Left suboccipital supracerebellar transtentorial approach for resection of tectal cavernous malformation

2019 ◽  
Vol 1 (2) ◽  
pp. V19
Author(s):  
Hussam Abou-Al-Shaar ◽  
Timothy G. White ◽  
Ivo Peto ◽  
Amir R. Dehdashti
Keyword(s):  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Entry Zone ◽  
Third Nerve Palsy ◽  
History Of ◽  
Tectal Plate ◽  
The Right ◽  
Transtentorial Approach ◽  
Third Nerve

A 64-year-old man with a midbrain cavernoma and prior bleeding presented with a 1-week history of diplopia, partial left oculomotor nerve palsy, and worsening dysmetria and right-sided weakness. MRI revealed a hemorrhagic left tectal plate and midbrain cavernoma. A left suboccipital supracerebellar transtentorial approach in the sitting position was performed for resection of his lesion utilizing the lateral mesencephalic sulcus safe entry zone. Postoperatively, he developed a partial right oculomotor nerve palsy; imaging depicted complete resection of the cavernoma. He recovered from the right third nerve palsy, weakness, and dysmetria, with significant improvement of his partial left third nerve palsy.The video can be found here: https://youtu.be/ofj8zFWNUGU.

Functional anatomy of headache: circle of Willis aneurysms, third cranial nerve and pain

2011 ◽  
pp. 82-88
Author(s):  
Marcelo Moraes Valença ◽  
Luciana P. A. Andrade-Valença ◽  
Carolina Martins
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Functional Anatomy ◽  
Circle Of Willis ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Microsurgical Anatomy ◽  
Third Nerve Palsy ◽  
The Right ◽  
Third Nerve

Patients with intracranial aneurysm located at the internal carotid artery-posterior communicating artery (ICA-PComA) often present pain on the orbit or fronto-temporal region ipsilateral to the aneurysm, as a warning sign a few days before rupture. Given the close proximity between ICA-PComA aneurysm and the oculomotor nerve, palsy of this cranial nerve may occurduring aneurysmal expansion (or rupture), resulting in progressive eyelid ptosis, dilatation of the pupil and double vision. In addition, aneurysm expansion may cause compression not only of the oculomotor nerve, but of other skull base pain-sensitive structures (e.g. dura-mater and vessels), and pain ipsilateral to the aneurysm formation is predictable. We reviewed the functional anatomy of circle of Willis, oculomotor nerve and its topographical relationships in order to better understand the pathophysiology linked to pain and third-nerve palsy caused by an expanding ICAPComA aneurysm. Silicone-injected, formalin fixed cadaveric heads were dissected to present the microsurgical anatomy of the oculomotor nerve and its topographical relationships. In addition, the relationship between the right ICA-PComA aneurysm and the right third-nerve is also shown using intraoperative images, obtained during surgical microdissection and clipping of an unruptured aneurysm. We also discuss about when and how to investigate patients with headache associated with an isolated third-nerve palsy.

scholarly journals Post traumatic isolated ipsilateral oculomotor nerve palsy

2019 ◽  
pp. 188-190
Author(s):  
Praveen Kumar ◽  
Sharad Pandey ◽  
Kulwant Singh ◽  
Mukesh Sharma ◽  
Prarthana Saxena
Keyword(s):  
Subdural Hematoma ◽  
Nerve Palsy ◽  
Chronic Subdural Hematoma ◽  
Oculomotor Nerve Palsy ◽  
Rare Presentation ◽  
Third Nerve Palsy ◽  
Common Causes ◽  
History Of ◽  
Post Traumatic ◽  
Third Nerve

The common causes of isolated third nerve palsy are microvascular infarction, intracranial aneurysm, diabetes, hypertension and atherosclerosis. Here we are presenting a case of 26-year female presenting with a history of head injury two months back. She presented with ptosis on the left side. On computed tomography, a large left-sided chronic subdural hematoma with significant midline shift was found. Isolated ipsilateral third nerve palsy is a rare presentation with unilateral chronic subdural hematoma. Improvement in ptosis after surgery indicate a good neurological outcome.

scholarly journals Oculomotor schwannoma causing a progressive complete third-nerve palsy

2019 ◽  
Vol 12 (8) ◽  
pp. e230272
Author(s):  
Emily Bentley ◽  
Ronak Ved ◽  
Caroline Hayhurst
Keyword(s):  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Mri Findings ◽  
Gadolinium Contrast ◽  
Management Options ◽  
Third Nerve Palsy ◽  
History Of ◽  
Suprasellar Cistern ◽  
Third Nerve

A 69-year-old woman presented with an 8-month history of diplopia and examination findings consistent with a right third-nerve palsy. Head MRI identified the presence of a 5.8 mm, nodular, isointense lesion in the suprasellar cistern, which demonstrated enhancement with gadolinium contrast. The lesion did not show any evidence of growth over a 3-month follow-up period. These MRI findings, alongside the clinical features, suggest oculomotor nerve schwannoma. Oculomotor schwannomas are a rare cause of third-nerve palsy. The presenting features and management options for oculomotor schwannomas are discussed to provide a framework for the diagnosis and management of these patients.

