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1.
Semin Ophthalmol ; 34(7-8): 541-542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31657259

RESUMO

Regarding the review article by Escuder AG, Hunter DG, entitled "The Role of Botulinum Toxin in the Treatment of Strabismus" Seminars in Ophthalmology. 2019;34(4): 198-204, we cannot agree with you more with your point of view about the dosage preparation for botulinum toxin A (BTA) in the strabismus surgery. Moreover, we also included a case series that used BTA as an adjunct in the surgery for large-angle sensory exotropia and abducens nerve palsy.


Assuntos
Doenças do Nervo Abducente/terapia , Toxinas Botulínicas Tipo A/administração & dosagem , Exotropia/terapia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Doenças do Nervo Abducente/fisiopatologia , Adulto , Exotropia/fisiopatologia , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Adulto Jovem
2.
J Pediatr Ophthalmol Strabismus ; 56: e53-e56, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31282962

RESUMO

A 53-year-old woman presented with diplopia and deviation of the left eye for the past 3 years. She had non-resolving isolated left lateral rectus palsy. She underwent a medial rectus recession and Hummelsheim (Wright's modification) procedure in her left eye. Postoperatively, the anterior segment ischemia resolved with steroids. [J Pediatr Ophthalmol Strabismus. 2019;56:e53-e56.].


Assuntos
Doenças do Nervo Abducente/cirurgia , Segmento Anterior do Olho/irrigação sanguínea , Isquemia/etiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Complicações Pós-Operatórias , Visão Binocular , Doenças do Nervo Abducente/fisiopatologia , Angiografia , Segmento Anterior do Olho/diagnóstico por imagem , Movimentos Oculares/fisiologia , Feminino , Humanos , Isquemia/diagnóstico , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Doenças Raras
3.
J Pediatr Ophthalmol Strabismus ; 56(4): 238-242, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322714

RESUMO

PURPOSE: To determine the magnitude of change between the preoperative and postoperative alignment and amount of postoperative drift for two vertical rectus muscle transpositions (VRTs). METHODS: Retrospective review of medical records of patients with total sixth cranial nerve palsy who underwent VRT procedures. The primary outcome measure was the magnitude of esotropia in prism diopters (PD) at the preoperative and postoperative visits. RESULTS: Twenty-seven patients were included. Sixteen had full tendon transposition with Foster augmentation (FTT+FA) and 11 had partial tendon transposition with resection and simultaneous medial rectus recession (PTT+R+MRR). A larger correction was obtained with PTT+R+MRR (mean ± standard deviation [SD]: 52 ± 19 PD; range: 27 to 87 PD) when compared to FTT+FA (mean: 40 ± 13 PD; range: 15 to 68 PD). At postoperative month 2, a greater esotropic drift was noted in the PTT+R+MRR group (16 PD) than the FTT+FA group (6 PD). Although the difference in the amount of correction was not statistically significant (P = .071), the difference in the amount of drift was statistically significant (P = .009). CONCLUSIONS: There was a trend toward greater correction with PTT+R+MRR than FTT+ FA, but it was not statistically significant. FTT+FA had significantly less postoperative drift than PTT+R+MRR. The results suggest that a small immediate postoperative overcorrection may be desirable in some VRT procedures. [J Pediatr Ophthalmol Strabismus. 2019;56(4):238-242.].


