Cavernous Hemangioma of the Third Cranial Nerve

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. E653-E653 ◽  
Author(s):  
Eyal Itshayek ◽  
Xicotencatl Perez-Sanchez ◽  
Jose E. Cohen ◽  
Felix Umansky ◽  
Sergey Spektor
Keyword(s):  
Cavernous Hemangioma ◽  
Neurological Deficit ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Caucasian Woman ◽  
Pharmacological Management ◽  
The Third ◽  
Interpeduncular Cistern ◽  
Hemorrhagic Event ◽  
History Of

Abstract OBJECTIVE The authors report a rare case of a cavernous hemangioma (CH) involving the third cranial nerve. CLINICAL PRESENTATION A 25-year-old Caucasian woman presented with neuralgic facial pain that responded to pharmacological management. She had no neurological deficit. Magnetic resonance imaging scans revealed a space-occupying lesion in the interpeduncular cistern with no evidence of hemorrhagic event. Preoperative cerebrospinal fluid and blood samples were negative for cytology and tumor markers. INTERVENTION The patient underwent craniotomy and exploration of the interpeduncular cistern. A lesion with the raspberry-like appearance characteristic of a CH was found emerging from between the fibers and completely encircling Cranial Nerve III. The surgeon decided to leave the lesion in place to avoid creation of a new neurological deficit in the young patient. The patient is asymptomatic with a stable radiological picture 18 months after surgery. CONCLUSION CH should be considered as a possible differential diagnosis of extra-axial space-occupying lesions along the course of the cranial nerves. Resection with resulting deficit may not be indicated in patients presenting with normal neurological function. Further research and longer follow-up periods are required to better understand the natural history of CH involving the cranial nerves.

Isolated Congenital Absence of Cranial Nerves: Report of Two Cases

2018 ◽  
Vol 49 (06) ◽  
pp. 405-407
Author(s):  
Vivek Agarwal ◽  
Sumeet Dhawan ◽  
Naveen Sankhyan ◽  
Sameer Vyas
Keyword(s):  
High Resolution ◽  
Mr Imaging ◽  
Cranial Nerve ◽  
Clinical Presentation ◽  
Cranial Nerves ◽  
Rare Condition ◽  
Congenital Absence ◽  
The Third ◽  
Seventh Cranial Nerve ◽  
The Right

AbstractIsolated cranial nerve absence is a rare condition that can be diagnosed using high-resolution cranial nerve magnetic resonance (MR) imaging. Thorough clinical examination with proper knowledge of the course of cranial nerves may help diagnose this rare condition. We describe two cases, one each of, isolated congenital absence of the third and seventh cranial nerve with their clinical presentation. High-resolution T2-weighted MR imaging was done in both patients which revealed absence of cisternal segment of the right-sided third nerve and cisternal with canalicular segment of the right-sided facial nerve.

scholarly journals Aberrant regeneration of the third cranial nerve

1970 ◽  
Vol 4 (1) ◽  
pp. 176-178
Author(s):  
UD Shrestha ◽  
S Adhikari
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Third Nerve Palsy ◽  
The Third ◽  
Trauma Case ◽  
History Of ◽  
Aberrant Regeneration ◽  
Over Time ◽  
Third Nerve ◽  
Storey Building

Background: Aberrant regeneration of the third cranial nerve is most commonly due to its damage by trauma. Case: A ten-month old child presented with the history of a fall from a four-storey building. She developed traumatic third nerve palsy and eventually the clinical features of aberrant regeneration of the third cranial nerve. The adduction of the eye improved over time. She was advised for patching for the strabismic amblyopia as well. Conclusion: Traumatic third nerve palsy may result in aberrant regeneration of the third cranial nerve. In younger patients, motility of the eye in different gazes may improve over time. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5872 NEPJOPH 2012; 4(1): 176-178

Using the Lateral Pontine Safe Entry Zone for Resection of Deep-Seated Cavernous Malformations in the Lateral Pons: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (5) ◽  
pp. E518-E519
Author(s):  
Daniel D Cavalcanti ◽  
Joshua S Catapano ◽  
Paulo Niemeyer Filho
Keyword(s):  
Trigeminal Nerve ◽  
Cranial Nerve ◽  
Cavernous Malformation ◽  
Vascular Malformations ◽  
Cranial Nerves ◽  
Cavernous Malformations ◽  
Entry Zone ◽  
History Of ◽  
Tumor Biopsies ◽  
Safe Entry Zone

