Complete Oculomotor Nerve Palsy Research Articles

Surgical management of oculomotor nerve palsy: a comparison of lateral rectus deactivation combined with either medial rectus resection or medial rectus fixation to the medial palpebral ligament

PurposeTo analyze and compare the outcome of two different surgical procedures in patients with complete oculomotor nerve palsy with large-angle exotropia. MethodsThe medical records of patients with total oculomotor nerve palsy and large-angle exotropia operated on at a single center from January 2006 to June 2020 were reviewed retrospectively. One group underwent lateral rectus deactivation with medial rectus resection (resection group); the other group underwent lateral rectus deactivation with medial rectus fixation to the medial palpebral ligament (fixation group). Surgical outcomes on the first postoperative day and at 6 months postoperatively were analyzed, including alignment and postoperative complications. All statistical analyses were performed using STATA version 14. A P value of <0.05 was considered significant. ResultsA total of 35 patients were included. There was a trend toward greater surgical success in the fixation group (93%) than in the resection group (65%), but these results were not statistically significant. Postoperative exotropic drifts were noted in both the procedures but tended to be more with patients in the resection group. Postoperative complications were noted only in the fixation group. ConclusionsLateral rectus deactivation with medial rectus fixation to the medial palpebral ligament requires more time and greater surgical expertise but appears to better prevent postoperative exotropic drift compared with lateral rectus deactivation combined with medial rectus resection.

A case of pituitary apoplexy presented with isolated complete oculomotor nerve palsy

The oculomotor nerve (CN3) innervates four extra-ocular muscles and contains parasympathetic fibers controlling pupillary light reflex (PLR). CN3 palsy with impaired PLR or complete CN3 palsy usually suggests a compressive lesion against the CN3 because the parasympathetic fibers located superficially on the cranial nerve trunk are affected. A cerebral aneurysm originated from posterior communicating artery, posterior cerebral artery or superior cerebellar artery is a common cause of isolated complete CN 3 palsy. Here, we reported a less common intracranial lesion causing isolated complete CN3 palsy for which the preceding recurrent temporal headaches before the CN3 palsy assisted the neurological localization.

Strategies for managing strabismus from oculomotor nerve palsy

Addressing ocular misalignment secondary to partial and complete oculomotor nerve palsy presents a special challenge to the strabismus surgeon, particularly when treating patients with binocular diplopia. We review the reported surgical options and, through illustrative cases, provide our own perspective on managing this disorder.

Efficacy and long-term results of endovascular embolization and surgical clipping for posterior communicating artery unruptured aneurysms complicated with oculomotor nerve palsy.

This study aimedto investigate the efficacy and long-term outcomes of endovascular embolization and surgical clipping for patients with posterior communicating artery unruptured aneurysms (PcomAs) concomitant with oculomotor nerve palsy (ONP). No significant (P > .05) difference existed in the age, gender, proportion of complete ONP, and size of eye fissure and pupil before treatment between 2 groups. After compared with before treatment, the eye fissure was widened significantly (P < .05) and the pupil narrowed significantly (P < .05), but no significant (P > .05) differences existed between the 2 groups. Complete ONP recovery was observed in 32 (80%) patients in the embolization group and 31 (77.5%) in the microsurgical group, partial ONP recovery occurred in 6 (15%) in the embolization group and 8 (20%) in the microsurgical group. The recovery rate was 95% in the embolization group and 97.5% in the microsurgical group, with no significant (P > .05) difference between 2 groups. The recovery rate of the ONP was significantly (P < .01) greater in the microsurgical group than that in the embolization group at follow-up of 1 month, 3 months, six and 12 months, respectively. At 18 months, the ONP recovery rate was not significantly different between 2 groups (95% vs 97.5%) Surgical clipping may have a faster effect on the recovery of oculomotor nerve palsy than endovascular embolization for patients with posterior communicating artery unruptured aneurysms complicated with oculomotor nerve palsy, but both approaches may result in a similar effect on the nerve recovery in the long run.Eighty patients treated with endovascular embolization or surgical clipping were retrospectively enrolled into the endovascular embolization group or surgical clipping and analyzed.