Assuntos
Doenças do Nervo Abducente/cirurgia , Esotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Doenças do Nervo Abducente/complicações , Doenças do Nervo Abducente/fisiopatologia , Esotropia/etiologia , Esotropia/fisiopatologia , Seguimentos , Humanos , Músculos Oculomotores/fisiopatologia , Período Pós-Operatório , Estudos Retrospectivos
5.
Jpn J Ophthalmol ; 63(4): 337-343, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31006061

RESUMO

PURPOSE: To present cases with idiopathic third and sixth cranial nerve neuritis. STUDY DESIGN: Retrospective observational study METHODS: The results of high resolution pre- and post- cranial nerve magnetic resonance images (MRI) with three-dimensional sequences for visualizing cranial nerves in patients with third, fourth, and sixth cranial nerve palsies who were treated at the Neuro-ophthalmology Department of Samsung Medical Center were reviewed. Patients with cranial nerve enhancement confirmed by experienced radiologists were identified. The medical records of these patients were reviewed, and their demographics, clinical presentations, laboratory results, and clinical outcomes were analyzed. RESULTS: Of 265 patients with third, fourth, and sixth cranial nerve palsy, 60 were identified by high resolution MRI as having enhancement of the corresponding cranial nerve. Among these, 17 patients with infiltrative, granulomatous, or tumorous lesions were excluded. In addition, 28 patients with identifiable causes of cranial nerve palsy, such as Miller-fisher syndrome, virus infection, or radiation-induced neuropathy, as well as patients with vasculopathic risk factors, were also excluded. Ultimately, a total of 15 patients with idiopathic third and sixth cranial nerve neuritis were included in this study. The mean age of these patients was 43 ± 15 years. Eight patients had sixth cranial nerve palsy, six third cranial nerve palsy (two partial and four complete), and one patient with complete third and sixth cranial nerve palsy. Nine patients received steroid treatment. Eleven patients recovered fully within a period ranging from a few days to one year. Two patients were much improved up to 1 month after initial presentation, but were then ultimately lost to follow-up. Another patient was lost to follow-up after the initial work-up. The other patient lost to follow-up had partially recovered during the first 6 months. CONCLUSIONS: We present patients with idiopathic third and sixth cranial nerve neuritis. They tended to respond well to steroid treatment and to have good prognoses. In order to better understand the long-term prognosis of cranial nerve neuritis and possible association with other neurologic disorders, a larger scale and longer-term study is needed.


Assuntos
Doenças do Nervo Abducente/diagnóstico , Nervo Abducente/diagnóstico por imagem , Neurite (Inflamação)/complicações , Doenças do Nervo Oculomotor/diagnóstico , Nervo Oculomotor/diagnóstico por imagem , Nervo Abducente/fisiopatologia , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/fisiopatologia , Adulto , Idoso , Movimentos Oculares/fisiologia , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurite (Inflamação)/diagnóstico , Nervo Oculomotor/fisiopatologia , Doenças do Nervo Oculomotor/etiologia , Doenças do Nervo Oculomotor/fisiopatologia , Estudos Retrospectivos , Adulto Jovem
6.
Graefes Arch Clin Exp Ophthalmol ; 257(1): 199-205, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30182295

RESUMO

BACKGROUND: To investigate prognostic factors in patients with augmented superior rectus transposition (SRT) for sixth nerve palsy. METHODS: Thirteen patients who were diagnosed with sixth nerve palsy and underwent augmented SRT between January 2015 and February 2017 in EENT Hospital of Fudan University were reviewed retrospectively. Data including age, sex, etiology of the abducens nerve palsy, degree of pre- and postoperative deviation in the primary position, pre- and postoperative abduction deficit, any induced vertical or torsional deviations, reoperations, and other complications was collected. Patients with undercorrection of SRT surgeries received additional inferior rectus transposition (IRT) surgery. RESULTS: Mean esodeviation in primary position improved from 81.92△ to 30.54△ (p < 0.001) with a 1.54-unit improvement in abduction (p = 0.001). Six patients achieved alignment defined as esodeviation in primary position within 10△ of orthotropia and seven patients were undercorrected after the first SRT surgery. Multivariable linear regression analysis showed that among factors (disease duration, preoperative esodeviation, preoperative abduction deficit), only the degree of preoperative abduction deficit (ß = - 13.68) was the prognostic factor for success of SRT surgery. After IRT procedures, the mean esodeviation in primary position improved from 40△ to 8△ (p < 0.01). CONCLUSION: The degree of preoperative abduction deficit is the prognostic factor for augmented SRT for sixth nerve palsy. Patients with worse abduction deficit have a greater likelihood of needing a secondary operation, and IRT could be a good choice for reoperation after SRT.


