Medial rectus disinsertion for management of chronic complete sixth nerve palsy

2021 ◽  
pp. 112067212110652
Author(s):  
Abbas Bagheri ◽  
Amirreza Veisi ◽  
Mehdi Tavakoli
Keyword(s):  
Nerve Palsy ◽  
Case Series ◽  
Medial Rectus ◽  
Retrospective Case ◽  
Primary Position ◽  
Sixth Nerve Palsy ◽  
Prism Dioptre ◽  
Abnormal Head ◽  
Sixth Nerve

Purpose To report the outcomes of the medial rectus (MR) disinsertion procedure for the management of refractory esotropia (ET) with or without Abnormal head posture (AHP) in chronic complete sixth nerve palsy. Methods This is a retrospective case series of patients with sixth nerve palsy who suffered from residual ET and diplopia following the conventional strabismus surgeries and underwent MR disinsertion procedure between April 2017 and February 2020. This procedure was offered to the patients who declined to use prism and did not wish to perform surgery on the fellow eye. The demographic and clinical data, including sex, age, visual acuity, pre and postoperative angle of strabismus, duction limitations, results of forced duction and force generation tests, details of prior strabismus surgeries, orbital CT scan findings, and follow up duration were collected from the medical records. Results Six patients were enrolled in this study. Mean age was 35.0  ±  14.0 years, and mean follow-up was 15.3  ±  5.9 months. The ET at the Primary position (PP) was 35.0  ±  18.4 prism dioptre (PD) before MR disinsertion, which decreased to 14.2  ±  17.4 PD after MR disinsertion procedure. Four cases needed additional complementary surgeries to improve residual ET in PP. No case developed overcorrection. Abduction deficiency was −5.0  ±  1.3 before MR disinsertion, which improved to − 2.8  ±  0.5 units at last follow-up. The mean of induced adduction deficiency was − 2.9  ±  0.4 at last follow-up. Conclusions MR disinsertion can be considered in patients with chronic complete sixth nerve palsy and refractory diplopia when the conventional methods have failed.

scholarly journals Augmented superior rectus muscle transposition in management of defective ocular abduction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohamed F. Farid ◽  
Ahmed E. M. Daifalla ◽  
Mohamed A. Awwad
Keyword(s):  
Nerve Palsy ◽  
Rectus Muscle ◽  
Muscle Transposition ◽  
Primary Position ◽  
Superior Rectus ◽  
Sixth Nerve Palsy ◽  
Abnormal Head ◽  
Duane Retraction Syndrome ◽  
Sixth Nerve ◽  
Superior Rectus Muscle

Abstract Background Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy. Methods a retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Effect on primary position esotropia (ET), abnormal head posture (AHP), limitation of ocular ductions as well as complications were reported and analyzed. Results a total of 21 patients were identified: 10 patients with 6th nerve palsy and 11 patients with Eso-DRS. In both groups, SRT was combined with ipsilateral MRc in 18 cases. ET, AHP and limited abduction were improved by means of 33.8PD, 26.5°, and 2.6 units in 6th nerve palsy group and by 31.1PD, 28.6°, and 2 units in Eso-DRS group respectively. Surgical success which was defined as within 10 PD of horizontal orthotropia and within 4 PD of vertical orthotropia was achieved in 15 cases (71.4%). Significant induced hypertropia of more than 4 PD was reported in 3 patients (30%) and in 2 patients (18%) in both groups, respectively. Conclusion augmented SRT with or without MRc is an effective tool for management of ET, AHP and limited abduction secondary to sixth nerve palsy and Eso-DRS. However, this form of augmented superior rectus muscle transposition could result in high rates of induced vertical deviation.

scholarly journals Therapeutic results in sixth nerve palsy

2015 ◽  
Vol 22 (1) ◽  
pp. 51-59
Author(s):  
Violeta-Ioana Pruna ◽  
Daniela Cioplean ◽  
Liliana Mary Voinea
Keyword(s):  
Nerve Palsy ◽  
Rectus Muscle ◽  
Lateral Rectus ◽  
Medial Rectus ◽  
Therapeutic Success ◽  
Primary Position ◽  
Sixth Nerve Palsy ◽  
Single Vision ◽  
Binocular Single Vision ◽  
Sixth Nerve

