Physiotherapy in Postinfection Injury to Cranial Nerves III, IV, and VI: A Case Study.

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.

Paresia transitoria del nervio troclear tras angioplastia percutánea / Transient trochlear nerve palsy following percutaneous angioplasty

CASO CLÍNICO: Presentamos el caso de un varón de 63 años con paresia troclear unilateral derecha que comenzó con diplopía vertical tras someterse a una angiografía coronaria programada con intervención percutánea coronaria por vía radial. Se resolvió espontáneamente en 2 meses. DISCUSIÓN: La oftalmoplejía tras la realización de angioplastia percutánea coronaria es una situación rara. Solamente se han descrito oftalmoplejías internucleares y paresias de los pares craneales III y VI tras angioplastias percutáneas, siendo este el primer caso de oftalmoplejía aislada del IV par craneal unilateral descrito tras dicho procedimiento

CASE REPORT: A case is presented of a 63-year-old man who suffered a unilateral isolated trochlear nerve palsy with vertical diplopia following an elective radial coronary angiography and percutaneous coronary intervention, which resolved spontaneously within 2 months. DISCUSSION: Ophthalmoplegia following coronary percutaneous angioplasty is rare. Only internuclear ophthalmoplegia, III and VI cranial nerve palsy have been previously reported following percutaneous angioplasty. This is the first reported case of unilateral isolated trochlear nerve ophthalmoplegia following this procedure

Orbital apex syndrome after trauma in a 6-year-old - a rare occurrence.

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.

Comparing Hypertropia in Upgaze and Downgaze Distinguishes Congenital From Acquired Fourth Nerve Palsies.

BACKGROUND: Isolated fourth nerve palsies are commonly caused by decompensation of a congenitally dysfunctional superior oblique muscle ("decompensated congenital palsies"). Distinguishing such palsies at initial presentation from palsies caused by presumed microvascular ischemia ("ischemic palsies") has value for patient reassurance and in forestalling ancillary testing. Abnormally large vertical fusional amplitudes traditionally have been used to identify decompensated congenital palsies, but that may not be a reliable distinguishing feature. This study was undertaken to determine if the amount of hypertropia in upgaze and downgaze might be a more efficient separator. We also studied traumatic and tumorous fourth nerve palsies to see if they could be distinguished from decompensated congenital palsies by using this hypertropia comparison. METHODS: Retrospective review of case records of patients diagnosed with isolated fourth nerve palsies at the University of Michigan Neuro-Ophthalmology Clinics over the past 15 years. We recorded the age, gender, vascular risk factors, duration of follow-up, cause, side of palsy, and alignment measurements in all patients. RESULTS: Inclusion criteria were met by 118 patients. Hypertropia was equal or greater in upgaze than downgaze in 50 of the 58 decompensated congenital palsies (86%) in whom those data were recorded. Hypertropia was never greatest in upgaze in the 15 patients with traumatic palsies. Vertical fusional amplitudes were increased in only 15 of 27 patients (56%) with decompensated palsies in whom those data were recorded. Torsional misalignment on double Maddox rod testing was present in 16 (94%), 13 (87%), and 3 (100%) patients with ischemic, traumatic, and tumorous palsies, but also in 19 patients (54%) with decompensated congenital palsies in whom those data were recorded. CONCLUSIONS: Hypertropia greater in upgaze than downgaze or equal in upgaze and downgaze was an efficient separator of congenital from ischemic and tumorous fourth nerve palsies, being characteristic of patients with decompensated congenital palsies and never present in patients with ischemic, traumatic, or tumorous palsies. Vertical fusional amplitudes and torsional misalignment did not effectively differentiate between the patient groups. Comparing the hypertropia in upgaze and downgaze improved differential diagnosis and reduces the potential for unnecessary ancillary tests.

Delayed Superior Orbital Fissure Syndrome After Reconstruction of Blowout Fracture.

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.

Modelo murino de lesión osteocondral: alternativa para trabajos experimentales / Osteochodral lesion mouse model: an alternative for experimental work

Objetivo. Analizar un modelo murino adulto de lesión osteocondral crítica (LOC) que sea reproducible y de bajo costo para estudios de experimentación. Material y método. Se desarrolló un trabajo experimental en 20 ratones BKS, de 15 semanas, realizando una LOC en el surco troclear de 0,5 mm de diámetro. Diez animales fueron sacrificados a los 7 y 14 días tras la cirugía. Para evaluar la capacidad de reparación o regeneración del modelo, se realizó un análisis histológico, mediante tinción de hematoxilina-eosina y safranina-O, evaluando con la escala ICRS-II. Se comparó la zona de lesión con áreas de cartílago sano del mismo animal (zonas control). Las puntuaciones obtenidas (promedios) en cada grupo se compararon entre sí determinándose diferencias significativas. Resultados. En la evaluación en los días 7 y 14 se encontró una diferencia significativa entre la zona de la LOC y las zonas control, sin existir diferencias entre los 2 períodos evaluados. Conclusión. El modelo murino adulto de LOC crítica, en la tróclea femoral, es altamente reproducible. La potencialidad de regeneración innata del animal secundaria a la presencia de fisis durante la vida adulta no logró reparar adecuadamente la lesión producida sobre el cartílago articular. Este modelo permitirá la realización de nuevos estudios orientados a obtener mejores tratamientos para las patologías condrales (AU)