Assuntos
Doenças do Nervo Abducente/complicações , Esotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Doenças do Nervo Abducente/fisiopatologia , Adulto , Idoso , Esotropia/etiologia , Esotropia/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
8.
Rom J Ophthalmol ; 63(4): 375-378, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31915737

RESUMO

Objective: To describe an isolated unilateral sixth nerve palsy, as a rare neuro-ophthalmic presentation of nasopharyngeal carcinoma. Methods: We report a 54-year-old female, known case of nasopharyngeal carcinoma who was treated with chemo-radiotherapy, and presented with isolated right sixth nerve palsy. Magnetic resonance imaging (MRI) indicated extension of tumor to intracranial fossa with clival involvement. Results: The patient was referred to an otolaryngologist for further evaluation and necessary intervention due to invasion of the cancer to intracranial fossa with involvement of right abducens nerve. Conclusions: Although, isolated sixth nerve palsies in adults over the age of 50 are usually ischemic; but in enduring cases, neoplastic processes should be considered.


Assuntos
Doenças do Nervo Abducente/complicações , Diplopia/etiologia , Movimentos Oculares/fisiologia , Carcinoma Nasofaríngeo/complicações , Neoplasias Nasofaríngeas/complicações , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Diplopia/diagnóstico , Diplopia/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico
9.
PLoS One ; 13(9): e0204078, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30226873

RESUMO

AIM: To investigate the performance of a newly developed three-dimensional (3D) biomechanical model in various transposition procedures for correction of complete sixth nerve palsy with educational purpose. METHODS: A 3D biomechanical eye model was created using Hyperworks software based on geometry data and the biochemical properties of the eyeball and extraocular muscles. A complete sixth nerve palsy model was achieved via modification of lateral rectus muscle strength. Four different muscle transposition procedures (the Hummelsheim, Jensen, Foster, and muscle union procedures) were set up, and the objective surgical effect of each procedure was calculated using 3D model simulation. RESULTS: In the 3D simulation, sixth nerve palsy was modeled by rotating the eye 34.16 degrees in the medial direction, consistent with 70 prism diopter (PD) esotropia. In surgical model simulation, the Hummelsheim procedure resulted in a 28 PD reduction of total deviation, the Jensen procedure achieved a 34 PD reduction, the Foster procedure led to a 57 PD reduction, the muscle union procedure yielded a 57 PD reduction in esotropia in sixth nerve palsy. CONCLUSION: The 3D simulation provided a consistent model of sixth nerve palsy and objective data excluding the potential for variation of surgical skill. It could also help predict surgical outcomes.


Assuntos
Fenômenos Biomecânicos/fisiologia , Movimentos Oculares/fisiologia , Fenômenos Fisiológicos Oculares , Músculos Oculomotores/fisiologia , Software , Doenças do Nervo Abducente/fisiopatologia , Adulto , Esotropia , Feminino , Humanos , Músculos Oculomotores/diagnóstico por imagem , Procedimentos Cirúrgicos Oftalmológicos
10.
Korean J Ophthalmol ; 32(3): 221-227, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29770635