Abstract The retrosigmoid approach is one of the main approaches used in the surgical management of pontine cavernous malformations. It definitely provides a lateral route to large central lesions but also makes possible resection of some ventral lesions as an alternative to the petrosal approaches. However, when these vascular malformations do not emerge on surface, one of the safe corridors delimited by the origin of the trigeminal nerve and the seventh-eight cranial nerve complex can be used.1-5  Baghai et al2 described the lateral pontine safe entry zone in 1982, as an alternative to approaches through the floor of the fourth ventricle when performing tumor biopsies. They advocated a small neurotomy performed right between the emergence of the trigeminal nerve and the facial-vestibulocochlear cranial nerves complex. Accurate image guidance, intraoperative cranial nerve monitoring, and comprehensive anatomical knowledge are critical for this approach.4,5  Knowing the natural history of a brainstem cavernous malformation after bleeding,6 we sought to demonstrate in this video: (1) the use of the retrosigmoid craniotomy in lateral decubitus for resection of deep-seated pontine cavernous malformations; (2) the wide opening of arachnoid membranes and dissection of the superior petrosal vein complex to improve surgical freedom and prevent use of fixed cerebellar retraction; and (3) the opening of the petrosal fissure and exposure of the lateral pontine zone for gross total resection of a cavernous malformation in a 19-yr-old female with a classical crossed brainstem syndrome. She had full neurological recovery after 3 mo of follow-up.  The patient consented in full to the surgical procedure and publication of the video and manuscript.

scholarly journals Benign abducens nerve palsy: diagnosis by exclusion

2019 ◽  
Vol 6 (3) ◽  
pp. 1380
Author(s):  
Praveen U. ◽  
Sushma Save ◽  
Sanjay Singh
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Cranial Nerves ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
Immunological Reaction ◽  
Post Vaccination ◽  
Lateral Rectus Muscle ◽  
Diagnosis By Exclusion ◽  
History Of

Of all the cranial nerves, the abducens nerve has the longest intracranial course hence is most common cranial nerve to be affected secondary to any potentially devastating intracranial cause. It can indicate significant underlying pathology. Abducens or sixth cranial nerve innervates lateral rectus muscle and pathology of this nerve results in abduction deficiency of ipsilateral eye. Most of the time it will be unilateral but bilateral involvement is also well known. It can recurrent without any underlying identifiable pathology. The 6th nerve palsy is considered as benign after ruling out all possible causes. Benign causes account for just 9 to 14% of all 6th nerve palsies in children. Most of the time benign 6th nerve palsy occurs after viral infection or vaccination as an immunological reaction. In our case patient had history of pentavalent vaccination 1 month back. After thorough investigation and ruling out all possible causes it was attributed to post vaccination immunological reaction. which resolved spontaneously over 4months.

Diagnosis and treatment of cavernous hemangioma of the internal auditory canal

2016 ◽  
Vol 124 (3) ◽  
pp. 639-646 ◽  
Author(s):  
Wei Dong Zhu ◽  
Qi Huang ◽  
Xi Ye Li ◽  
Hong Sai Chen ◽  
Zhao Yan Wang ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Cavernous Hemangioma ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Middle Cranial Fossa ◽  
Surgical Removal ◽  
Translabyrinthine Approach ◽  
History Of ◽  
Cranial Fossa