scholarly journals Early Endovascular Management of Oculomotor Nerve Palsy Associated with Posterior Communicating Artery Aneurysms

2010 ◽  
Vol 16 (1) ◽  
pp. 17-21 ◽  
Author(s):  
A. Santillan ◽  
W.E. Zink ◽  
J. Knopman ◽  
H.A. Riina ◽  
Y.P. Gobin
Keyword(s):  
Nerve Palsy ◽  
Clinical Presentation ◽  
Endovascular Embolization ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Endovascular Management ◽  
Third Nerve Palsy ◽  
The Third ◽  
Third Nerve

Palsy of the third cranial nerve (oculomotor nerve, CNIII) is a well-known clinical presentation of posterior communicating artery (P-com) aneurysm. We report a series of 11 patients with partial or complete third nerve palsy secondary to P-com aneurysm. All were treated with endovascular embolization within seven days of symptom onset. Third nerve palsy symptoms resolved in 7/11 (64%), improved in 2/11 (18%) and did not change in 2/11 (18%) patients

Aberrant regeneration in idiopathic oculomotor nerve palsy

1980 ◽  
Vol 52 (6) ◽  
pp. 854-856 ◽  
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.

scholarly journals Pituitary Apoplexy Causing Compression of Third Cranial Nerve—Management

2019 ◽  
Vol 08 (02) ◽  
pp. 119-122
Author(s):  
Václav Masopust
Keyword(s):  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Clinical Symptoms ◽  
Rapid Development ◽  
Sella Turcica ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Future Research ◽  
Third Nerve Palsy ◽  
Increased Pressure

AbstractLesions of the oculomotor nerve as the first sign of pituitary adenoma are rare. The cause of such lesions without other clinical symptoms is discussed in this study. A small cohort of 4 patients (3.1%) with oculomotor nerve palsy (third nerve palsy) as the only neurologic deficit, from 129 patients who got operated upon for pituitary adenomas, is presented. In this group (mean age: 55 years, range: 36–65 years), all patients (two women and two men) underwent surgery. In two cases, there was arrested pneumatization and thickened bone. In the remaining two cases, a macroscopically visible, very solid opaque diaphragm was present, after the removal of the tumor and thickened bone. Complete adjustment was observed in all patients within 1 week after the surgery. Two factors that seem to increase the high risk for the development of oculomotor nerve palsy are that the cavernous sinus may be the only weak structure surrounding the sella turcica when the diaphragm and bone are thickened; and the rapid development of increased pressure in this region. The increased pressure on the cavernous sinus during the anatomical variations is the primary cause for lesions on the oculomotor nerve. However, this conjecture cannot be statistically demonstrated because of the small number of cases. Future research should be conducted on larger samples to increase statistical inference and generalizability.

Upper basilar artery aneurysms: oculomotor outcomes in 163 cases

2005 ◽  
Vol 102 (3) ◽  
pp. 482-488 ◽  
Author(s):  
Hisham Al-Khayat ◽  
Haitham Al-Khayat ◽  
Jonathan White ◽  
David Manner ◽  
Duke Samson
Keyword(s):  
Basilar Artery ◽  
Nerve Palsy ◽  
Arterial Occlusion ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Stepwise Logistic Regression ◽  
Categorical Data Analysis ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The purpose of this study was to identify factors predictive of postoperative oculomotor nerve palsy among patients who undergo surgery for distal basilar artery (BA) aneurysms. The data can be used to estimate preoperative risk in this population. The natural history of oculomotor nerve palsy in patients with good outcomes is also defined. Methods. The cases of 163 patients with distal BA aneurysms, who were treated surgically between 1996 and 2002, were retrospectively studied to identify factors contributing to oculomotor nerve palsy. After the data had been collected, stepwise logistic regression procedures were used to determine the predictive effects of each variable on the development of oculomotor nerve palsy and to create a scoring system. Factors that interfered with resolution of oculomotor dysfunction in patients with good outcomes were also studied. Postoperative oculomotor nerve palsy occurred in 86 patients (52.8%) with distal BA aneurysms. The following factors were associated with postoperative oculomotor dysfunction, as determined by a categorical data analysis: 1) younger patient age (p < 0.001); 2) poor admission Hunt and Hess grade (p < 0.001); 3) use of temporary arterial occlusion (p < 0.001); 4) poor Glasgow Outcome Scale score (p < 0.001); and 5) the presence of a BA apex aneurysm that projected posteriorly (p < 0.001). For patients with good outcomes, postoperative oculomotor nerve palsy resolved completely within 3 months in 31 patients (52%) and within 6 months in 47 patients (80%). The projection of the BA aneurysm was associated with incomplete oculomotor recovery at 6 months postoperatively (p = 0.019). Conclusions. The results of this study can help identify patients with a high risk for the development of oculomotor nerve palsy. This may help neurosurgeons in preoperative planning and discussions.