RESUMO

PURPOSE: This study aimed to evaluate the clinical course and prognostic factors of acquired third, fourth, and sixth cranial nerve (CN) palsy grouped according to etiology. METHODS: This study involved a retrospective review of the medical records of 153 patients who were diagnosed with acquired paralytic strabismus from January 2004 to July 2015. Outcomes, recovery rates, and time to recovery were investigated according to the affected CN: CN3, CN4, and CN6 palsies. The patients were classified into four groups based on etiology: idiopathic, traumatic, neoplastic, and vascular. RESULTS: The mean age of the patients was 59.8 ± 14.5 years and the mean follow-up period was 10.8 months. Out of the 153 patients, 63 (41.2%) had CN3 palsy, 35 (22.9%) had CN4 palsy, and 55 (35.9%) had CN6 palsy. The most common causes were vascular related (54.9%), followed by idiopathic (28.1%), trauma (8.5%), and neoplasm (5.88%). About 50% of the patients recovered within six months. Among the four etiologic groups, the idiopathic group showed the best prognosis because about 50% of the patients in this group recovered within three months. This was followed by the vascular, traumatic, and neoplastic groups. Cox proportional hazard analysis revealed a significant association between the baseline prism diopter and recovery rate. CONCLUSIONS: The prognosis and natural history of paralytic strabismus vary depending on its cause. The vascular group had the best recovery rate and shortest recovery time, whereas the neoplastic group required the longest time to recover.


Assuntos
Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Oculomotor/diagnóstico , Estrabismo/diagnóstico , Doenças do Nervo Troclear/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/inervação , Músculos Oculomotores/fisiopatologia , Doenças do Nervo Oculomotor/fisiopatologia , Prognóstico , República da Coreia , Estudos Retrospectivos , Estrabismo/fisiopatologia , Doenças do Nervo Troclear/fisiopatologia
11.
Graefes Arch Clin Exp Ophthalmol ; 256(5): 983-987, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29299740

RESUMO

PURPOSE: Superior rectus transposition (SRT) with medial rectus recession has been used for the treatment of sixth nerve palsy and esotropic Duane retraction syndrome (DRS). The purpose of this study was to compare the results of augmented SRT (with scleral fixation) without medial rectus recession in DRS and sixth nerve palsy. METHODS: Patients with unilateral esotropic DRS (DRS group) and sixth nerve palsy were included in this prospective, comparative study and underwent SRT. Preoperative forced duction testing was negative or slightly positive in both groups. Prospective measurements were compared between the two groups. RESULTS: There were 11 patients in the DRS group and 11 patients in the sixth nerve palsy group. The mean preoperative esotropia decreased from 20.9 ± 6.0 prism diopter (PD) at far to 13.2 ± 5.8 PD in the DRS group (P = 0.003). The same measurement improved from 28.0 ± 8.5 PD to 8.4 ± 7.3 PD in the sixth nerve palsy group (P = 0.003). In the sixth nerve palsy group, the improvement in primary gaze esotropia and abnormal head posture was more than the DRS group (Both P < 0.001).The average dose effect for SRT was 7.8 ± 2.2 PD in the DRS group and 19.2 ± 4.6 PD in the sixth nerve palsy group. Although objective intorsion was significantly induced after SRT, subjective torsion was not significant after surgery in both groups. CONCLUSION: SRT appears to be more effective in improving primary gaze deviation and head posture in sixth nerve palsy compared with DRS. Subjective torsional and vertical diplopia were rare in both groups.


Assuntos
Doenças do Nervo Abducente/cirurgia , Síndrome da Retração Ocular/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/transplante , Procedimentos Cirúrgicos Oftalmológicos/métodos , Doenças do Nervo Abducente/fisiopatologia , Adulto , Diplopia/fisiopatologia , Síndrome da Retração Ocular/fisiopatologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Visão Binocular/fisiologia
12.
J AAPOS ; 22(1): 12-16.e1, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29199032