Sudden vision loss and neurological deficits after facial hyaluronic acid filler injection

BackgroundThe ongoing expansion of the cosmetic armamentarium of facial rejuvenation fails to uncover the inherent risks of cosmetic interventions. Informed consent to all risks of cosmetic filler injections and potential sequelae, including ocular and neurological complications, should be carefully ensured. We present two cases of complications following facial hyaluronic acid filler injections.Case presentationsCase 1: A 43-year-old woman presented with monocular vision loss of the left eye, associated ptosis, ophthalmoplegia, periocular pain and nausea, cutaneous changes of the glabella region and forehead, and sensory impairment in the left maxillary branch dermatome (V2) after receiving a hyaluronic acid (HA) filler injection into the left glabellar area. On ophthalmological examination, an ophthalmic artery occlusion (OAO) was diagnosed upon identification of a “cherry-red spot”. Magnetic resonance imaging (MRI) revealed a left ischemic optic neuropathy. Supportive therapy and hyaluronidase injections were initiated. A follow-up MRI of the head performed two months after presentation corresponded to stable MRI findings. The patient had irreversible and complete vision loss of the left eye, however, the ptosis resolved.Case 2: A 29-year-old woman was admitted to hospital a few hours after a rhinoplasty and cheek augmentation with hyaluronic acid, presenting with acute monocular vision loss in the right eye, retrobulbar pain, fatigue and vomiting. In addition, the patient presented a harbinger of impending skin necrosis and a complete oculomotor nerve palsy on the right side, choroidal ischemia and vision impairment. Supportive treatment and hyaluronidase injections into the ischemic tissue were initiated. A small scar at the tip of the nose, vision impairment and an irregular pupillary margin on the right side persisted at follow-up.ConclusionThese two case reports and the literature review emphasize the pathophysiological mechanisms leading to potentially devastating complications. In order to reduce the risk of vision loss secondary to cosmetic filler injections, practitioners should possess a thorough knowledge of anatomy and preventive strategies.

Predictors of complete recovery of oculomotor nerve palsy induced by posterior communicating artery aneurysms in patients aged eighteen to sixty

ObjectiveTo explore prognostic factors of complete recovery of oculomotor nerve palsy (ONP) induced by posterior communicating artery aneurysm (PcomAA). MethodPcomAA patients aged 18–60 years combined with ONP who underwent surgical clipping or endovascular embolization at our institution between January 2014 and January 2020 were enrolled. Characteristics included maximum diameter of aneurysm, width of aneurysm, subarachnoid hemorrhage (SAH), duration of ONP, age, sex, ONP type, treatment method were compared. Based on the recovery of ONP, patients were separated into two groups: complete recovery group, partial and no recovery group. Analyzing by univariate and multivariate logistic regressions to identify the independent prognostics for complete ONP recovery. We established a score based on these prognostics. Receiver operating characteristics (ROC) were conducted to under the performance of the predictors and score. ResultsFinally, ONP type (OR 6.457 95% CI 1.664–25.052, p = 0.007), treatment method (OR 5.051, 95% CI 1.332–19.158, p = 0.017), and interval to treatment ≤2 weeks (OR 25.601 95% CI 6.222–105.340, p < 0.001) were independent predictors of complete ONP recovery. The score had an area under the curve (AUC) value of 0.870. We defined that the score higher than 5 points as easier to achieve complete ONP recovery, and the AUC value of this definition was 0.821. ConclusionsFor ONP induced by PcomAA in patients aged 18–60 years, the best prognostic factor for complete ONP recovery was timely treatment. The ONP type and treatment methods were correlated with complete ONP recovery.

Complete third nerve oculomotor nerve palsy as initial presentation of pituitary tuberculosis

Complete third nerve oculomotor nerve palsy as initial presentation of pituitary tuberculosis