OBJECT Cavernous hemangioma of the internal auditory canal (IAC) is an extremely rare type of tumor, and only 50 cases have been reported in the literature prior to this study. The aim in this study was to describe the symptomatology, radiological features, and surgical outcomes for patients with cavernous hemangioma of the IAC and to discuss the diagnostic criteria and treatment strategy for the disease. METHODS The study included 6 patients with cavernous hemangioma of the IAC. All patients presented with sensorineural hearing loss and tinnitus, and 2 also suffered from vertigo. Five patients reported a history of facial symptoms with hemispasm or palsy: 3 had progressive facial weakness, 1 had a hemispasm, and 1 had a history of recovery from sudden facial paresis. All patients underwent CT and MRI to rule out intracanalicular vestibular schwannomas and facial nerve neuromas. Five patients had their tumors surgically removed, while 1 patient, who did not have facial problems, was followed up with a wait-and-scan approach. RESULTS All patients had a presurgical diagnosis of cavernous hemangioma of the IAC, which was confirmed pathologically in the 5 patients who underwent surgical removal of the tumor. The translabyrinthine approach was used to remove the tumor in 4 patients, while the middle cranial fossa approach was used in the 1 patient who still had functional hearing. Tumors adhered to cranial nerves VII and/or VIII and were difficult to dissect from nerve sheaths during surgeries. Complete hearing loss occurred in all 5 patients. In 3 patients, the facial nerve could not be separated from the tumor, and primary end-to-end anastomosis was performed. Intact facial nerve preservation was achieved in 2 patients. Patients were followed up for at least 1 year after treatment, and MRI showed no evidence of tumor regrowth. All patients experienced some level of recovery in facial nerve function. CONCLUSIONS Cavernous hemangioma of the IAC can be diagnosed preoperatively through analysis of clinical features and neuroimaging. Early surgical intervention may preserve the functional integrity of the facial nerve and provide a better outcome after nerve reconstruction. However, preservation of functional hearing may not be achieved, even with the retrosigmoid or middle cranial fossa approaches. The translabyrinthine approach seems to be the most appropriate approach overall, as the facial nerve can be easily located and reconstructed.

Operative management of tumors involving the cavernous sinus

1986 ◽  
Vol 64 (6) ◽  
pp. 879-889 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Aage R. Møller
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Preoperative Evaluation ◽  
Operative Procedure ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Petrous Apex ◽  
Content Type ◽  
The Third ◽  
Fine Print

✓ In the past, neurosurgeons have been reluctant to operate on tumors involving the cavernous sinus because of the possibility of bleeding from the venous plexus or injury to the internal carotid artery (ICA) or the third, fourth, or sixth cranial nerves. The authors describe techniques for a more aggressive surgical approach to neoplasms in this area that are either benign or locally confined malignant lesions. During the last 2 years, seven tumors involving the cavernous sinus have been resected: six totally and one subtotally. The preoperative evaluation included axial and coronal computerized tomography, cerebral angiography, and a balloon-occlusion test of the ICA. Intraoperative monitoring of the third, fourth, sixth, and seventh cranial nerves was used to assist in locating the nerves and in avoiding injury to them. The first major step in the operative procedure was to obtain proximal control of the ICA at the petrous apex and distal control in the supraclinoid segment. The cavernous sinus was then opened by a lateral, superior, or inferior approach for tumor resection. Temporary clipping and suture of the ICA was necessary in one patient. None of the patients died or suffered a stroke postoperatively. Permanent trigeminal nerve injury occurred in three patients; in two, this was the result of tumor invasion. One patient suffered temporary paralysis of the third, fourth, and sixth cranial nerves, and in another the sixth cranial nerve was temporarily paralyzed. Preoperative cranial nerve deficits were improved postoperatively in three patients. Radiation therapy was administered postoperatively to four patients. These seven patients have been followed for 6 to 18 months to date and none has shown evidence of recurrence of the intracavernous tumor.

scholarly journals Receptors and afferents of the third, fourth, and sixth cranial nerves

1910 ◽  
Vol 82 (557) ◽  
pp. 450-457 ◽  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Nerve Fibres ◽  
Sixth Cranial Nerve ◽  
The Third ◽  
The Brain

The view generally accepted regarding the functions of the third, fourth, and sixth cranial nerve pairs is that they are purely motor. Certain experiments and observations made by one of us and published some years ago threw doubt, however, on this belief. It was then shown that severance of the third or fourth or sixth nerves at origin from the brain produces degeneration of practically all the nerve-fibres of the respective muscles innervated by those nerves and of the receptive endorgans with which those muscles are, as was shown, plentifully supplied.

scholarly journals Cranial nerve involvement: its role in intracranial tuberculosis

2020 ◽  
Vol 9 (1) ◽  
pp. 196
Author(s):  
Baiakmenlang Synmon ◽  
Ashok Kayal
Keyword(s):  
Neurological Deficit ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Pulmonary Involvement ◽  
Severe Form ◽  
P Value ◽  
Cranial Nerve Involvement ◽  
Tubercular Meningitis ◽  
Focal Neurological Deficit ◽  
Nerve Involvement

