnoid Cyst Causing an Oculomotor Nerve Palsy in a Pediatric Patient: A Case Report

Journal of Pediatric Neurology ◽

10.1055/s-0040-1716869 ◽

2020 ◽

Author(s):

Lauren Hennein ◽

Nailyn Rasool ◽

Maanasa Indaram

Keyword(s):

Visual Acuity ◽

Case Report ◽

Pediatric Patient ◽

Arachnoid Cyst ◽

Nerve Palsy ◽

Pediatric Population ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Oculomotor Palsy ◽

Cyst Fenestration

AbstractAn arachnoid cyst causing a compressive oculomotor nerve palsy is rare in the pediatric population. We describe a case of an acquired, partial oculomotor nerve palsy in a 3-year-old boy caused by an arachnoid cyst in the left crural cistern with associated amblyopia. The patient's amblyopia was aggressively treated, and he underwent cyst fenestration. Two months postoperatively, he continued to demonstrate a partial oculomotor palsy with improved visual acuity and recurrence of the cyst. This case demonstrates that cyst fenestration may not always resolve these paretic effects, cysts may recur after fenestration, and amblyopia must be treated in this setting.

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Endovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-015802 ◽

2020 ◽

Vol 12 (10) ◽

pp. 964-967

Author(s):

Francesco Signorelli ◽

Raoul Pop ◽

Mario Ganau ◽

Helene Cebula ◽

Antonino Scibilia ◽

...

Keyword(s):

Nerve Palsy ◽

Univariate Analysis ◽

Oculomotor Nerve ◽

Posterior Communicating Artery ◽

Oculomotor Nerve Palsy ◽

Surgical Clipping ◽

Unruptured Aneurysms ◽

Significant Difference ◽

Complete Treatment

BackgroundThere is no consensus regarding the best treatment option for unruptured aneurysms of the posterior communicating artery (PCom) presenting with oculomotor nerve palsy (ONP). We aimed to assess predictors of ONP recovery in a multicenter series of consecutive patients.Materials and methodsA retrospective review of prospective databases in three tertiary neurosurgical centers was carried out, selecting patients with ONP caused by unruptured PCom aneurysms, treated by surgical clipping or embolization, between January 2006 and December 2013. Patient files and imaging studies were used to extract ophthalmological assessments, treatment outcomes, and follow-up data. Predictors of ONP recovery during follow-up were explored using univariate and multivariate analyses.ResultsWe identified 55 patients with a median ONP duration before treatment of 11 days (IQR 4.5–18); the deficit was complete in 27 (49.1%) and incomplete in 28 (50.9%) cases. Median aneurysm size was 7 mm (IQR 5–9). Twenty-four (43.6%) patients underwent surgical clipping and 31 (56.4%) embolization as the primary treatment. Overall, ONP improved in 40 (72.7%) patients and persisted/recurred in 15 (27.3 %). Surgery, interval to complete treatment <4 weeks, aneurysm recurrence during follow-up, and retreatment during follow-up were significantly correlated with ONP outcome in the univariate analysis. In the multivariate analysis, independent predictors of ONP improvement were interval to complete treatment <4 weeks (OR 5.15, 95% CI 1.37 to 23.71, p=0.015) and aneurysm recurrence during follow-up (OR 0.1, 95% CI 0.02 to 0.47, p=0.003).ConclusionThere was no significant difference in ONP recovery between surgical clipping and embolization. The best predictor for ONP recovery was timely, complete, and durable aneurysm exclusion.

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Umbilical hernia in children

Medicinski pregled ◽

10.2298/mpns0306291m ◽

2003 ◽

Vol 56 (5-6) ◽

pp. 291-294 ◽

Cited By ~ 10

Author(s):

Smiljana Marinkovic ◽

Svetlana Bukarica

Keyword(s):