RESUMO

PURPOSE: To evaluate surgical outcome of superior rectus transposition (SRT) in esotropic Duane syndrome (DS) and abducens nerve palsy. METHODS: Retrospective medical record analysis of all patients with esotropic DS and abducens nerve palsy treated with SRT at our center with minimum follow-up of 6 months. Primary outcome measures were esotropia in primary position and abduction limitation. Secondary outcome measures included head turn, stereopsis, and cyclovertical deviations. RESULTS: A total of 20 eyes of 19 patients were included: 9 with DS and 10 with traumatic abducens nerve palsy. One patient had bilateral esotropic DS. Mean age of DS patients was 12.5 ± 10.1 years; of abducens nerve palsy patients, 25.4 ± 11.3 years. Medial rectus recession (MRc) of 3.5 mm was additionally performed in 5 DS eyes. An adjustable MRc 5.6 ± 2.2 mm with or without augmentation suture was performed in all abducens nerve palsy patients. In DS patients, esotropia improved from 27.5Δ ± 5.4Δ to 3.6Δ ± 6.4Δ (P < 0.001), abduction limitation reduced from -3.8 to -1.8 (P < 0.001), and head posture improved from 20° to 4° (P < 0.001) at 6 months. In abducens nerve palsy patients, esotropia improved from 51.5Δ ± 18.8Δ to 6.1Δ ± 10.7Δ (P < 0.001), abduction limitation reduced from -3.8 to -2, and head posture improved from 25° to 8° (P < 0.001). Stereopsis improved in 4 patients (P = 0.12). No patient had vertical deviation or torsional diplopia. CONCLUSIONS: In our patient cohort with esotropic DS or abducens nerve palsy, SRT reduced esotropia and improved abduction. Because of a long-term exotropic drift, initial undercorrection in the immediate postoperative period may prevent eventual overcorrection.


Assuntos
Doenças do Nervo Abducente/cirurgia , Síndrome da Retração Ocular/cirurgia , Esotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Doenças do Nervo Abducente/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Síndrome da Retração Ocular/fisiopatologia , Esotropia/fisiopatologia , Movimentos Oculares/fisiologia , Feminino , Movimentos da Cabeça/fisiologia , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
13.
J Neuroophthalmol ; 38(2): 156-159, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28837440

RESUMO

BACKGROUND: Late recurrence of visual symptoms associated with carotid-cavernous fistula (CCF), including diplopia, is uncommon and raises concern for new or recurrent fistula formation. METHODS: We report 2 patients with traumatic CCFs, where cranial nerve paresis resolved after endovascular CCF treatment only to reappear years later. RESULTS: No evidence of recurrent or new fistula formation was found. Both were treated successfully with strabismus surgery. CONCLUSIONS: Although the cause of delayed onset diplopia after successful treatment is still unknown, theories include late compression of cranial nerves within the cavernous sinus due to coil mass that can cause chronic ischemia, delayed inflammation due to a thrombophilic nidus created by the coil mass, or injury to the cranial nerves that manifests later due to decompensated strabismus.


Assuntos
Doenças do Nervo Abducente/etiologia , Fístula Carotidocavernosa/terapia , Diplopia/etiologia , Embolização Terapêutica/efeitos adversos , Doenças do Nervo Oculomotor/etiologia , Doenças do Nervo Abducente/fisiopatologia , Doenças do Nervo Abducente/cirurgia , Acidentes de Trânsito , Adulto , Fístula Carotidocavernosa/diagnóstico por imagem , Angiografia Cerebral , Diplopia/fisiopatologia , Diplopia/cirurgia , Procedimentos Endovasculares , Movimentos Oculares/fisiologia , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Doenças do Nervo Oculomotor/fisiopatologia , Doenças do Nervo Oculomotor/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Recidiva , Adulto Jovem
14.
Am Orthopt J ; 67(1): 72-79, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28904218

