Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 141
Filtrar
3.
Laryngoscope ; 131(3): 513-517, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32809233

RESUMO

OBJECTIVES: While abducens nerve palsy (ANP) is a known risk in the setting of some endoscopic endonasal skull base surgery (ESBS), frequency and prognosis of post-operative palsy remain unknown. Our goals were to determine the frequency and prognosis of ANP after high-risk ESBS, and identify factors associated with recovery. METHODS: Retrospective case series of all patients with pathology at highest risk for abducens nerve injury (pituitary adenoma, chordoma, meningioma, chondrosarcoma, cholesterol granuloma) generated a list of patients with abducens nerve palsy after ESBS performed from 2011-2016. A validated ophthalmologic clinical grading scale measuring lateral rectus duction from 0 to -5 (full motion to inability to reach midline) was measured at multiple time points to assess recovery of ANP. RESULTS: Of 655 patients who underwent ESBS with increased risk of abducens injury, 40 (6.1%) post-operative palsies were identified and 39 patients with dedicated examination at multiple time points were included in subsequent analysis. Complete resolution was noted in 25 patients (64%) within 12 months. While 19 of 23 (83%) with a partial palsy had complete resolution, only six of 16 (38%) with a complete palsy resolved entirely (P = .005; Fisher's exact test). All six patients with delayed onset of palsy resolved (P = .070; Fisher's exact test). Meningioma and chordoma had higher rates of both temporary and permanent post-operative ANP (P < .0001; Fisher's exact). CONCLUSIONS: The frequency of post-operative ANP following ESBS is low, even in high-risk tumors. While only a minority of complete abducens nerve palsies recover, patients with partial or delayed palsy post-operatively are likely to recover function without intervention. LEVEL OF EVIDENCE: IV Laryngoscope, 131:513-517, 2021.


Assuntos
Traumatismo do Nervo Abducente/etiologia , Técnicas de Diagnóstico Oftalmológico/estatística & dados numéricos , Endoscopia/efeitos adversos , Complicações Intraoperatórias/etiologia , Cuidados Pré-Operatórios/estatística & dados numéricos , Base do Crânio/cirurgia , Nervo Abducente/patologia , Nervo Abducente/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Base do Crânio/inervação , Base do Crânio/patologia , Resultado do Tratamento
4.
Surg Radiol Anat ; 42(11): 1371-1375, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32607642

RESUMO

The aim of this work was to determine reliable anatomical landmarks for locating and preserving the abducens nerves (6th cranial nerves) during trans-facial or trans-nasal endoscopic approaches of skull base tumors involving the clivus and the petrous apex. In order to describe this specific anatomy, we carefully dissected 10 cadaveric heads under optic magnification. Several measurements were taken between the two petro-sphénoidal foramina, from the bottom of the sella and the dorsum sellae. The close relationship between the nerves and the internal carotid artery were taken into account. We defined a trapezoid area that allowed drilling the clivus safely, preserving the 6th cranial nerve while being attentive to the internal carotid artery. The caudal part of this trapezium is, on average, 20 mm long at mi-distance between the two petro-sphenoidal foramina. The cranial part is at the sella level, a line between both paraclival internal carotid arteries. Oblique lateral edges between the cranial and caudal parts completed the trapezium.


Assuntos
Traumatismo do Nervo Abducente/prevenção & controle , Nervo Abducente/anatomia & histologia , Fossa Craniana Posterior/inervação , Complicações Intraoperatórias/prevenção & controle , Neoplasias da Base do Crânio/cirurgia , Traumatismo do Nervo Abducente/etiologia , Pontos de Referência Anatômicos , Cadáver , Artéria Carótida Interna/anatomia & histologia , Corantes/administração & dosagem , Fossa Craniana Posterior/irrigação sanguínea , Fossa Craniana Posterior/patologia , Fossa Craniana Posterior/cirurgia , Endoscopia/efeitos adversos , Endoscopia/métodos , Humanos , Sela Túrcica/inervação , Neoplasias da Base do Crânio/patologia
5.
Acta Neurochir (Wien) ; 162(6): 1249-1257, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32100111

