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1.
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 , Imagem por Ressonância Magnética , Neuroimagem , Exame Neurológico , Paralisia/etiologia , Prognóstico , Tomografia Computadorizada por Raios X
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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 , Imagem por Ressonância Magnética , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Osso Petroso/cirurgia
9.
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 Cirúrgicos Reconstrutivos/métodos , Resultado do Tratamento
10.
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
11.
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
12.
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 , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , 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
13.
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
14.
Neurosurg Focus ; 34(3): E4, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23451716

RESUMO

Interest in studying the anatomy of the abducent nerve arose from early clinical experience with abducent palsy seen in middle ear infection. Primo Dorello, an Italian anatomist working in Rome in the early 1900s, studied the anatomy of the petroclival region to formulate his own explanation of this pathological entity. His work led to his being credited with the discovery of the canal that bears his name, although this structure had been described 50 years previously by Wenzel Leopold Gruber. Renewed interest in the anatomy of this region arose due to advances in surgical approaches to tumors of the petroclival region and the need to explain the abducent palsies seen in trauma, intracranial hypotension, and aneurysms. The advent of the surgical microscope has allowed more detailed anatomical studies, and numerous articles have been published in the last 2 decades. The current article highlights the historical development of the study of the Dorello canal. A review of the anatomical studies of this structure is provided, followed by a brief overview of clinical considerations.


Assuntos
Nervo Abducente/anatomia & histologia , Anatomia/história , Fossa Craniana Posterior/anatomia & histologia , Ligamentos/anatomia & histologia , Microcirurgia/métodos , Neurocirurgia/métodos , Osso Esfenoide/anatomia & histologia , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/patologia , Doenças do Nervo Abducente/cirurgia , Traumatismo do Nervo Abducente/patologia , Traumatismo do Nervo Abducente/prevenção & controle , Traumatismo do Nervo Abducente/cirurgia , Áustria , Artéria Carótida Interna/anatomia & histologia , Fossa Craniana Posterior/irrigação sanguínea , Fossa Craniana Posterior/cirurgia , Dura-Máter/anatomia & histologia , História do Século XIX , Humanos , Imageamento Tridimensional , Itália , Osso Esfenoide/irrigação sanguínea , Osso Esfenoide/cirurgia
15.
Neurosurg Rev ; 36(3): 371-6, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23196421

RESUMO

In transsphenoidal surgery (TSS) for pituitary tumors, the use of endoscopes allows approach to the lateral sides in and around the cavernous sinus. However, this approach is often associated with a risk of cranial nerve dysfunction causing impaired extraocular movement. We employed a novel, simple, and real-time monitoring system using electrooculography during TSS to avoid postoperative extraocular motor nerve dysfunction. A conventional electroencephalograph, which is available in every hospital, was used to detect effects induced by intraoperative manipulation on the cranial nerves related to extraocular movement (EOM) during TSS for pituitary adenomas. One hundred patients with pituitary adenomas who underwent endonasal endoscope-assisted TSS with EOM monitoring were included in the present study. When the extraocular motor nerves were stimulated mechanically directly or even indirectly by surgical procedures, abnormal extraocular muscle responses [electrooculograms (EOGm)] appeared on the monitor screen. When repeated or continuous EOGm were recorded, surgical procedures were discontinued briefly for around 5 to 10 s. The EOGm disappeared promptly when surgical procedures were stopped. Permanent extraocular dysfunction did not occur in the present series of patients. One, who was the fifth patient in the present series, of 100 patients (1.0 %) had transient delayed diplopia after TSS. We have not experienced any more postoperative EOM dysfunction since the first case. EOM monitoring during TSS is a novel, efficient, and simple method to prevent postoperative cranial nerve palsy related to EOM.


Assuntos
Traumatismo do Nervo Abducente/prevenção & controle , Eletroculografia/métodos , Monitorização Fisiológica/métodos , Neurônios Motores/fisiologia , Traumatismos do Nervo Oculomotor/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Osso Esfenoide/cirurgia , Traumatismos do Nervo Troclear/prevenção & controle , Adenoma/patologia , Adenoma/cirurgia , Adulto , Idoso , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Resultado do Tratamento , Adulto Jovem
17.
Indian J Ophthalmol ; 60(2): 149-50, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22446916

RESUMO

Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity. However, delayed-onset post-traumatic bilateral abducens paresis is extremely rare. We present two cases. The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days. The cause in the former was detected to be chronic subdural hematoma and in the latter is speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves. The delayed onset of bilateral abducens paresis following head injury may vary according to the cause. There may be another mechanism of injury apart from direct trauma. Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.


Assuntos
Traumatismo do Nervo Abducente/diagnóstico por imagem , Acidentes de Trânsito , Traumatismos Cranianos Fechados/diagnóstico por imagem , Hematoma Subdural Crônico/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traumatismo do Nervo Abducente/etiologia , Adulto , Traumatismos Cranianos Fechados/complicações , Hematoma Subdural Crônico/complicações , Humanos , Masculino , Fatores de Tempo , Adulto Jovem
18.
World Neurosurg ; 77(1): 119-21, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22130113

RESUMO

OBJECTIVE: The abducens nerve is frequently injured after head trauma and some investigators have attributed this to its long intracranial course. The present study aimed to elucidate an additional mechanism to explain this phenomenon. METHODS: Twelve fresh adult cadavers underwent dissection of Dorello canal using standard microsurgical techniques. In addition, traction was applied to the nerve at its entrance into this canal before and after transection of Gruber ligament to observe for movement. RESULTS: In all specimens, a secondary tunnel (i.e., tube within a tube) was found within Dorello canal that exclusively contained the abducens nerve. This structure rigidly fixated the abducens nerve as it traversed Dorello canal, thereby not allowing any movement. Transection of Gruber ligament did not detach the nerve, but after release of the inner tube, the nerve was easily mobilized. CONCLUSIONS: Rigid tethering of the abducens nerve with a second tube within Dorello canal affords this nerve no ability for movement with motion of the brainstem. We hypothesize that this finding is a main factor in the high incidence of abducens nerve injury after head trauma.


Assuntos
Traumatismo do Nervo Abducente/patologia , Fossa Craniana Posterior/anatomia & histologia , Fossa Craniana Posterior/patologia , Traumatismos Craniocerebrais/patologia , Nervo Abducente/anatomia & histologia , Traumatismo do Nervo Abducente/etiologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Traumatismos Craniocerebrais/complicações , Dissecação , Dura-Máter/anatomia & histologia , Feminino , Humanos , Ligamentos/anatomia & histologia , Masculino , Microcirurgia , Pessoa de Meia-Idade
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