Umbilical Hernia ◽

Pain Treatment ◽

Pediatric Population ◽

Treatment Options ◽

Clinical Manifestations ◽

Great Majority ◽

Common Condition ◽

Direct Hernia ◽

Incomplete Closure

Introduction Umbilical hernia is a common condition in the pediatric population. Embryology Umbilical hernia is a consequence of incomplete closure or weakness at the umbilical ring, where protrusion of intraabdominal contents may occur. Anatomy Fascia posterior to the canal is thinner creating an area of weakness. Congenital or direct hernia occurs in this area, while herniation in the umbilical canal leads to indirect or acquired hernia. Incidence The incidence of umbilical hernia is 1.9% to l8.5% in white population. Clinical manifestations The great majority of pediatric umbilical hernias are asymptomatic. Incarceration and strangulation are uncommon Rupture of umbilical hernia with resultant evisceration is extremely rare Umbilical hernia may also be the source of intermittent umbilical or abdominal pain. Treatment Treatment options for umbilical hernias range from simple observation to surgical repair. The great majority close spontaneously and observation with periodic follow-up is appropriate in most cases. There are no available data to suggest that strapping improves or accelerates closure. Operation would be recommended for defects greater than 1cm, by the age 3 to 4. Persistence or enlargement of fascial defect during the period of observation are reasons to consider repair, whatever the age. Complications Complications of operative repair of umbilical hernias include those related to anesthesia and local wound infections. Conclusion Umbilical hernia is a common condition among infants and children. In the great majority of cases the natural history is one of eventual closure without treatment. If spontaneous closure does not occur until the age of 3-4 years, operative correction is recommended.

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Early Recurrence of an Infantile Endodermal Oculomotor Nerve Cyst following Surgical Fenestration: A Case Report

Pediatric Neurosurgery ◽

10.1159/000511774 ◽

2021 ◽

Vol 56 (2) ◽

pp. 157-162

Author(s):

Victor M. Lu ◽

Aditya Raghunathan ◽

Michael J. Link ◽

David J. Daniels

Keyword(s):

Case Report ◽

Surgical Intervention ◽

Early Recurrence ◽

Oculomotor Nerve ◽

Rare Entity ◽

Oculomotor Palsy ◽

Case Presentation ◽

Postoperative Course

Introduction: Infantile endodermal oculomotor nerve cyst (EONC) is an extremely rare entity. There are very few pediatric cases reported in the literature, and as expected, oculomotor palsy is the most common presenting symptom. To date however, the risk of recurrence of these lesions following surgical intervention is unclear due to a lack of long-term radiological follow-up. Case Presentation: We present a case of a 13-month-old male patient with an EONC and detail his surgical fenestration and postoperative course. Somewhat surprisingly, re-expansion occurred within 6 months and remained stable 2 years later. Discussion: A surgical approach to fenestration of an EONC in an infant is possible and should be performed by an expert neurosurgeon. Early recurrence is underreported in the current literature, and we encourage longer term radiological surveillance of these lesions after surgery to optimize primary and recurrent management in the future.

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Ruptured aneurysm in the posterior communicating segment of carotid artery presenting with contralateral oculomotor nerve palsy

Surgical Neurology International ◽

10.25259/sni_203_2019 ◽

2019 ◽

Vol 10 ◽

pp. 177

Author(s):

Guilherme Finger ◽

Otávio Garcia Martins ◽

William Mazzucco Nesi ◽

Mateus Carvalho Casarin ◽

Leandro Pelegrini de Almeida ◽

...

Keyword(s):

Nerve Palsy ◽

Medical Literature ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Case Description ◽

Brain Aneurysm ◽

Vascular Abnormalities ◽

Neurological Signs ◽

Brain Aneurysms ◽

Common Sign

Background: Brain aneurysms are mostly discovered during the investigation of subarachnoid hemorrhage (SAH). Some patients present neurological signs that may suggest the aneurysm’s topography, and the oculomotor nerve palsy (ONP) of the same side of the aneurysm is the most common sign. Only one case report of contralateral palsy was previously described in the medical literature. Case Description: Authors describe a patient who presented a classic manifestation of SAH associated with complete ONP, whose vascular investigation demonstrated a brain aneurysm located in the contralateral intracranial carotid. The patient was surgically treated with great neurologic outcome, and late angiography did not evidence other vascular abnormalities. Conclusion: The ipsilateral ONP is a common sign found in posterior communicating artery aneurysms; however, such aneurysm can have different presentations due to the elevation of intracranial pressure, and, in rarer cases, the ONP cannot be operated as a localizing sign.

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Endovascular coil embolization of anterior choroidal artery aneurysms

Journal of Neurosurgery ◽

10.3171/2009.4.jns08934 ◽

2009 ◽

Vol 111 (5) ◽

pp. 963-969 ◽

Cited By ~ 18

Author(s):

Hyun-Seung Kang ◽

Bae Ju Kwon ◽

O-Ki Kwon ◽

Cheolkyu Jung ◽

Jeong Eun Kim ◽

...