Background: Tubercular meningitis is the most severe form of extra pulmonary involvement. Lack of specific and sensitive test calls for a multi-displinary and combined approach to make the diagnosis at the earliest. Various factors guide us to the etiology of meningoencephalitis but cranial nerve involvement has the highest predictive value.Methods: A prospective study from August 2013 to September 2015 carried in GMCH, Guwahati where 93 patients of intracranial tuberculosis was included.Results: This present   study comprised of 36 females (38.7%) and 57 males (61.3%) with a mean age of   32.3±17.05 and a range of 2-72 years. The typical clinicalfeatures of meningitis was found in 78.6%. Focal neurological deficit and cranial nerve involvement was seen in 40 (43%) and 58 (62.4%) respectively. Among the cranial nerves (CN), the most commonly involved is the 2nd CN seen in 33 (35.5%), followed by 6th (16.1%), 7th (11.8%), 3rd (7.5%), 8th (3.2%), 9th  and 10th, (2.2%) 4th (1.1%) and 5th (1.1%). Six patients developed visual loss and two patients hearing loss as sequelae. The presence of cranial nerve involvement and focal neurological deficit was shown to be associated with a poor prognosis (p value=0.04**, significant; Fisher’s exact test).Conclusions: Bedside clinical examination of patients of meningoencephalitis to detect cranial nerve involvement will definitely help us with the diagnosis and prognosis of tubercular meningitis.

scholarly journals A UNIQUE CASE OF BILATERAL VOCAL FOLD PARALYSIS FOLLOWING SPINAL ANAESTHESIA

2020 ◽  
Vol 3 ◽  
pp. 3-5
Author(s):  
Manasij Mitra ◽  
Nupur Biswas ◽  
Kumar Shailendra ◽  
Anil Chandra Jain ◽  
Maitraye Basu
Keyword(s):  
Spinal Anaesthesia ◽  
Cranial Nerve ◽  
Vocal Fold ◽  
Case Reports ◽  
Cranial Nerves ◽  
Trochanteric Fracture ◽  
Vocal Fold Paralysis ◽  
Cranial Nerve Palsies ◽  
Bilateral Vocal Fold Paralysis ◽  
History Of

Cranial nerve palsies are potential but rare complications of spinal anaesthesia. Most of the literatures support upper cranial nerve palsies like VI, IV and III cranial nerve palsies. Intrathecal hypotension resulting in tractional injury of the cranial nerves is the likely mechanism of injury. As on date, some cases of unilateral vocal fold paralysis and very little bilateral vocal fold paralysis have been described in case reports. We have described a patient who developed hoarseness and dysphagia 7 days after receiving spinal anaesthesia for fixation of inter-trochanteric fracture femur. The patient was diagnosed with bilateral vocal fold paralysis. He was managed conservatively and exhibited complete spontaneous recovery as has been described in the previously reported cases. Any patient presenting with idiopathic vocal fold paralysis should be enquired about the history of spinal or epidural anaesthesia. If the history is affirmative, then it points towards transient intrathecal hypotension as a potential etiology of the cranial nerve palsy.

Reconstruction of the third through sixth cranial nerves during cavernous sinus surgery

1992 ◽  
Vol 76 (6) ◽  
pp. 935-943 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Giuseppe Lanzino ◽  
Chandra N. Sen ◽  
Spiros Pomonis
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Recovery Of Function ◽  
Cranial Nerves ◽  
Sinus Surgery ◽  
Content Type ◽  
The Third ◽  
Successful Recovery ◽  
Cranial Nerve Function ◽  
Fine Print

✓ Sixteen reconstruction procedures of the third through sixth cranial nerves were carried out in 14 patients during operations on 149 tumors involving the cavernous sinus. A direct end-to-end anastomosis was performed in five nerves, whereas in 11 cases the nerve stumps were bridged by means of an interposing nerve graft. The sixth cranial nerve was most frequently reconstructed (nine cases). In four cases, the fifth nerve or root was repaired. The third nerve was reconstructed in two patients, and the fourth nerve was repaired in only one case. Recovery of function, either partial or complete, was observed in 13 nerves: the third in two instances, the fourth in one, the fifth in three, and the sixth in seven. No return of function occurred in three nerves. In patients with a successful recovery of cranial nerve function, either binocular function or the cosmetic result was improved. These results suggest that repair of the third through sixth cranial nerves injured during surgery should be pursued in suitable patients.

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