Surgical management of persistent post-traumatic trans-tentorial brain hernia

IntroductionTemporal engagement may persist after etiologic surgical treatment of acute subdural hematoma (ASH) without clinical improvement despite normalized intracranial pressure (ICP). The aim of this study was to assess the feasibility of secondary direct temporal lobe disengagement (DTLD) after surgery for supratentorial ASH and to evaluate clinical outcome. Materials and methodsThis was a retrospective analysis of 4 patients undergoing secondary DTLD. Patient data were recorded at admission, pre- and postoperatively and at 6months’ follow-up (FU): age, gender, Rotterdam score, Glasgow Coma Scale (GCS), neurological deficits, oculomotor nerve palsy (ONP), ICP, midline shift, complications and Extended Glasgow Outcome Scale (GOS-E). ResultsAt postoperative evaluation 48h after DTLD, we observed a significant improvement in GCS score (initial 6±3, preoperative 7±3, postoperative 14±1; P=0.02), midline shift (initial 16±3mm, preoperative 13±5mm, postoperative 9±2mm; P=0.049) and ONP (P=0.01). In all cases, early postoperative imaging documented visualization of a patent ipsilateral peri-mesencephalic cistern. At 6-month FU, GOS-E showed 75% good recovery and 25% disability. Complete ONP recovery was observed in 75% of patients (P=0.01). Neurological deficits were present at FU in 25% of patients. No surgery-related complications or mortality were recorded. ConclusionsIn traumatic brain injury, secondary DTLD may allow simple, effective and safe management of trans-tentorial uncal herniation, avoiding more challenging procedures. Clinical results are promising, as this technique seems to favorably influence neurological outcome in this selected subgroup of patients with persistent clinical and radiological signs of temporal engagement after etiological treatment with normal ICP values.

Clipping versus coiling for the treatment of oculomotor nerve palsy induced by posterior communicating artery aneurysms: A comparison of effectiveness.

BackgroundA long debate has been going on in the clinical effectiveness to determine whether surgical clipping or coiling more favorable for oculomotor nerve palsy (ONP) caused by PcomAA. We aimed to perform a study, focusing on the effectiveness of ONP induced by PcomAA after treatment of surgical clipping and endovascular coiling.MethodPotential studies were searched on PubMed, EMBASE, Web of Science, and Cochrane Library from database inception to February 2021, and STATA version 12.0 was exerted to process the pooled data.ResultsA total of 16 articles are included in the study, hailing from the United States, South Korea, the United Kingdom, France, Germany, Korea, China, Japan, Britain, and Singapore. The results showed that the clipping group was related to a higher incidence of complete ONP recovery at follow‐up (OR = 5.808, 95% CI 2.87 to 11.76, p < 0.001), the lower rates of partial ONP recovery (OR = 0.264, 95% CI 0.173 to 0.402, p < .001) and no improvement of ONP at follow‐up (RD = –0.149, 95% CI –0.247 to –0.051, p = .003). In the subgroup of complete ONP recovery based on the condition of patients, clipping was associated with a higher incidence of complete ONP recovery in patients with the incomplete initial ONP (OR = 3.579, p = .020) and ruptured aneurysm (OR = 5.38, p = .020). Regarding the subgroup of complete ONP recovery based on the quality of studies, similar results also appeared.ConclusionSurgical clipping was more favorable to the recovery from ONP caused by PcomAA endovascular coiling due to a higher rate of recovery and recovery degree of ONP. Besides that, more evidence‐based performance is necessary to supplement this opinion.

Enhanced adjustable nasal transposition of split lateral rectus muscle for surgical management of oculomotor nerve palsy

Lateral rectus transposition to the medial rectus muscle has recently generated interest in the management of oculomotor nerve palsy. We report 4 cases of complete oculomotor nerve palsy with a large-angle exotropia that were treated with a modified adjustable nasal transposition of the split lateral rectus muscle. Forced duction testing for the lateral rectus muscle showed good adduction in all 4cases. Postoperative alignment within 10Δ in straight-ahead gaze was achieved in all 4 cases; adjustment was required in 2 cases.

Oculomotor Nerve Palsy that Developed after Endovascular Treatment in an Acute Stroke Patient with a Dissecting Occlusion of the Extracranial Internal Carotid Artery

Oculomotor nerve palsy is underrecognized clinical manifestation of extracranial internal carotid artery (ICA) dissection. Herein we report a case of complete oculomotor nerve palsy following endovascular revascularization, which developed in a patient with acute stroke due to extracranial ICA dissecting occlusion. We also discuss about the development mechanism of oculomotor nerve palsy, considering the vascular anatomy and the possibility of periprocedural complications during endovascular treatment.