Abstract Authors aim to assess through a retrospective study the efficiency of different therapeutic methods used in VIth nerve palsy. 60 patients with VIth nerve palsy, admitted and treated in Oftapro Clinic, were divided into two groups: a group with partial dysfunction (paresis) of sixth nerve and a group with the complete abolition of neuromuscular function (VIth nerve palsy). Initial examination included assessment of neuromuscular function, binocular vision and existence of medial rectus muscle contracture (ipsi- and contralateral) and contralateral lateral rectus inhibitory palsy. Neuromuscular dysfunction was graded from - 8 (paralysis) to 0 (normal abduction). Therapeutic modalities ranged from conservative treatment (occlusion, prism correction), botulinum toxin chemodenervation and surgical treatment: medial rectus recession + lateral rectus resection, in cases of paresis, and transposition procedures (Hummelscheim and full tendon transfer) in cases of sixth nerve palsy. Functional therapeutic success was defined as absence of diplopia in primary position, with or without prism correction, and surgical success was considered obtaining orthoptic alignment in primary position or a small residual deviation (under 10 PD). 51 patients had unilateral dysfunction, and 9 patients had bilateral VI-th nerve dysfunction. 8 patients had associated fourth or seventh cranial nerves palsy. The most common etiology was traumatic, followed by tumor and vascular causes. There were 18 cases of spontaneous remission, partial or complete (4-8 months after the onset), and 6 cases enhanced by botulinum toxin chemodenervation. 17 paretic eyes underwent surgery, showing a very good outcome, with restoration of binocular single vision. The procedure of choice was recession of medial rectus muscle, combined with resection of lateral rectus muscle. All patients with sixth nerve palsy underwent surgery, except one old female patient, who refused surgery. Hummelscheim procedure was applied in 19 cases, and full tendon transfer in 6 cases. In 13 cases partial results were obtained, who needed further prismatic correction or reintervention. In 12 cases the outcome was very good, with restoration of binocular single vision, without prismatic correction. Therapeutic success in sixth nerve palsy depends on accurate assessment of neuromuscular dysfunction and appropriate choice of therapeutic modality for each case. Interdisciplinary collaboration is mandatory for correct etiologic diagnosis of sixth nerve palsy.

Surgery option in the management of delayed diplopia after radiation therapy for nasopharyngeal carcinoma

2018 ◽  
Vol 28 (5) ◽  
pp. 547-551
Author(s):  
Leilei Zou ◽  
Sujia Wu ◽  
Yan Liu ◽  
Shu Wang ◽  
Wen Wen ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Case Series ◽  
Topical Anesthesia ◽  
Lateral Rectus ◽  
Prism Diopter ◽  
Retrospective Case ◽  
Patient Reported ◽  
Sixth Nerve

Purpose: Radiation therapy is a standard treatment for nasopharyngeal carcinoma. Diplopia due to radiation damage to the sixth nerve significantly erodes the patient’s quality of life. This study investigated the effectiveness of extraocular surgery in the treatment of delayed diplopia caused by radiation therapy. Methods: A retrospective case series of 16 patients (7 men and 9 women) with delayed diplopia after radiation therapy for nasopharyngeal carcinoma was enrolled in the study. Unilateral lateral rectus resection was performed under topical anesthesia. Follow-up time was more than 12 months. Outcome measures were prism diopter and self-reported symptoms. Results: All patients diagnosed with sixth nerve palsy reported elimination of symptoms on postoperative day 1 without complications. One patient required a second procedure due to recurrence of symptoms. At 12-month follow-up, no patient reported recurrence of symptoms. The absolute horizontal deviation significantly decreased from a preoperative value of 16 prism diopter to a value of 1.5 prism diopter postoperatively (p < 0.001). Conclusion: These results suggest that unilateral lateral rectus resection under topical anesthesia is an effective treatment for delayed diplopia after radiation therapy for nasopharyngeal carcinoma. A large randomized prospective study to confirm these findings is warranted.