Keyword(s):

Coil Embolization ◽

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Thromboembolic Events ◽

Anterior Choroidal Artery ◽

Endovascular Coil Embolization ◽

Anterior Choroidal ◽

Choroidal Artery

Object Anterior choroidal artery (AChA) aneurysms are difficult to treat, and the clinical outcome of patients is occasionally compromised by ischemic complications after clipping operations. The purpose of this study was to document the outcome and follow-up results of endovascular coil embolization in patients with AChA aneurysms. Methods Between July 1999 and March 2008, 88 patients with 90 AChA aneurysms (31 ruptured and 59 unruptured aneurysms) were treated with endovascular coil embolization in 91 sessions. There were 87 small aneurysms (< 10 mm) and 3 large aneurysms, with a mean aneurysm volume of 60.9 ± 83.3 mm3. Preprocedural oculomotor nerve palsy associated with AChA aneurysms was noted in 8 patients. Efficacy and safety were evaluated based on the degree of initial occlusion, procedure-related complications, patient outcome based on the Glasgow Outcome Scale score, and follow-up results. Results The degree of angiographic occlusion of the aneurysms was complete for 15 aneurysms (17%), near complete for 69 aneurysms (77%) and partial for 6 aneurysms (7%). There were 4 (4.4%) symptomatic procedure-related complications (3 thromboembolic events and 1 procedural hemorrhage). The procedural hemorrhage resulted in death; however, the thromboembolic events only caused transient deficits. A favorable outcome (Glasgow Outcome Scale score of 5 or 4) was achieved in 90% (79 of 88) of the patients at the time of discharge. No patient showed signs of bleeding or rebleeding during the follow-up period (mean 25 months). Major aneurysm recanalization occurred in 2 cases. The AChA aneurysm–associated oculomotor nerve palsy tended to become aggravated transiently after coil embolization and then completely recovered over the course of 2–9 months. Conclusions Coil embolization is a safe and effective treatment modality in cases of AChA aneurysms. Coil embolization enables procedural recognition of arterial compromise and immediate reestablishment of flow, thus contributing to a favorable outcome.

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Aberrant regeneration in idiopathic oculomotor nerve palsy

Journal of Neurosurgery ◽

10.3171/jns.1980.52.6.0854 ◽

1980 ◽

Vol 52 (6) ◽

pp. 854-856 ◽

Cited By ~ 5

Author(s):

Jose F. Laguna ◽

Michael S. Smith

Keyword(s):

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Content Type ◽

Third Nerve Palsy ◽

Aberrant Regeneration ◽

Oculomotor Function ◽

Third Nerve ◽

Fine Print

✓ Aberrant regeneration of the oculomotor nerve usually follows injury to the nerve by posterior communicating artery aneurysms or trauma. A case of idiopathic third nerve palsy with pupillary involvement occurred in an otherwise healthy 38-year-old man. Follow-up examination 32 months later showed evidence of oculomotor function with aberrant regeneration.

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Unilateral Oculomotor Nerve Enhancement in Diabetic Oculomotor Nerve Palsy: A Retrospective Study

10.21203/rs.3.rs-45696/v1 ◽

2020 ◽

Author(s):

Juan Zhao ◽

Yong Li ◽

Qing-Lin Chang ◽

Jia-Wei Wang ◽

Hou-Liang Sun

Keyword(s):

Nerve Palsy ◽

Glycosylated Hemoglobin ◽

Disease Onset ◽

Complete Recovery ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Diabetic Patients ◽

Imaging Features ◽

Onset Age

Abstract Background No previous studies have explored the imaging features of oculomotor nerve palsy (ONP) in diabetic patients. In our clinical practice, isolated ONP with diabetes is partly treated with glucocorticosteroids because nerve enhancement is habitually interpreted as inflammation. Our study thus aims to summarize the imaging findings of isolated ONP with diabetes.Methods Our study included 59 patients with a clinical diagnosis of diabetic ONP. Patients were recruited from our department between January 2015 and December 2019. Orbital MRI was retrospectively analyzed for each patient, and follow-up imaging was obtained for 3 patients.Results Thickening and enhancement of the ipsilateral oculomotor nerve were detected in 38 (64.41%) patients, indicating simultaneous involvement of the cavernous segment and inferior division of the intraorbital segment. After clinically complete recovery, repeated MRI in 3 patients revealed a slightly reduced degree of enhancement of the oculomotor nerve. No differences were detected in the sex ratio (p=0.976), median onset age (p=0.563), median duration of diabetes (p=0.697), plasma glycosylated hemoglobin (HbAlc) level (p=0.278) or interval from disease onset to MRI between patients with and without enhancement of the oculomotor nerve. Conclusions Thickening and enhancement of the unilateral oculomotor nerve can be detected in patients with diabetic ONP and indicates the main involvement of the cavernous segment and the inferior division of the intraorbital segment, which may be helpful for differentiating this condition from other etiologies in isolated ONP.