Complete third nerve palsy as a presenting feature of an interpeduncular lipoma

Background Intracranial lipomas are rare, benign lesions, of congenital origin commonly found incidentally on imaging studies. Methods We describe a case of interpeduncular lipoma in an 18 year-old female presenting with a painful left complete oculomotor (IIIrd) nerve palsy and associated headache, which to the best of our knowledge has not been reported in an adult patient. Results Following eye patching and steroid treatment, at 6-week follow-up the patient’s pain had significantly improved however the complete IIIrd nerve palsy remained. Conclusions Evidence suggests improvement will occur regardless with conservative management independent of radiological changes to the lipoma.

Przyśrodkowa transpozycja włókien rozszczepionego mięśnia prostego bocznego w całkowitym porażeniu nerwu okoruchowego – opis przypadku

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Pelińska K, Ordon AJ, Loba P. Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy – a case study. Klinika Oczna / Acta Ophthalmologica Polonica. 2020;122(3):124-127. doi:10.5114/ko.2020.98653. APA Pelińska, K., Ordon, A. J., & Loba, P. (2020). Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy – a case study. Klinika Oczna / Acta Ophthalmologica Polonica, 122(3), 124-127. https://doi.org/10.5114/ko.2020.98653 Chicago Pelińska, Katarzyna, Agata J Ordon, and Piotr Loba. 2020. "Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy – a case study". Klinika Oczna / Acta Ophthalmologica Polonica 122 (3): 124-127. doi:10.5114/ko.2020.98653. Harvard Pelińska, K., Ordon, A., and Loba, P. (2020). Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy – a case study. Klinika Oczna / Acta Ophthalmologica Polonica, 122(3), pp.124-127. https://doi.org/10.5114/ko.2020.98653 MLA Pelińska, Katarzyna et al. "Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy – a case study." Klinika Oczna / Acta Ophthalmologica Polonica, vol. 122, no. 3, 2020, pp. 124-127. doi:10.5114/ko.2020.98653. Vancouver Pelińska K, Ordon A, Loba P. Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy – a case study. Klinika Oczna / Acta Ophthalmologica Polonica. 2020;122(3):124-127. doi:10.5114/ko.2020.98653.

Management of oculomotor nerve schwannoma: Systematic review of literature and illustrative case.

Background:Oculomotor nerve schwannoma (ONS) is an extremely rare intracranial benign tumor. Till date, there is no standard treatment of oculomotor schwannoma. Here, we present an illustrative case report of ONS, perform a systematic review of literature on surgically and radiosurgically treated cases and morbidity related to both treatment modalities.Methods:We performed a systematic review of literature for cases with ONS treated with surgery or radiosurgery using PubMed/Ovid Medline.Results:Till date, there are 60 reported cases of ONS (45 treated surgically and seven radiosurgically) with the dominance of female gender (53%) and mean age of 35.2 years (Range 1–66). In 8% of the cases, there was no involvement of cranial nerve (CN) III and 92% of the cases CN III alone or together with CN II, IV, V, and VI. In 67% of the cases a complete resection and 33% a partial resection performed. In 73% of the cases, postoperative third nerve palsy was documented, 22% improved after surgery and in around 5% of cases, the outcome was not described. In the radiosurgically treated cases of nonvestibular schwannoma including ONS, the progression-free interval of approximately 2 years was above 90%.Conclusion:Due to the high rate of postoperative complete oculomotor nerve palsy, a subtotal resection avoiding the nerve injury seems to be a feasible option. Radiosurgery is another option to treat small size schwannoma. A combined treatment with microsurgery followed by radiosurgery may allow effective treatment for large size oculomotor schwannoma.

Third nerve decompression by anterior petroclinoid ligament opening after clipping of posterior communicating artery aneurysm—How I do it

Posterior communicating artery aneurysms sometimes present with partial or complete oculomotor nerve palsy, due to direct oculomotor nerve compression, irritation by subarachnoid blood, or both. Superiority of surgical clipping over endovascular coiling in terms of postoperative outcome is still controversial. Direct oculomotor nerve decompression by opening of the anterior petroclinoid ligament during aneurysm clipping is performed as a simple and feasible surgical maneuver which allows to improve the decompression effect obtained by aneurysm exclusion. Anterior petroclinoid ligament opening permits to achieve a better oculomotor nerve decompression. Its efficiency on the recovery of the deficit needs to be proved by larger series.