Recovery of Cranial Nerve Deficits in Patients Presenting with Pituitary Apoplexy: A Case Series

2021 ◽  
Author(s):  
Mohammed Alahmari ◽  
Fahad Alkherayf ◽  
Andrea Lasso ◽  
Fatmahalzahra Banaz ◽  
Sepideh Mohajeri ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Case Series ◽  
Surgical Decompression ◽  
Tumor Type ◽  
Visual Deficit ◽  
Nerve Recovery ◽  
Sixth Nerve

Abstract Background Pituitary apoplexy (PA) is a rare complication of pituitary tumors that can present with a myriad of symptoms, including sudden onset cranial nerve deficits. After patient stabilization and hormone replacement, surgical decompression is often recommended. The timing of surgical decompression remains controversial. In this case series, we describe our institutional experience pertaining to the cranial nerve recovery in patients who underwent endoscopic endonasal transsphenoidal (EETS) surgery for PA while evaluating outcome based on tumor stage using the suprasellar infrasellar parasellar anterior posterior (SIPAP) classification. Design Present study is a single-institution retrospective cohort. Methods A retrospective review of all EETS cases for pituitary tumor resection between November 2009 and August 2018. Queries of the hospital database were completed by trained personnel to identify cases of PA treated using the EETS approach. Baseline characteristics, tumor type, endocrine data, and SIPAP classification based on preoperative magnetic resonance imaging (MRI) and operation characteristics were extracted from medical records. Postoperative results were extracted for the duration of the follow-up period available for each patient. Results Fifteen cases of PA were identified. Patient follow-up period was a mean of 30 months. The cranial nerve deficits present at admission were visual deficit (33%); unilateral third nerve palsy (47%) and unilateral sixth nerve palsy (27%). No fourth nerve palsies were observed. Following EETS, 60% of patients with preoperative visual deficit had normal visual fields. For those with third and sixth nerve palsies preoperatively, 43 and 75%, respectively, had return to normal function postoperatively. SIPAP tumor characteristics were not related to postoperative cranial nerve recovery. Conclusion In this series of surgically treated patients with pituitary apoplexy, all cranial nerve deficits normalized or improved following surgery. The tumor SIPAP classification was not associated with patient outcome. Though in a small series, the presented results suggest surgical treatment is beneficial for these patients.

Evaluation of augmented temporal superior rectus transposition combined with adjustable medial rectus recession in sixth nerve palsy and esotropic Duane syndrome type 1

2018 ◽  
Vol 22 (4) ◽  
pp. e47
Author(s):  
Adeel Suhail Sethi ◽  
Tobias Emil Torp-Pedersen ◽  
Claes Sepstrup Loenkvist ◽  
Bente Baun Iversen ◽  
Morten Dornonville De La Cour ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Medial Rectus ◽  
Syndrome Type ◽  
Superior Rectus ◽  
Sixth Nerve Palsy ◽  
Duane Syndrome ◽  
Sixth Nerve

The Aetiology and Management of Long-Lasting Sixth Nerve Palsy in Ophthalmoplegic Migraine

Cephalalgia ◽  
2007 ◽  
Vol 27 (3) ◽  
pp. 275-278 ◽  
Author(s):  
B Manzouri ◽  
A Sainani ◽  
GT Plant ◽  
JP Lee ◽  
J Sloper
Keyword(s):  
Botulinum Toxin ◽  
Nerve Palsy ◽  
Adult Patients ◽  
The Other ◽  
Medial Rectus ◽  
Sixth Nerve Palsy ◽  
Ophthalmoplegic Migraine ◽  
Squint Surgery ◽  
Sixth Nerve

The features and management of two adult patients with ophthalmoplegic migraine and longlasting sixth nerve palsies are described. Both had had previous shorter episodes of diplopia following migraine-like headaches. One recovered following an injection of botulinum toxin to the medial rectus of her affected eye 11 months after the onset of diplopia. The other patient had previously had surgery for a consecutive divergent squint and required further squint surgery to realign his eyes 1 year after the onset of his sixth nerve palsy. Both botulinum toxin and squint surgery may be useful in the management of longstanding sixth nerve palsy in patients with ophthalmoplegic migraine. The aetiology of ophthalmoplegic migraine is discussed.

scholarly journals Retrospective case series with one year follow-up after radial nerve palsy associated with humeral fractures

2016 ◽  
Vol 41 (1) ◽  
pp. 191-196 ◽  
Author(s):  
Nikolaus Wilhelm Lang ◽  
Roman Christian Ostermann ◽  
Cathrin Arthold ◽  
Julian Joestl ◽  
Patrick Platzer
Keyword(s):  
Radial Nerve ◽  
Nerve Palsy ◽  
Case Series ◽  
Humeral Fractures ◽  
Radial Nerve Palsy ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
One Year
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