RESUMO

BACKGROUND: Ocular motor dysfunction is one of the most common postoperative complications of petroclival meningioma. However, its incidence, recovery rate, and independent risk factors remain poorly explored. METHODS: A prospective analysis of 31 petroclival meningiomas was performed. Operative approaches were selected by utilizing a new 6-region classification of petroclival meningiomas we proposed. Two scores were used to evaluate the functions of the oculomotor and abducens nerves. Pearson correlation analysis and binary logistic regression analysis were used to identify independent risk factors for intraoperative oculomotor and abducens nerve injury. RESULTS: Postoperative new-onset dysfunctions in the pupillary light reflex and eye/eyelid movements as well as abducens paralysis were detected in eight (25.8%), ten (32.3%) and twelve (38.7%) cases, respectively. Their corresponding recovery rates after 6 months of follow-up were 75% (6/8), 80% (8/10), and 83.3% (10/12), respectively, and their mean times to start recovery were 4.03, 2.43, and 2.5 months, respectively. Tumor invasion into the suprasellar region/sphenoid sinus was the only risk factor for dysfunctions in both the pupillary light reflex (p = 0.001) and eye/eyelid movements (p = 0.002). Intraoperative utilization of the infratrigeminal interspace was the only risk factor for dysfunction in eyeball abduction movement (p = 0.004). CONCLUSIONS: Dysfunctions of the oculomotor and abducens nerves recovered within 6 months postoperatively. Tumor extension into the suprasellar region/sphenoid sinus was the only risk factor for oculomotor nerve paralysis. Eye/eyelid movements were more sensitive than the pupillary light reflex in reflecting nerve dysfunctions. Intraoperative utilization of the infratrigeminal interspace was the only risk factor for abducens nerve paralysis.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Traumatismos do Nervo Oculomotor/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Neoplasias da Base do Crânio/cirurgia , Nervo Abducente/patologia , Traumatismo do Nervo Abducente/etiologia , Traumatismo do Nervo Abducente/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Nervo Oculomotor/patologia , Traumatismos do Nervo Oculomotor/etiologia , Complicações Pós-Operatórias/etiologia , Reflexo Pupilar
6.
Ned Tijdschr Geneeskd ; 1632019 09 13.
Artigo em Holandês | MEDLINE | ID: mdl-31556495

RESUMO

BACKGROUND Due to its long intracranial course, the abducens nerve is vulnerable in case of acceleration injury of the head. In rare cases, this may lead to posttraumatic paralysis of this cranial nerve. CASE DESCRIPTION A 4-year-old girl visited the emergency department after sustaining a head trauma. Neurological examination revealed no focal abnormalities at first. Three days later, she experienced diplopia, the consequence of isolated abducens nerve paralysis. CT and MRI brain imaging revealed no abnormalities. We treated her with an eye patch for a short time. At examination after 1 year, she was no longer experiencing any symptoms and the paralysis had almost completely disappeared. CONCLUSION Isolated paralysis of the abducens nerve may occur until up to 6 days after a trauma, without any visible intracranial abnormalities revealed by imaging. Even though only few children with this condition have been described, prognosis seems to be favourable and symptoms disappear in the majority of patients. Frequent follow-up by the ophthalmologist and the orthoptist is recommended, possibly with symptomatic treatment of the diplopia.