Recovery of oculomotor nerve palsy after endovascular and surgical treatment of posterior communicating artery aneurysms: A single institutional experience

Introduction:Surgical oculomotor nerve palsy(ONP), defined by ptosis, ophthalmoplegia, diplopia and pupillary dilatation, is associated with intracranial aneurysms, especially posterior communicating artery (PcomA) aneurysms. Treatment of PcomA aneurysms include endovascular coiling and surgical clipping. This study retrospectively compared the recovery of ONP in patients who underwent endovascular coiling or surgical clipping.Methods:A retrospective review of patients with PcomA aneurysms who presented with ONP between 1998 and 2012 in the National Neuroscience Institute, Singapore, was performed. Inclusion criteria included adult patients of age above 21 who have radiologically confirmed PcomA aneurysms with presentation of ipsilateral ONP. The aneurysms may be unruptured or ruptured with WFNS grade 2 subarachnoid hemorrhage (SAH) or better. Only patients with completely surgically or endovascularly obliterated PcomA aneurysms with regular follow-up are included.Results:A total of 22 patients were recruited. They were treated by either endovascular coiling or surgical clipping. The two groups of patients were demographically comparable, with 11 patients in each arm. 13 (59%) patients had unruptured aneurysms and 9 (41%) had WFNS grade 2 or better SAH. 13 (59%) patients presented with complete ONP and 9 (41%) had partial ONP. 64% of patients who underwent surgical clipping had resolution of ONP completely, compared to 18% of endovascularly coiling (P = 0.03) at 1-month follow-up.Conclusion:Compared to endovascular coiling, surgically clipped PcomA aneurysms are associated with a faster rate of full recovery of ONP.

Idiopathic Isolated (Right) Complete Oculomotor Nerve Palsy Management with Ayurvedic Treatment

Idiopathic Isolated (Right) Complete Oculomotor Nerve Palsy Management with Ayurvedic Treatment

Recovery of oculomotor nerve palsy after endovascular treatment of ruptured posterior communicating artery aneurysm.

Oculomotor nerve palsy (ONP) may result from Posterior communicating artery (Pcom) aneurysms. Endovascular treatment of ruptured Pcom aneurysms generally is a safe procedure, but the effect of this therapy on ONP is incompletely elucidated. This retrospective study evaluates outcomes of ONP after endovascular treatment for ruptured Pcom aneurysm and with the intention to clarify predictors of recovery. From May 2010 to October 2015, 210 patients with Pcom aneurysms underwent endovascular treatment at our institution. Among them, 34 patients with ruptured aneurysms and either complete or incomplete ONP were identified. The outcomes and predictors of ONP recovery were analyzed. At the last available clinical follow-up, ONP resolution was complete in 21 (61.8%) patients and incomplete in 8 (23.5%) patients. The mean resolution time after embolization was 24.5days. Five patients showed no signs of ONP recovery. In no case was an initial incomplete ONP observed to worsen. There was a statistically insignificant trend toward complete recovery among patients with initial incomplete ONP (OR=4.17; 95% CI, 0.75-23.18; P=0.103). Endovascular treatment appears to be an effective treatment modality for ruptured Pcom aneurysm and related ONP. The initial incomplete ONP might encourage complete ONP recovery after endovascular treatment.

Central serous chorioretinopathy following medial transposition of split lateral rectus muscle for complete oculomotor nerve palsy

Central serous chorioretinopathy (CSCR) is an incompletely understood condition in which a primary dysfunction of the choriocapillaris, retinal pigment epithelium, or both causes a detachment of the neurosensory retina. We report the first case of CSCR as a complication of strabismus surgery and explore pathogenic mechanisms.

Medial rectus muscle anchoring in complete oculomotor nerve palsy

The management of exotropia resulting from complete oculomotor nerve palsy is challenging. Conventional therapeutic interventions, including supramaximal resection and recession, superior oblique tendon resection and transposition, and several ocular anchoring procedures have yielded less-than-adequate results. Here we describe a novel surgical technique of anchoring the medial rectus muscle to the medial orbital wall in combination with lateral rectus disinsertion and reattachment to the lateral orbital wall.