Oculomotor Nerve Anastomosis

Abstract We report a patient who underwent anastomosis of the left oculomotor nerve, which had been inadvertently and bluntly severed during the resection of a left parasellar chromophobe pituitary adenoma. Neural regeneration was confirmed by the reappearance of voluntary adduction of the eyeball, clinical signs of aberrant regeneration, and the appearance of an action potential on electromyography of the levator palpebrae superioris muscle 1 year after end-to-end anastomosis of the nerve.

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Aberrant regeneration of the oculomotor nerve: implications for neurosurgeons

Neurosurgical FOCUS ◽

10.3171/foc-07/11/e14 ◽

2007 ◽

Vol 23 (5) ◽

pp. E14 ◽

Cited By ~ 53

Author(s):

Eric D. Weber ◽

Steven A. Newman

Keyword(s):

Cranial Nerve ◽

Clinical Signs ◽

Treatment Strategies ◽

Oculomotor Nerve ◽

Oculomotor Palsy ◽

Upper Eyelid ◽

Aberrant Regeneration ◽

Nerve Dysfunction ◽

Neurosurgical Intervention

✓Aberrant regeneration of cranial nerve III, otherwise known as oculomotor synkinesis, is an uncommon but well-described phenomenon most frequently resulting from trauma, tumors, and aneurysms. Its appearance usually follows an oculomotor palsy, but it can also occur primarily without any preceding nerve dysfunction. It is vital that neurosurgeons recognize this disorder because it may be the only sign of an underlying cavernous tumor or PCoA aneurysm. The tumor most often implicated is a cavernous or parasellar meningioma, but any tumor that causes compression or disruption along the course of the oculomotor nerve may cause primary or secondary misdirection. The most common clinical signs of oculomotor synkinesis consist of elevation of the upper eyelid on attempted downward gaze or adduction, adduction of the eye on attempted upward or downward gaze, and constriction of the pupil on attempted adduction. The authors present the largest series of patients with oculomotor synkinesis, including those in whom it developed after neurosurgical intervention, to illustrate various presentations. In addition, the various mechanisms that contribute to synkinesis are reviewed. Last, the treatment strategies for both oculomotor palsies and synkinesis are discussed.

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Patterns of Oculomotor Nerve Distribution to the Levator Palpebrae Superioris Muscle, and Correlation to Temporary Ptosis After Blepharoplasty

Annals of Plastic Surgery ◽

10.1097/00000637-200110000-00003 ◽

2001 ◽

Vol 47 (4) ◽

pp. 381-384 ◽

Cited By ~ 11

Author(s):

Kun Hwang ◽

Dae Kwang Lee ◽

In Hyuk Chung ◽

Se Il Lee

Keyword(s):

Oculomotor Nerve ◽

Levator Palpebrae ◽

Levator Palpebrae Superioris Muscle

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IMPLICIT OF CONTRALATERAL EYE SURGERY IN ABERRANT REGENERATION OF OCULOMOTOR NERVE PALSY (OCULOMOTOR SYNKINESIS)

International Journal of Advanced Research ◽

10.21474/ijar01/10728 ◽

2020 ◽

Vol 8 (3) ◽

pp. 1092-1094

Author(s):

V Rajesh Prabu ◽

◽

Rajlaxmi B Wasnik ◽

Parul Priyambada ◽

Ranjini H ◽

...

Keyword(s):

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Eye Surgery ◽

Aberrant Regeneration ◽

Contralateral Eye

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Experimental Study on the Effect of Electrostimulation on Neural Regeneration After Oculomotor Nerve Injury

Journal of Molecular Neuroscience ◽

10.1007/s12031-014-0358-8 ◽

2014 ◽

Vol 54 (4) ◽

pp. 639-652 ◽

Cited By ~ 3

Author(s):

Ningxi Zhu ◽

Chunmei Zhang ◽

Zhen Li ◽

Youqiang Meng ◽

Baohui Feng ◽

...

Keyword(s):

Experimental Study ◽

Nerve Injury ◽

Oculomotor Nerve ◽

Neural Regeneration

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Structural Abnormalities in the Levator Palpebrae Superioris Muscle in Patients With Congenital Blepharoptosis

Ophthalmic Surgery Lasers and Imaging ◽

10.3928/15428877-20070701-03 ◽

2007 ◽

Vol 38 (4) ◽

pp. 283-289 ◽

Cited By ~ 6

Author(s):

Aleksandra Iljin ◽

Anna Zielinska ◽

Michal Karasek ◽

Andrzej Zielinski ◽

Aleksandra Omulecka

Keyword(s):

Structural Abnormalities ◽

Levator Palpebrae ◽

Levator Palpebrae Superioris Muscle

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Functioning Pituitary Adenoma with Xanthogranulomatous Features: Review of Literature and Case Report

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1675232 ◽

2018 ◽

Vol 80 (05) ◽

pp. 449-457

Author(s):

Ciro A. Vasquez ◽

Angela Downes ◽

Bette K. Kleinschmidt-DeMasters ◽

A Samy Youssef

Keyword(s):

Case Report ◽

Pituitary Adenoma ◽

Clinical Signs ◽

Cystic Mass ◽

Sellar Region ◽

Contrast Administration ◽

Pubmed Search ◽

Weighted Magnetic Resonance Imaging ◽

Intratumoral Bleeding ◽

Tomography Scan

Abstract Objectives We present a patient with a prolactin-secreting adenoma with extensive secondary, noninfectious, xanthogranulomatous changes due to remote intratumoral bleeding and provide a literature review of xanthogranulomas (XGs) of the sellar region with emphasis on prolactinomas with xanthogranulomatous features. Design Case report, with PubMed search of cases of sellar XG, focusing on neuroimaging and surgical approach. Results A 35-year-old male was found to have a large sellar/suprasellar calcified/cystic mass. Endoscopic transsphenoidal approach for extradural resection was performed and diagnosis made. Review generated 31 patients with the diagnosis of sellar XG. In a minority (6 patients), the underlying lesion for the XG was a pituitary adenoma. Headache was the most common presenting symptom and panhypopituitarism the most common endocrinological abnormality. Examples of hyperprolactinemia associated with sellar XG are also uncommon and due to stalk effect. Neuroimaging of XG on T1-weighted magnetic resonance imaging (MRIs) showed 18 cases (56.3%) were hyperintense, 1 case (3.13%) was isointense, 4 (12.5%) had mixed-signal intensity, and 2 (6.25%) were hypointense. On T2-weighted MRIs, five lesions (15.6%) were hyperintense, three (9.38%) were isointense, nine (28.1%) were heterogeneous, and nine (28.1%) were hypointense. Only one case (3.1%) had calcifications on computed tomography scan similar to ours. In 14 cases (43.7%), the lesions enhanced with contrast administration on MRI. Conclusion Prolactinomas with secondary xanthogranulomatous change represent a rare cause of XG of the sella. With no radiological or clinical signs specific for XG of the sellar region, preoperative diagnosis can be challenging, if not impossible.

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