scholarly journals Case of Periodic Oculomotor Nerve Palsy

2020 ◽  
Vol V (1) ◽  
pp. 107-114
Author(s):  
G. A. Klyachkin
Keyword(s):  
Nerve Palsy ◽  
Russian Literature ◽  
Periodic Paralysis ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Foreign Literature ◽  
History Of

Periodically recurring paralysis of the oculomotor nerve (migraine ophthalmoplegique French authors) is not often observed. In foreign literature, I managed to collect 24 cases, and in Russian literature, as far as I know, there is only one observation by prof. L.O.Darkshevich. In view of this, I think it is interesting to give a brief history of the illness of one patient, in whom, during the last day, I observed periodic paralysis of the oculomotor nerve

scholarly journals ISOLATED OCULOMOTOR NERVE PALSY

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Melissa T. E. Ratag ◽  
Ralf R Pangalila
Keyword(s):  
Ct Scan ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Uncontrolled Hypertension ◽  
Oculomotor Nerve Palsy ◽  
Relative Afferent Pupillary Defect ◽  
Primary Position ◽  
Normal Limits ◽  
The Right ◽  
Per Oral

Abstract: We reported a case of a 59-year-old male who came to the hospital with the chief complaint of a droopy upper right eyelid originating a month before, accompanied by diplopia. This patient was also suffering from uncontrolled hypertension. The ophthalmologic examination of the right eye showed a best corrected visual acuity (BCVA) of 1.0. In the primary position there was a deviation to the temporal side; limitations on elevation, adduction, and depression; and an endorotation on nasal down gaze. The aberrant regenerative trigeminal nerve was noticed, but the relative afferent pupillary defect (RAPD) was not found. The anterior and posterior segments of the right eye were normal. Laboratory tests were within normal limits and the CT-scan did not show any abnormality. Conclusion: Based on all the tests performed, the diagnosis of the patient was an isolated oculomotor nerve palsy of the right eye. The patient was treated with a non-steroid anti inflammatory drug and a neurotropic vitamine, and had to be observed for three months. Keywords: palsy, oculomotor nerve, right eye.   Abstrak: Kami melaporkan kasus seorang laki-laki berusia 59 tahun dengan keluhan utama kelopak mata atas kanan tertutup sejak satu bulan lalu, disertai diplopia. Dalam anamnesis ditemukan adanya riwayat hipertensi sedangkan riwayat trauma tidak ada. Pemeriksaan oftalmologi mata kanan didapatkan tajam penglihatan 6/6, pergerakan bola mata kanan tampak sedikit deviasi ke temporal pada posisi primer, serta keterbatasan dalam elevasi, aduksi, dan depresi. Mata kanan tampak endorotasi saat melirik ke nasal bawah dan terdapat aberrant regenerative; relative afferent pupillary defect (RAPD) tidak ditemukan. Segmen anterior dan posterior dalam batas normal. Pemeriksaan laboratorium dan CT scan kepala dalam batas normal. Simpulan: Berdasarkan hasil pemeriksaan oftalmologik dan pemeriksaan penunjang ditegakkan diagnosis isolated oculomotor nerve palsy mata kanan yang ditangani dengan pemberian anti inflamasi non steroid dan neurotropik per oral sambil diobservasi selama tiga bulan. Kata kunci: kelumpuhan, saraf okulomotor, mata kanan.

Recurrent painful ophthalmoplegic neuropathy: a cause for recurrent third nerve palsy in a child

2021 ◽  
Vol 14 (11) ◽  
pp. e246179
Author(s):  
Jayakumari Nandana ◽  
Sruthi S Nair ◽  
Sachin Girdhar ◽  
Soumya Sundaram
Keyword(s):  
Nerve Palsy ◽  
Immunosuppressive Agents ◽  
Rare Condition ◽  
Oculomotor Nerve ◽  
Third Nerve Palsy ◽  
Hunt Syndrome ◽  
Recurrent Painful Ophthalmoplegic Neuropathy ◽  
Third Nerve

Recurrent painful ophthalmoplegic neuropathy (RPON), previously called ophthalmoplegic migraine, is a rare condition characterised by recurrent episodes of headache and ophthalmoplegia. We report a case of 11-year-old girl with recurrent painful ophthalmoplegia due to isolated right oculomotor nerve involvement. MR brain imaging showed enhancing lesion of cisternal segment of right oculomotor nerve. A possibility of Tolosa Hunt syndrome was considered and she was treated with glucocorticoids, followed by azathioprine due to recurrence. In the fourth episode, she developed migraine headache followed by right third nerve palsy, after which the diagnosis was revised to RPON. She was started on flunarizine along with short-term glucocorticoids. At 1-year follow-up, she remained asymptomatic. RPON should be considered in patients with recurrent third nerve palsy to avoid inadvertent long-term exposure to immunosuppressive agents.

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