Assuntos
Traumatismo do Nervo Abducente/complicações , Traumatismos Craniocerebrais/complicações , Diplopia/etiologia , Paralisia/complicações , Traumatismo do Nervo Abducente/etiologia , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Imageamento por Ressonância Magnética , Neuroimagem , Exame Neurológico , Paralisia/etiologia , Prognóstico , Tomografia Computadorizada por Raios X
7.
Scand J Pain ; 20(1): 211-214, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31541603

RESUMO

The abducens nerve palsy is most likely caused by microvascular issue. Spontaneous recovery of vasculopathic abducens nerve palsies was common at 3-6 months. But recovery time was longer when many risk factors were present. Several patients had residual esotropia or abduction deficit. Cervical sympathetic block has an established use in treating patients with disorders related to cranial circulatory insufficiency. It causes a significant increase in cerebral blood flow. We report a case of a 67-year-old man with acute horizontal diplopia and right periocular pain. He had been diagnosed with right abducens nerve palsy caused by microvascular ischemia. We performed ultrasound-guided superior cervical sympathetic ganglion blocks. After 4 weeks, the symptoms had been completely resolved. We introduce ultrasound-guided superior cervical sympathetic ganglion blocks for management of abducens nerve palsy caused by microvascular ischemia, which could be an effective novel method to promote recovery from diplopia.


Assuntos
Traumatismo do Nervo Abducente , Bloqueio Nervoso Autônomo , Diplopia , Isquemia/complicações , Gânglio Cervical Superior , Idoso , Vértebras Cervicais , Diplopia/etiologia , Diplopia/terapia , Humanos , Masculino , Ultrassonografia
8.
Int J Neurosci ; 129(9): 923-929, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30889365

RESUMO

Objective: Through the development of beagle abducens nerve injury model, taking electroacupuncture as the core and microglia as the starting point, the author investigated whether electroacupuncture can promote the repair of injured abducens nerve by cannabinoid receptor-mediated regulation of microglia activation. Methods: Healthy beagle dogs were randomly divided into five groups: sham operation group (A), injury group (B), electroacupuncture pretreatment group (C), antagonist group (D) and solvent group (E). After stimulation with electroacupuncture, the expression of cannabinoid 1 receptor (CB1R) and cannabinoid 2 receptor (CB2R) in A, B and C microglia cells was detected by Western Bolt analysis, and further the expression of CB2R in five groups was further analyzed by immunofluorescence, thereby statistical differences were analyzed. Results: Among group A, group B and group C, Western Blot analysis showed that there were no significant changes in the expression of CB1R protein after electroacupuncture [F (2, 12)=1.75, p = 0.215]. After electroacupuncture preconditioning for 15 min for 2 weeks, group C was compared with group A and group B, which showed CB2 was affected. The expression of CB2R protein was significantly increased among groups A, B and C [F (2, 12)=5189.57, p < 0.001], but there was no significant difference in the expression of CB2R protein between group A and group B (p > 0.05). The results of immunofluorescence showed that Arginse/CD11b was significantly increased in group C comparing to group A (*p < 0.001), while there was a significant increase in group E comparing to group A about Arginse/CD11b [F (4, 20)=4345.44, p < 0.001]. Conclusions: The CB2R in the cannabinoid receptor is mainly involved in the electro-acupuncture-induced neuroprotection. Electroacupuncture can promote the repair of injured abducens nerve by CB2R-mediated activation of microglia.


Assuntos
Traumatismo do Nervo Abducente/metabolismo , Traumatismo do Nervo Abducente/terapia , Eletroacupuntura/métodos , Microglia/metabolismo , Receptor CB2 de Canabinoide/biossíntese , Traumatismo do Nervo Abducente/genética , Animais , Cães , Expressão Gênica , Masculino , Distribuição Aleatória , Receptor CB2 de Canabinoide/genética
9.
Morphologie ; 103(341 Pt 2): 103-109, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30713002

