BACKGROUND Aneurysm compression,diabetes,and traumatic brain injury are well-known causative factors of oculomotor nerve palsy(ONP),while cases of ONP induced by neurovascular conflicts have rarely been reported in th...BACKGROUND Aneurysm compression,diabetes,and traumatic brain injury are well-known causative factors of oculomotor nerve palsy(ONP),while cases of ONP induced by neurovascular conflicts have rarely been reported in the medical community.Here,we report a typical case of ONP caused by right posterior cerebral artery(PCA)compression to increase neurosurgeons’awareness of the disease and reduce misdiagnosis and recurrence.CASE SUMMARY A 54-year-old man without a known medical history presented with right ONP for the past 5 years.The patient presented to the hospital with right ptosis,diplopia,anisocoria(rt 5 mm,lt 2.5 mm),loss of duction in all directions,abduction,and light impaired pupillary reflexes.Magnetic resonance angiography and computed tomography venography examinations showed no phlebangioma,aneurysm,or intracranial lesion.After conducting oral glucose tolerance and prostigmin tests,diabetes and myasthenia gravis were excluded.Cranial nerve magnetic resonance imaging showed that the right PCA loop was in direct contact with the cisternal segment of the right oculomotor nerve(ON).Microvascular decompression(MVD)of the culprit vessel from the ON through a right subtemporal craniotomy was carried out,and the ONP symptoms were significantly relieved after 3 mo.CONCLUSION Vascular compression of the ON is a rare pathogeny of ONP that may be refractory to drug therapy and ophthalmic strabismus surgery.MVD is an effective treatment for ONP induced by neurovascular compression.展开更多
目的分析三维可变翻转角快速自旋回波序列(3D-sampling perfection with application-optimized contrasts by using different flip angle evolutions,3D-SPACE)联合三维时间飞跃法磁共振血管成像(3D-time of flight magnetic resonanc...目的分析三维可变翻转角快速自旋回波序列(3D-sampling perfection with application-optimized contrasts by using different flip angle evolutions,3D-SPACE)联合三维时间飞跃法磁共振血管成像(3D-time of flight magnetic resonance angiography,3D-TOF-MRA)融合技术在行伽马刀治疗前对三叉神经显示、定位的精准性。方法选取西安大兴医院临床诊断为三叉神经痛拟行伽马刀治疗的患者28例,均行3D-SPACE及3D-TOF-MRA成像,观察三叉神经颅内段与邻近神经血管的关系,评估术前两种序列融合技术对三叉神经血管压迫的检出率及精准性。结果28例患者中,3D-SPACE联合3D-TOF-MRA序列融合技术检出有症状侧三叉神经血管压迫28例,其中右侧17例(2级2例,3级8例,4级7例),左侧11例(3级3例,4级8例),检出率为100%。结论3D-SPACE联合3D-TOF-MRA序列融合技术可以清晰显示三叉神经颅内段与周围神经血管的位置关系,为伽马刀治疗靶区勾画可提供精准的定位信息。展开更多
基金Supported by National Natural Science Foundation of China,No.32070791the Key Scientific Research Projects of Military Logistics,No.BWJ20J002.
文摘BACKGROUND Aneurysm compression,diabetes,and traumatic brain injury are well-known causative factors of oculomotor nerve palsy(ONP),while cases of ONP induced by neurovascular conflicts have rarely been reported in the medical community.Here,we report a typical case of ONP caused by right posterior cerebral artery(PCA)compression to increase neurosurgeons’awareness of the disease and reduce misdiagnosis and recurrence.CASE SUMMARY A 54-year-old man without a known medical history presented with right ONP for the past 5 years.The patient presented to the hospital with right ptosis,diplopia,anisocoria(rt 5 mm,lt 2.5 mm),loss of duction in all directions,abduction,and light impaired pupillary reflexes.Magnetic resonance angiography and computed tomography venography examinations showed no phlebangioma,aneurysm,or intracranial lesion.After conducting oral glucose tolerance and prostigmin tests,diabetes and myasthenia gravis were excluded.Cranial nerve magnetic resonance imaging showed that the right PCA loop was in direct contact with the cisternal segment of the right oculomotor nerve(ON).Microvascular decompression(MVD)of the culprit vessel from the ON through a right subtemporal craniotomy was carried out,and the ONP symptoms were significantly relieved after 3 mo.CONCLUSION Vascular compression of the ON is a rare pathogeny of ONP that may be refractory to drug therapy and ophthalmic strabismus surgery.MVD is an effective treatment for ONP induced by neurovascular compression.
文摘目的分析三维可变翻转角快速自旋回波序列(3D-sampling perfection with application-optimized contrasts by using different flip angle evolutions,3D-SPACE)联合三维时间飞跃法磁共振血管成像(3D-time of flight magnetic resonance angiography,3D-TOF-MRA)融合技术在行伽马刀治疗前对三叉神经显示、定位的精准性。方法选取西安大兴医院临床诊断为三叉神经痛拟行伽马刀治疗的患者28例,均行3D-SPACE及3D-TOF-MRA成像,观察三叉神经颅内段与邻近神经血管的关系,评估术前两种序列融合技术对三叉神经血管压迫的检出率及精准性。结果28例患者中,3D-SPACE联合3D-TOF-MRA序列融合技术检出有症状侧三叉神经血管压迫28例,其中右侧17例(2级2例,3级8例,4级7例),左侧11例(3级3例,4级8例),检出率为100%。结论3D-SPACE联合3D-TOF-MRA序列融合技术可以清晰显示三叉神经颅内段与周围神经血管的位置关系,为伽马刀治疗靶区勾画可提供精准的定位信息。