RESUMO

PURPOSE: To report four cases of early onset sixth-nerve palsy all of whom had eccentric fixation. METHODS: A retrospective case note review was undertaken of all cases presenting to the senior author's private and NHS practice with early onset sixth palsy between 2006 and 2012. As well as demographic information, details of ophthalmic, orthoptic, electrophysiological examinations, and radiological investigations that were extracted from the records. RESULTS: Four children with unilateral or asymmetric early onset sixth-nerve palsy were identified, of which three were congenital. All four had MRI and only one had a normal MRI. Age at presentation ranged from 14-42 months, but all four had marked esotropia and poor visual acuities in the worst affected eye with eccentric fixation, which became more easily or only noticeable after surgical correction. Three patients with congenital sixth-nerve palsy underwent vertical muscle transposition with Botulinum Toxin A (BTXA) to the ipsilateral medial rectus, and two of these patients also had Foster sutures to the transposed vertical muscles. The fourth patient had unilateral medial rectus recession and lateral rectus resection. The mean preoperative measurement was 55Δ ET (range 50-60Δ), and the mean postoperative measurement was 11Δ ET (range 16XT-25ET) at near, and 2Δ XT (range 15XT-14ET) at distance. CONCLUSIONS: We speculate that early onset paralytic strabismus due to congenital sixth-nerve palsy results in an inability to cross fixate which results in the development of eccentric fixation. Attempts to use reverse occlusion to negate the eccentric fixation failed. We therefore recommend early surgery for this condition to avoid this sequelae.


Assuntos
Doenças do Nervo Abducente/diagnóstico , Esotropia/diagnóstico , Fixação Ocular/fisiologia , Doenças do Nervo Abducente/fisiopatologia , Doenças do Nervo Abducente/cirurgia , Idade de Início , Pré-Escolar , Diagnóstico Precoce , Esotropia/fisiopatologia , Esotropia/cirurgia , Humanos , Lactente , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Resultado do Tratamento , Visão Binocular
15.
Indian J Ophthalmol ; 65(7): 636-638, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28724831

RESUMO

Abducens palsy is one of the commonly encountered cranial nerve palsies in strabismus clinic. For large-angle esotropia, due to complete abducens palsies, various vertical recti transposition (VRT) procedures have been described. Hummelsheim and Jensen's procedure are especially popular among them. Risk of anterior segment ischemia and induced vertical deviation postVRT prompt to search for better procedures to correct the esotropia and also improve the abduction. Modified Nishida's procedure (no split, no tenotomy transposition) is one of the newly described procedure in this direction. We describe three cases of complete abducens nerve palsy treated by this procedure.


Assuntos
Doenças do Nervo Abducente/complicações , Esotropia/cirurgia , Movimentos Oculares , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Criança , Esotropia/etiologia , Esotropia/fisiopatologia , Feminino , Humanos , Músculos Oculomotores/fisiopatologia , Cápsula de Tenon
17.
World Neurosurg ; 104: 883-899, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28465275

RESUMO

BACKGROUND: Limited or no literature exists identifying factors associated with functional nerve recovery in patients undergoing resection of sixth cranial nerve (CN VI) schwannomas. METHODS: A systematic review of literature was performed on CN VI schwannomas that were treated surgically. Synthesizing the findings pooled from the literature, we investigated associations of patient demographics and clinical characteristics with postsurgical CN VI functional recovery in multivariable regression models. In addition, we present the findings of an adolescent woman surgically managed for intracavernous CN VI schwannoma. Complete encasement of the cavernous segment of the internal carotid artery is unique to our case. RESULTS: We synthesized data of 32 patients from 29 studies, and our index case. Overall, the mean age of the patients was 44.0 ± 16.5 years, and approximately 52% (n = 17) were female. Most tumors were left-sided (n = 18; 54.5%), with an average size of 3.46 ± 1.71 cm. The most common location was cisternal (n = 11; 33%), followed by cavernous sinus (CS) proper (n = 9; 27%), cisterocavernous (n = 8; 24%), orbital (n = 4; 12%) and caverno-orbital (n = 1; 3%). CN VI recovery was reported in less than half the cohort (n = 14; 45%). Tumor extension in the CS was significantly associated with lesser likelihood (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.01-0.98; P = 0.048) of postsurgical CN VI recovery. Although female gender (OR, 0.86; 95% CI, 0.07-10.09; P = 0.906), large tumor size (>2.5 cm) (OR, 0.45; 95% CI, 0.07-2.89; P = 0.397), and solid consistency (OR, 0.37; 95% CI, 0.03-4.19; P = 0.421) were associated with lesser odds for recovery, these were not statistically significant. Likewise, although gross total resection (OR, 6.28; 95% CI, 0.33-118.25; P = 0.220) was associated with higher odds of nerve recovery, the estimates were statistically insignificant. CONCLUSIONS: CS involvement is associated with lesser odds for functional nerve recovery in patients undergoing surgical resection for CN VI schwannoma.