RESUMO

The aim of this study is to present the variations of nervus abducens in localization and number as it pierces the clival dura mater. The calvaria of 16 cadaveric heads were removed by making horizontal incisions from Glabella to Inion in both sides of the head. The dura mater was dissected. Cerebrum and cerebellum were taken out by obtuse dissection. Dissections of cavernous sinus were made under the stereomicroscope and the findings were photographed. Out of 16 specimens, one of them was excluded. Fifteen heads were bilaterally analyzed. Analysis of these nerves presented four different variations. Variation types a classified CN VI as a single trunk and entering a single dural pore with 77% occurrence. Variation type b classified CN VI with two branches running in the petroclival region and entering a single dural pore with 10% occurrence. Variation type c classified CN VI as 2 trunks and entering 2 separate but close dural pores with 10% occurrence. Variation type d classified CN VI with 2 distinct trunks and 2 branches entering 2 separate but close dural pores with 3% occurrence. CN VI plays a major role in the clinic of the eye. Due to its intracranial and extracranial course, injuries to the head and to the nerve may result in malfunctioning of the lateral muscles of the eye. Therefore, the variations of branching, relations and its course were analyzed.


Assuntos
Nervo Abducente/anatomia & histologia , Variação Anatômica , Traumatismo do Nervo Abducente/etiologia , Traumatismo do Nervo Abducente/prevenção & controle , Cadáver , Seio Cavernoso/anatomia & histologia , Seio Cavernoso/cirurgia , Fossa Craniana Posterior/anatomia & histologia , Fossa Craniana Posterior/cirurgia , Dissecação/métodos , Humanos , Microcirurgia
10.
Am J Phys Med Rehabil ; 98(6): e57-e59, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30300229

RESUMO

The patient with bacterial infection sequelae in the form of damage to cranial nerves III, IV, and VI was followed up. He had exhibited clinical and radiographic signs of paranasal sinusitis. Before his physiotherapy, the patient received standard treatment with natural and synthetic antibiotics and steroids. After acute signs of infection resolved without any functional improvement, the patient was referred to a rehabilitation unit to undergo neuromuscular re-education of the paralyzed extraocular muscles. Periorbital hydrocortisone iontophoresis and visuomotor exercises with intense ideomotor stimulation led to complete and rapid resolution of extraocular muscle paralysis and diplopia. Physiotherapy can be an effective treatment of choice after failed pharmacological treatment in patients with damage to cranial nerves III and VI. It has many theoretical advantages, including noninvasiveness and avoidance of first-pass metabolism of drugs administered systemically.


Assuntos
Traumatismo do Nervo Abducente/terapia , Doenças dos Nervos Cranianos/reabilitação , Traumatismos do Nervo Oculomotor/terapia , Modalidades de Fisioterapia , Traumatismos do Nervo Troclear/terapia , Traumatismo do Nervo Abducente/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Nervo Oculomotor/complicações , Traumatismos do Nervo Troclear/complicações
11.
S Afr Med J ; 107(9): 747-749, 2017 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-28875880

RESUMO

Orbital apex syndrome is rare, but can occur as a consequence of trauma from fracture of the medial orbit. This case report highlights the fact that a high index of suspicion is needed when a patient presents with a facial injury, especially in children who cannot give an account of the actual events that transpired. Radiological investigation should be done early when an underlying injury is suspected in a trauma patient. A low threshold for computed tomography should be maintained when proptosis and vision loss are present.


Assuntos
Traumatismo do Nervo Abducente/diagnóstico , Diagnóstico Tardio , Traumatismos do Nervo Oculomotor/diagnóstico , Fraturas Orbitárias/diagnóstico , Traumatismos do Nervo Trigêmeo/diagnóstico , Traumatismos do Nervo Troclear/diagnóstico , Traumatismo do Nervo Abducente/tratamento farmacológico , Traumatismo do Nervo Abducente/etiologia , Analgésicos/uso terapêutico , Antibacterianos/uso terapêutico , Blefaroptose/etiologia , Criança , Dexametasona/uso terapêutico , Exoftalmia/etiologia , Hematoma/diagnóstico , Hematoma/etiologia , Humanos , Masculino , Traumatismos do Nervo Oculomotor/tratamento farmacológico , Traumatismos do Nervo Oculomotor/etiologia , Nervo Oftálmico/lesões , Oftalmologia , Fraturas Orbitárias/complicações , Distúrbios Pupilares/etiologia , Radiografia , Encaminhamento e Consulta , Síndrome , Tomografia Computadorizada por Raios X , Traumatismos do Nervo Trigêmeo/tratamento farmacológico , Traumatismos do Nervo Trigêmeo/etiologia , Traumatismos do Nervo Troclear/tratamento farmacológico , Traumatismos do Nervo Troclear/etiologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia
12.
J Clin Neurosci ; 44: 30-33, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28673673

