Management Of 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.

Surgical management of oculomotor nerve palsy - a review of the literature.

We aim to review the surgical management techniques available for patients with oculomotor nerve (OMN) palsy, compare and contrast the approaches and subsequent outcomes. A search of the literature was carried out to yield all papers relevant to the topic, and a wide spectrum of surgical techniques were identified. These included: muscle shortening and lengthening procedures, muscle transposition, globe fixation and ptosis surgery. Patients often require a synergistic combination of these techniques. Strabismus surgery for OMN palsy can be approached through a variety of different techniques to improve the quality of life, independence and aesthetics for the patient.

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.

Isolated Oculomotor Nerve Palsy in Mild Traumatic Brain Injury.

Isolated oculomotor nerve palsy is rarely encountered after mild traumatic brain injury. It is difficult to offer patients accurate management strategies or prognostic assessments because only a few reports have described the management of oculomotor nerve palsy. We performed a search for all clinical studies of isolated oculomotor nerve palsy after mild traumatic brain injury published up to July 9, 2019. We placed no restrictions on language or year of publication in our search, and we searched the following key words: traumatic brain injury, isolated oculomotor nerve palsy, mild head trauma, management, and prognosis. We identified 14 cases of isolated oculomotor nerve palsy after mild traumatic brain injury. In three cases, steroids were used to manage the oculomotor nerve palsy. Five patients who had underlying brain lesions underwent surgery, and seven patients were observed and followed up. The time to partial or complete resolution was 6.0 ± 5.3 mos with a range of 0.5-18 mos. This review includes a survey of surgical treatment for the management of traumatic brain injury that underlies oculomotor nerve palsies, steroid therapy to reduce related brain edema, and oculomotor rehabilitation with training eye movement behavior.

Managing the patient with oculomotor nerve palsy

To provide clinically relevant information regarding the evaluation and current treatment options for oculomotor nerve palsies. We survey recent literature and provide some insights into these studies. Recent case reports highlight emerging new causes of oculomotor cranial nerve palsies, including sellar chordoma, odontogenic abscess, nonaneurysmal subarachnoid hemorrhage, polycythemia, sphenoiditis, neurobrucellosis, interpeduncular fossa lipoma, metastatic pancreatic cancer, leukemia, and lymphoma. Surgical studies have focused on modifications and innovations regarding strabismus surgery for this condition. New globe fixation procedures may include fixation to the medial orbital wall by precaruncular and retrocaruncular approaches, apically based orbital bone periosteal flap fixation and the suture/T-plate anchoring platform system. Management of oculomotor nerve palsy depends in part upon the underlying cause and anatomical location of the lesion. Careful clinical evaluation and appropriate imaging can identify a definitive cause in most cases. Surgical options depend on the number, extent, and severity of the muscles involved as well as the presence or absence of signs of aberrant regeneration. The clinician should also address issues that arise due to involvement of the pupil and accommodation. Strabismus surgery can be challenging but also rewarding with appropriate selection and staging of procedures.

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

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.

Surgical Management of Oculomotor Nerve Palsy

We treated seven patients with unilateral oculomotor nerve palsy by transposition of the insertion of the superior oblique tendon to a point anterior and medial to the insertion of the superior rectus muscle without trochleotomy (Scott procedure). Additionally, large recessions of the lateral rectus muscle of involved eyes and, occasionally, recess/resect procedures of horizontal recti muscles of non-involved eyes were performed. All patients were followed up between one and eight years. Orthophoria in the primary position was achieved and maintained with one operation in four patients. A fifth patient had only a small residual exotropia. In two patients who had aberrant regeneration of the oculomotor nerve, surgery on horizontal recti muscles of the noninvolved eye improved the eyelid position of the involved eye after three operations.

Surgical management of oculomotor nerve palsy with lateral rectus transplantation to the medial side of globe.

An operation for complete third nerve paralysis involving lateral rectus muscle transplantation to the medial side of the globe as a basic procedure is described. An inferior rectus muscle recession plus resection of an apparent completely paralysed medial rectus was subsequently performed at a second stage operation. The results appeared to be an improvement on previous surgery, particularly in terms of ocular motility, with almost full adduction of the operated eye being achieved. This adduction movement occurred as part of a normal conjugate movement of the two eyes, and the question arises as to the responsible muscles, with some evidence to suggest that relearned action of the transplanted lateral rectus muscle may be implicated. Finally, a Fasanella-Servat procedure as a third stage operation appeared to be adequate to correct the ptosis.

Results Following Surgical Management of Oculomotor Nerve Palsy With a Modified Knapp Procedure

Thirteen patients with oculomotor nerve palsy had their strabismus managed with a recess/resect procedure on the horizontal recti of the affected eye. A simultaneous graded supraplacement of both horizontal recti in the affected eye was used to manage the hypotropia in 9 of 11 patients with unilateral palsies. If some medial rectus function exists, correction of III nerve palsy is best achieved with a recess/resect procedure with supraplacement of the horizontal recti, 1 mm for each 2 prism diopters of hypotropia in primary position. Eight of 13 patients required additional procedures. Four of 13 patients did achieve high levels of binocular function.

Superior Oblique Transposition for Third Nerve Palsy

Four eyes of three adult patients underwent anterior transposition and advancement of the superior oblique tendon without trochleotomy in the surgical management of oculomotor nerve palsy. In each of the cases, this procedure proved unsatisfactory, either because of inadequate horizontal alignment, postoperative hyperdeviations, or paradoxical ocular movements. Even in these difficult cases, “supermaximum” horizontal rectus muscle surgery appeared to result in satisfactory ocular alignment.