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Diabetic Oculomotor Nerve Palsy Displaying Enhancement of the Oculomotor Nerve in the Orbit and Cavernous Sinus on MRI

European Neurology ◽

10.1159/000514100 ◽

2021 ◽

pp. 1-8

Author(s):

Juan Zhao ◽

Yong Li ◽

Qinglin Chang ◽

Jiawei Wang ◽

Houliang Sun

Keyword(s):

Complete Resolution ◽

Nerve Palsy ◽

Motor Nerve ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Imaging Data ◽

Mri Features ◽

The Difference ◽

Hospital Days

Introduction: Imaging data were scarce on diabetic oculomotor nerve palsy (ONP). Our study explored the MRI features and their clinical implications for diabetic ONP. Methods: Fifty-nine patients with a clinical diagnosis of diabetic ONP were recruited from our department between January 2015 and December 2019. Orbital MRI was retrospectively analyzed, and follow-up scans were obtained for 5 patients. Based on the ocular motor nerve palsy scale, the difference in the scores on the first and last hospital days was defined as the improvement score and was used to assess the treatment effects in all. Results: Thirty-eight (64.41%) patients presented thickening and enhancement of the cavernous segment and inferior division of the intraorbital segment of the ipsilateral oculomotor nerve, with the cisternal segment spared in all. After complete resolution of symptoms, follow-up MRI in 5 patients revealed that the enhancement was less obvious compared with the previous images. 6 patients in the enhancement group and 4 patients in the nonenhancement group were treated with 80 mg of methylprednisolone. Significant differences were not detected in the median improvement scores between patients with and those without corticosteroid use (p = 0.240). Conclusion: Thickening and enhancement of the unilateral oculomotor nerve were common imaging findings in diabetic ONP, and they persisted after complete resolution of symptoms in some patients. The cavernous segment and the inferior division of the intraorbital segment were simultaneously involved, and the cisternal segment was often spared. Refraining from corticosteroids was recommended even with nerve enhancement.

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Endovascular repair of posterior communicating artery aneurysms, associated with oculomotor nerve palsy: A review of nerve recovery

Interventional Neuroradiology ◽

10.1177/1591019915583222 ◽

2015 ◽

Vol 21 (3) ◽

pp. 312-316 ◽

Cited By ~ 4

Author(s):

Mark John Sheehan ◽

Ruth Dunne ◽

John Thornton ◽

Paul Brennan ◽

Seamus Looby ◽

...

Keyword(s):

Nerve Palsy ◽

Complete Recovery ◽

Oculomotor Nerve ◽

Posterior Communicating Artery ◽

Oculomotor Nerve Palsy ◽

Endovascular Coiling ◽

Partial Recovery ◽

Nerve Function ◽

Nerve Recovery

Purpose Oculomotor nerve palsy (ONP) is often the presenting symptom in patients with posterior communicating artery (PCOMM) aneurysms with variable recovery of oculomotor nerve function following treatment. In this study we report the ophthalmologic outcome of 20 patients treated by endovascular coiling for PCOMM aneurysm-induced ONP. Methods We performed 230 PCOMM aneurysm endovascular coilings between the years 2006 and 2011, of which 20 cases presented with ONP. We recorded the degree of nerve recovery – complete, partial or none – while also documenting other predictive factors, such as degree of pre-intervention nerve deficit, presence of subarachnoid haemorrhage (SAH), size and location of the PCOMM aneurysm and length of follow-up. Results Of the 20 patients, 9 (45%) presented with complete ONP and 11 (55%) with partial ONP. After an average follow-up period of 16 months, all patients achieved oculomotor nerve recovery; 9 (45%) patients had complete recovery and 11 (55%) patients had partial recovery. Of the 9 patients who presented with complete ONP, 5 (56%) patients made a complete recovery and 4 (44%) made a partial recovery. Of the 11 patients who initially presented with partial ONP, 4 (36%) made a complete recovery and 7 (64%) made a partial recovery. 7 (35%) patients also had a SAH, of whom 3 (43%) made a complete recovery with 4 (57%) making a partial recovery. Conclusions ONP can occur with PCOMM aneurysm with or without SAH. Endovascular coiling is an effective treatment for ONP due to PCOMM aneurysms.

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