RESUMO

Although abducens nerve palsy is an established sequela of head trauma - given the prolonged intracranial course of the nerve - bilateral injury is rare. Here, we present two cases of bilateral traumatic abducens nerve avulsion, in the absence of regional fractures, one of which presented two months following the initial trauma. Additionally, we review the current literature on bilateral abducens nerve palsy secondary to trauma, discussing the anatomy of the nerve's course and potential mechanisms of injury.


Assuntos
Traumatismo do Nervo Abducente/diagnóstico por imagem , Traumatismo do Nervo Abducente/etiologia , Adulto , Idoso de 80 Anos ou mais , Feminino , Humanos
14.
Neurosurg Rev ; 40(2): 339-343, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28124175

RESUMO

One of the most important and useful pieces of information in the preoperative evaluation of a large petroclival meningioma is the running course of the abducens nerve. The abducens nerve is small and has a long intracranial course, making it prone to compression by the tumor at various anatomical points. In relatively large tumors, it is difficult to confirm the entire course of the abducens nerve, even by heavy T2-thin slice imaging. We report a case of successful preoperative estimation of the course of the abducens nerve that aided in its complete preservation during the resection of a large petroclival tumor.


Assuntos
Nervo Abducente/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Fossa Craniana Posterior/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Osso Petroso/diagnóstico por imagem , Nervo Abducente/cirurgia , Traumatismo do Nervo Abducente/etiologia , Traumatismo do Nervo Abducente/prevenção & controle , Adulto , Neoplasias Encefálicas/cirurgia , Simulação por Computador , Fossa Craniana Posterior/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Osso Petroso/cirurgia
16.
Ear Nose Throat J ; 95(12): E15-E20, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27929602

RESUMO

The vast majority of benign tumors of the cerebellopontine angle, temporal bone, and parotid gland can be successfully resected without permanent injury to the facial nerve. Malignant tumors or recurrent disease may require facial nerve sacrifice, especially if preoperative facial paresis is present. This article will present case examples of the various methods to reconstruct facial animation after lateral skull base resections that require sacrifice of cranial nerve VII, and the associated mimetic facial musculature. Facial mimetic outcome after reanimation was graded using the House-Brackmann scale. Primary neurorrhaphy or interposition grafting may be performed when both the proximal and distal portions of the facial nerve are available and viable facial musculature is present. If only the distal facial nerve and viable facial musculature are available, a split hypoglossal to facial nerve anastomosis is used. A proximal facial nerve to microvascular free flap is performed when the proximal facial nerve is available without distal nerve or viable musculature. A cross-facial to microvascular free flap is performed when the proximal and distal facial nerve and facial musculature are unavailable. The above methods resulted in a House-Brackmann score of III/VI in all case examples postoperatively. The method of facial reanimation used depends on the availability of viable proximal facial nerve, the location of healthy, tumor-free distal facial nerve, and the presence of functioning facial mimetic musculature.


