Microsurgical removal of previously placed aneurysm clips and application of new clips for recurrent cerebral aneurysms

2007 ◽  
Vol 107 (4) ◽  
pp. 881-883 ◽  
Author(s):  
Hiroshi Kashimura ◽  
Kuniaki Ogasawara ◽  
Yoshitaka Kubo ◽  
Yasunari Otawara ◽  
Akira Ogawa
Keyword(s):  
Nerve Palsy ◽  
Cerebral Aneurysms ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Motor Weakness ◽  
Aneurysm Clip ◽  
Aneurysm Neck ◽  
Present Technique ◽  
Long Time ◽  
Gentle Pressure

✓ A technique is described for removing previously placed aneurysm clips and applying new aneurysm clips for the treatment of regrown or reruptured cerebral aneurysms in patients more than 10 years after the original clipping of the aneurysm neck. The adherent tissue covering previously placed clips is cut just on and alongside the clips themselves using a small scalpel. Using the clip applicator, gentle pressure is applied to open the clip blade as little as possible. The aneurysm clip is carefully slid out along the line where the clip blade has resided, and a new aneurysm clip is applied. The procedure was successfully accomplished in four patients. Whereas three of these patients had an uneventful postoperative course, the remaining patient experienced transient right oculomotor nerve palsy and left-sided motor weakness. The present technique is a useful procedure for treatment of regrown or reruptured cerebral aneurysms occurring a significantly long time after initial clipping of an aneurysm neck.

Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery

2012 ◽  
Vol 117 (5) ◽  
pp. 904-910 ◽  
Author(s):  
Erdem Güresir ◽  
Patrick Schuss ◽  
Volker Seifert ◽  
Hartmut Vatter
Keyword(s):  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Surgical Strategy ◽  
Oculomotor Nerve Palsy ◽  
Aneurysm Neck ◽  
Nerve Decompression ◽  
Full Resolution ◽  
Current Series ◽  
Aneurysm Dissection

Object Resolution of oculomotor nerve palsy (ONP) after clipping of posterior communicating artery (PCoA) aneurysms has been well documented. However, whether additional decompression of the oculomotor nerve via aneurysm sac dissection or resection is superior to pure aneurysm clipping is the subject of much debate. Therefore, the objective in the present investigation was to analyze the influence of surgical strategy—specifically, clipping with or without aneurysm dissection—on ONP resolution. Methods Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured PCoA aneurysms causing ONP were treated at the authors' institution. Oculomotor nerve palsy was evaluated on admission and at follow-up. The electronic database MEDLINE was searched for additional data in published studies of PCoA aneurysms causing ONP. Two reviewers independently extracted data. Results Overall, 8 studies from the literature review and 6 patients in the current series (121 PCoA aneurysms) met the study inclusion criteria. Ninety-four aneurysms were treated with simple aneurysm neck clipping and 27 with clipping plus aneurysm sac decompression. The surgical strategy, simple aneurysm neck clipping versus clipping plus oculomotor nerve decompression, had no effect on full ONP resolution on univariate (p = 0.5) and multivariate analyses. On multivariate analysis, patients with incomplete ONP at admission were more likely to have full resolution of the palsy than were those with complete ONP at admission (p = 0.03, OR = 4.2, 95% CI 1.1–16). Conclusions Data in the present study indicated that ONP caused by PCoA aneurysms improves after clipping without and with oculomotor nerve decompression. The resolution of ONP is inversely associated with the initial severity of ONP.

Oculomotor nerve palsy in patients with cerebral aneurysms

1989 ◽  
Vol 12 (2) ◽  
pp. 125-132 ◽  
Author(s):  
Shigeru Fujiwara ◽  
Kiyotaka Fujii ◽  
Shunji Nishio ◽  
Toshio Matsushima ◽  
Masashi Fukui
Keyword(s):  
Nerve Palsy ◽  
Cerebral Aneurysms ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy

Pituitary Apoplexy Presenting as Isolated Oculomotor Nerve Palsy

2007 ◽  
Vol 41 (4) ◽  
pp. 246
Author(s):  
Moon Seok Yang ◽  
Won Ho Cho ◽  
Seung Heon Cha
Keyword(s):  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy

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.

scholarly journals T cell acute lymphoblastic leukaemia presenting with sudden onset right oculomotor nerve palsy with normal neuroradiography and cerebrospinal fluid studies

2012 ◽  
Vol 2012 (mar26 1) ◽  
pp. bcr0120125685-bcr0120125685
Author(s):  
V. R. Bhatt ◽  
M. Naqi ◽  
R. Bartaula ◽  
S. Murukutla ◽  
S. Misra ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
T Cell ◽  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Nerve Palsy ◽  
Sudden Onset ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy

Oculomotor Nerve Palsy Due To Posterior Communicating Artery Aneurysm: Clipping vs Coiling

2021 ◽  
Author(s):  
Alexandrina S. Nikova ◽  
Georgios S Sioutas ◽  
Katerina Sfyrlida ◽  
Grigorios Tripsianis ◽  
Michael Karanikas ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Artery Aneurysm ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Aneurysm Clipping ◽  
Posterior Communicating Artery Aneurysm

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.

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