Assuntos
Doenças do Nervo Abducente/fisiopatologia , Doenças do Nervo Abducente/cirurgia , Nervo Abducente/fisiopatologia , Nervo Abducente/cirurgia , Neoplasias dos Nervos Cranianos/fisiopatologia , Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/fisiopatologia , Neurilemoma/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Radiocirurgia , Recuperação de Função Fisiológica/fisiologia , Adolescente , Adulto , Idoso , Seio Cavernoso/fisiopatologia , Seio Cavernoso/cirurgia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Adulto Jovem
18.
Am J Ophthalmol ; 177: 100-105, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28249714

RESUMO

PURPOSE: To compare the effectiveness of superior rectus transposition and medial rectus recession (SRT/MRc) vs inferior and superior rectus transposition (VRT) for acquired sixth nerve palsy. DESIGN: Consecutive, interventional case series. METHODS: The medical records of a consecutive series of patients with acquired sixth nerve palsy who underwent VRT or SRT/MRc by a single surgeon were reviewed. The preoperative and postoperative findings were compared between the 2 groups. RESULTS: Eight patients (mean age, 46.8 years) underwent SRT/MRc and 8 patients underwent VRT (mean age, 51.1 years). Lateral fixation was performed on all but 4 patients in the VRT group. Preoperative esotropia in primary position and abduction deficit were similar in both groups (SRT/MRc, 41.9 prism diopter [PD], -4.6; VRT, 55.6 PD, -4.5; P = .195, 1.0). The SRT/MRc group underwent a mean MR recession of 6 (range, 5-7) mm. Four patients in the VRT later underwent MR recession (mean 5.3 mm, range 5-6 mm). In addition, 5 patients in the VRT group had 1 or more botulinum toxin injections in the medial rectus muscle. No additional procedures were performed in the SRT/MR group. Fewer additional procedures were performed with SRT/MR (SRT/MR, 0; VRT, 1.8 ± 1.2; P < .010). At last follow-up, residual esotropia (SRT/MRc, 7.1 PD; VRT, 10.3 PD; P = .442) was similar in both groups, but abduction was better in the SRT/MRc group (SRT/MR, -3.0 ± 0.7; VRT, -3.8 ± 0.4; P = .038). There were no new persistent vertical deviations or torsional diplopia. CONCLUSIONS: Final outcomes were similar with SRT/MRc vs VRT. However, fewer additional surgical procedures were needed with SRT/MR.


Assuntos
Doenças do Nervo Abducente/cirurgia , Diplopia/cirurgia , Esotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Doenças do Nervo Abducente/complicações , Doenças do Nervo Abducente/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Diplopia/etiologia , Diplopia/fisiopatologia , Esotropia/complicações , Esotropia/fisiopatologia , Movimentos Oculares , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Am J Ophthalmol ; 177: 126-130, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28254627