Assuntos
Traumatismo do Nervo Abducente/cirurgia , Paralisia Facial/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/cirurgia , Base do Crânio/cirurgia , Traumatismo do Nervo Abducente/etiologia , Traumatismo do Nervo Abducente/fisiopatologia , Adulto , Idoso , Face/fisiopatologia , Face/cirurgia , Músculos Faciais/fisiopatologia , Músculos Faciais/cirurgia , Paralisia Facial/etiologia , Paralisia Facial/fisiopatologia , Feminino , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Procedimentos de Cirurgia Plástica/métodos , Resultado do Tratamento
17.
World Neurosurg ; 88: 689.e5-689.e8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26723286

RESUMO

BACKGROUND: Avulsion of the abducens nerve in the setting of geniculate ganglion injury after temporal bone fracture is unreported previously. We discuss clinical assessment and management of a patient with traumatic avulsion of cranial nerve (CN) VI in the setting of an ipsilateral CN VII injury after temporal bone fracture and call attention to this unusual injury. CASE DESCRIPTION: A 26-year-old man suffered a temporal bone fracture after a motor vehicle accident and developed diplopia and right-sided facial droop. Six weeks after the accident, the patient was readmitted with worsening diplopia and ipsilateral facial weakness. He demonstrated absent lateral gaze on the right suggestive of either restrictive movement or right. CN VI DEFICIT: In addition, he had right-sided facial palsy graded as 6/6 House-Brackmann. High-resolution computed tomography demonstrated a right-sided longitudinal otic capsule-sparing temporal bone fracture that propagated into the facial nerve canal and geniculate fossa. Magnetic resonance imaging revealed discontinuity of the right CN VI between the pons and the Dorello canal, as well as injury to the ipsilateral geniculate ganglion. CN VII was intact proximally, from the pons through the internal auditory canal. Consensus was reached to proceed with conservative management. At 13 months after injury, the patient reported 1/6 House-Brackmann with no improvement in CN VI function. CONCLUSIONS: This case illustrates 2 subtle findings on imaging with potential therapeutic implications, notably the role of surgical intervention for facial nerve palsy.


Assuntos
Traumatismo do Nervo Abducente/etiologia , Paralisia Facial/diagnóstico , Paralisia Facial/etiologia , Fraturas Cranianas/complicações , Fraturas Cranianas/diagnóstico , Osso Temporal/lesões , Traumatismo do Nervo Abducente/diagnóstico , Traumatismo do Nervo Abducente/terapia , Adulto , Diagnóstico Diferencial , Paralisia Facial/terapia , Humanos , Masculino , Radiografia , Fraturas Cranianas/terapia , Osso Temporal/diagnóstico por imagem , Osso Temporal/patologia
18.
J Craniofac Surg ; 27(1): e8-10, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26674904

RESUMO

The superior orbital fissure syndrome (SOFS) has been known to be a condition caused by impairment of the nerves that cross the superior orbital fissure. Traumatic SOFS is an uncommon complication which occurs usually within 48 hours after a facial injury. A 25-year-old male sustained facial trauma following an altercation. Clinical findings on presentation included swelling, ecchymosis, hyphema, subretinal hemorrhage, and mild extraocular movement limitation upon lateral gaze on his right eyelids. Facial computed tomography scan confirmed fractures of the medial walls of the right orbit and herniation of orbital soft tissue without the incarceration of medial rectus muscle. Ten days after the trauma, the operation was performed. On postoperative day 16, the patient showed ptosis of the right upper eyelid with a fixed pupil, and there was a hypoesthesia over the distribution of the right supraorbital and supratrochlear nerves. The authors diagnosed as a delayed SOFS and prescribed 4 mg of methylprednisolone q.i.d. for 30 days. After steroid therapy, extraocular movement limitations improved progressively. After 8 months, movement was completely restored. The authors experienced delayed SOFS on posttrauma day 27, and it was treated by steroid therapy. Surgical intervention is required when there is an evident etiology such as underlying hematoma or plate migration. If the reason is not clear like our case, steroid therapy can be considered as one of the options. Particularly, the authors should give special attention to the patient who has congenitally narrow superior orbital fissure, like Fujiwara et al suggested.


Assuntos
Traumatismos dos Nervos Cranianos/etiologia , Síndromes de Compressão Nervosa/etiologia , Órbita/inervação , Fraturas Orbitárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias , Traumatismo do Nervo Abducente/etiologia , Adulto , Anti-Inflamatórios/uso terapêutico , Blefaroptose/etiologia , Glucocorticoides/uso terapêutico , Hérnia/diagnóstico por imagem , Humanos , Masculino , Metilprednisolona/uso terapêutico , Osso Nasal/lesões , Transtornos da Motilidade Ocular/etiologia , Fraturas Orbitárias/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Traumatismos do Nervo Troclear/etiologia
19.
J Neurointerv Surg ; 8(8): 830-3, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26186933

RESUMO

INTRODUCTION: Trigeminal neuralgia (TN) is characterized by episodes of shooting pain in the areas innervated by one or more divisions of the trigeminal nerve. The initial treatment of TN is with drugs but the increased frequency and intensity of the neuralgic episodes often force the patient to seek alternative therapies. Microvascular decompression (MVD) and radiofrequency thermal lesioning of trigeminal rootlets (RFTR) offer close to the best results for TN. MVD has the disadvantage of being an open surgical procedure with its attendant risks and longer hospital stay, whereas RFTR is a short, 'day-care' procedure. However this latter procedure involves positioning of the RF needle in the area behind the trigeminal ganglion through the foramen ovale, which can pose significant challenges. OBJECTIVE: To use the fluoroscopic support of a biplane catheter laboratory to access the foramen, and flat detector CT to confirm the location of the tip of the RF needle in the optimal position. METHODS: Fifty-three patients with TN underwent RFTR under local anesthesia with conscious sedation. RESULTS: All patients reported pain relief with hypesthesia over the offending trigeminal division. In seven patients the needle tip required repositioning according to the CT images. Two patients each had loss of corneal reflex and abducens nerve palsy after the procedure. No other complications were seen. CONCLUSIONS: The superior view in two planes coupled with the anatomical confirmation of the position of the needle tip in the Meckel's cave during the rhizotomy reduces the need for multiple passages of the needle to access the foramen ovale and achieves accurate needle tip positioning. The technique increases the safety and precision of such treatments and helps to manage potential complications.


Assuntos
Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Fluoroscopia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/prevenção & controle , Rizotomia/efeitos adversos , Rizotomia/métodos , Tomografia Computadorizada por Raios X/métodos , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/cirurgia , Traumatismo do Nervo Abducente/etiologia , Idoso , Anestesia Local , Sedação Consciente , Doenças da Córnea/etiologia , Feminino , Forame Oval/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Agulhas , Neuronavegação , Resultado do Tratamento
20.
BMJ Case Rep ; 20152015 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-26354834

RESUMO

An isolated fourth ventricle is characterised by cerebrospinal fluid (CSF) trapping in the fourth ventricle. Although there is no consensus regarding treatment, ventriculoperitoneal (VP) shunting of the fourth ventricle is an option. Complications include infection, mechanical irritation of the brainstem, malfunction and overdrainage. Cranial nerve palsy is a rare complication and has been mostly described in children. We present two adult cases of abducens and facial nerve palsies occurring secondary to this procedure. Placement of a higher resistance valve brought about complete recovery in one patient while withdrawal of the catheter by a few millimetres led to complete recovery in the second patient.


Assuntos
Traumatismo do Nervo Abducente/complicações , Doenças dos Nervos Cranianos/terapia , Quarto Ventrículo/cirurgia , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Traumatismo do Nervo Abducente/etiologia , Adolescente , Doenças dos Nervos Cranianos/líquido cefalorraquidiano , Doenças dos Nervos Cranianos/etiologia , Feminino , Quarto Ventrículo/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Derivação Ventriculoperitoneal/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...