RESUMO

PURPOSE: Superior rectus transposition has been popularized for the treatment of abduction deficiencies. Potential complications include induced vertical deviation and torsion. A new procedure, the inferior rectus transposition (IRT), may be similarly beneficial for patients at risk for postoperative vertical deviation or incyclotropia. The purpose of this study is to describe the outcomes of patients undergoing IRT. DESIGN: Prospective, interventional case series. METHODS: Five patients in an academic pediatric ophthalmology and strabismus practice with a complete lateral rectus palsy who underwent IRT were studied. Changes in anomalous head posture, ocular rotations, ocular alignment, and torsion preoperatively to postoperatively were compared. RESULTS: The patients ranged in age from 19-89 years. There was a significant correction in the angle of esotropia (ET) from 39±17Δ (14-55Δ) to 12 ± 9.8Δ (0-22Δ) postoperatively (P = .02). Two of 5 patients had preoperative hypertropia of the affected eye (1.4 ± 2.2Δ; range, 2-5Δ). One of those had no vertical deviation postoperatively and 1 patient resulted in 2Δ hypotropia. One patient without vertical misalignment preoperatively developed a small postoperative vertical deviation. Torticollis significantly improved from 31.4 ± 11.6° to 5 ± 5.8° (P = .004). All patients improved abduction, with a mean of -4.4 ± 0.5 preoperatively to -3.4 ± 0.9 postoperatively (P = .07). CONCLUSION: Initial postoperative follow-up in patients with abducens palsy undergoing IRT shows a significant improvement in ocular alignment and torticollis. In patients with preoperative hypertropia, IRT resulted in a downward shifting effect on the operated eye. IRT may be a beneficial procedure for patients with preoperative hypertropia or intorsion requiring transposition procedures. Future studies with larger populations and longer durations of follow-up will be required before this procedure can be recommended.


Assuntos
Doenças do Nervo Abducente/cirurgia , Esotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular , Doenças do Nervo Abducente/complicações , Doenças do Nervo Abducente/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Esotropia/etiologia , Esotropia/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
20.
J Med Case Rep ; 11(1): 63, 2017 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-28274277

RESUMO

BACKGROUND: Intradural extramedullary cavernous angiomas of the central nervous system are a rare type of cavernous angioma, but they can cause fatal subarachnoid hemorrhage. The efficacy of resection for this type of cavernous malformations remains uncertain. This is the first report to recommend surgical resection of these types of lesions regardless of the fatal condition. CASE PRESENTATION: Our patient was a 70-year-old Japanese man who experienced a sudden onset of an occipital headache, followed by bilateral abducens nerve palsy. Magnetic resonance imaging revealed a small amount of hemorrhage in both of the lateral ventricles and an intradural extramedullary mass lesion in the left side of his foramen magnum. Two weeks after the appearance of initial symptoms, he became comatose. A computed tomography scan showed an increase in the subarachnoid intraventricular hemorrhaging and of the acute hydrocephalus. Following ventricular drainage, total tumor resection was performed using the lateral suboccipital transcondylar approach in conjunction with a first cervical hemilaminectomy. We observed a grape-like vascular-rich tumor with calcification that was adhering tightly to the wall of his left vertebral artery. A histopathological examination of the surgery specimen identified it as a cavernous angioma. After placement of a ventriculoperitoneal shunt and 2 months of rehabilitation, he recovered completely. CONCLUSIONS: An intradural extramedullary foramen magnum cavernous malformation is quite rare. The fragile surface of our patient's lesion was causing repeated subarachnoid hemorrhage and consequently progressive fatal neurological deterioration. Surgical resection of the lesion to prevent repeated hemorrhage was performed and he recovered fully. Therefore, we recommend surgical resection of the lesion regardless of the potentially fatal condition.


Assuntos
Doenças do Nervo Abducente/fisiopatologia , Forame Magno/patologia , Hemangioma Cavernoso/diagnóstico , Malformações Arteriovenosas Intracranianas/diagnóstico , Imagem por Ressonância Magnética , Hemorragia Subaracnóidea/diagnóstico , Derivação Ventriculoperitoneal/métodos , Doenças do Nervo Abducente/etiologia , Idoso , Cefaleia/etiologia , Hemangioma Cavernoso/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
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