Objective. To report a reproducible and inexpensive model of critical osteochondral lesion (LOC) in adult mice for experimental studies Material and method. An experimental study was conducted on 20 BKS mice of 15 weeks old, in which a LOC of 0.5 mm in diameter was made in the trochlear groove. Ten animals were sacrificed at day 7, and the other 10 animals at day 14 of follow up. To assess the ability of the animal to repair/regenerate, a histological analysis was performed using hematoxylin-eosin and safranin-O stains, and the results were evaluated by the ICRS scale using areas of healthy cartilage from the same joint as control. The Mann-Whitney U test was used for the statistical analyses of scores (averages). Results. Significant differences were found in days 7 and 14 between the LOC area and control areas, but no differences were found between the day 7 and day 14. Conclusion. This model of LOC in the trochlear groove of adult mice is highly reproducible, and could be used in further studies to obtain better treatments for chondral pathologies (AU)

Neuropatía cubital secundaria a artropatía neuropática del codo por siringomielia cervicotorácica / Ulnar neuropathy due to neuropathic arthropathy of the elbow caused by cervicothoracic syringomyelia

La artropatía neuropática o articulación de Charcot es una artritis degenerativa progresiva asociada a un déficit neurosensorial con múltiples etiologías, siendo la siringomielia la segunda causa más frecuente después de la diabetes mellitus. El hombro es la articulación que con más frecuencia se afecta en miembros superiores, siendo la artropatía neuropática del codo una entidad muy poco prevalente. La neuropatía cubital es una complicación rara, que puede aparecer en los pacientes con artropatía neuropática del codo debido al atrapamiento nervioso que ocasiona la desestructuración articular. Existen muy pocos casos descritos en la literatura de neuropatía cubital secundaria a una artropatía neuropática del codo por siringomielia. El objetivo de este trabajo es presentar el caso de una paciente de 61 años con neuropatía cubital secundaria a artropatía neuropática del codo por siringomielia cervicotorácica (AU)

Neuropathic arthropathy, or Charcot joint, is a progressive degenerative arthritis with multiple causes, syringomyelia being the second most common cause after diabetes mellitus. The shoulder is the most frequently affected joint in the upper limbs, and neuropathic arthropathy of the elbow is very infrequent. Ulnar neuropathy is a complication that can occur in patients with neuropathic arthropathy of elbow due to nerve entrapment causing by joint disintegration. There are very few previous case reports of ulnar neuropathy secondary to neuropathic arthropathy of the elbow due to syringomyelia. This report describes the case of a 61-year-old woman with ulnar neuropathy due to neuropathic arthropathy of the elbow caused by cervicothoracic syringomyelia (AU)

Persistent diplopia and superior oblique muscle dysfunction following dissection of the orbital periosteum in cranial base surgery.

BACKGROUND/AIMS: Persistent diplopia secondary to a fourth cranial nerve palsy is poorly documented after open cranial base surgery. METHODS: Six cases of fourth cranial nerve palsy after cranial base surgery were drawn from the Neuro-Ophthalmology and Head and Neck Surgery Clinics at the University of Michigan from 2004 to 2012. RESULTS: Six patients developed diplopia and ocular misalignment in a pattern suggestive of superior oblique palsy following dissection of the medial orbital periosteum as part of a surgical approach to the anterior cranial base. Among the four patients in whom follow-up examination was available, the misalignment improved spontaneously in three patients and was stable in the fourth patient, but did not completely resolve in any patient. CONCLUSIONS: This sparsely documented phenomenon is likely caused by dysfunction of the superior oblique muscle, possibly the result of malposition of the trochlea after spontaneous reattachment of the periosteum. Special factors such as invasive tumours, repeated surgeries of this nature, prior radiation, or chemical cementing material that adversely affects wound healing may be contributory.

O gel de plasma rico em plaquetas propicia a regeneração da cartilagem articular do joelho de ovelhas / Platelet-rich plasma gel promotes regeneration of articular cartilage in knees of sheeps

Objetivo: Avaliar a regeneração da cartilagem articular em defeitos osteocondrais do joelho induzidos pelo plasma rico em plaquetas (PRP) autógeno. Métodos: Defeitos osteocondrais produzidos no sulco troclear de ambos os joelhos de dez ovelhas foram preenchidos com PRP autógeno à direita e deixados vazios à esquerda. Avaliação macroscópica e histológica foram efetuadas 12 semanas mais tarde. Os resultados foram avaliados por um escore geral de ambas as avaliações macroscópica e histológica comparativamente entre os lados por meio do teste pareado de Wilcoxon. Resultados: o aspecto macroscópico não foi uniforme entre os animais, nem diferiu entre os joelhos direitos e esquerdos (p=0,03125); em nenhum caso o tecido regenerado se nivelou com a cartilagem normal circundante. Ao exame histológico, cartilagem aparentemente normal não foi detectada em nenhum joelho, mas uma cartilagem pouco diferenciada estava presente em sete joelhos direitos e em três joelhos esquerdos. Tecido fibrocartilaginoso estava presente nos joelhos restantes, com diferença significante no escore geral entre os joelhos direitos e esquerdos (p=0,0313). Conclusão: o PRP como usado neste estudo tem propriedades reparativas da cartilagem articular no joelho de ovelhas, principalmente por estimular a formação de tecido fibrocartilaginoso. Trabalho Experimental.

Objective: To assess the regeneration of osteochondral defects in the joint cartilage of the knee induced by autologous platelet-rich plasma (PRP). methods: osteochondral defects produced in the trochlear groove of both knees of ten sheep; defects of the right knees were filled with autologous PRP and the left knees were left unfilled. macroscopic and microscopic evaluation was carried out 12 week later. the results were evaluated by the total score of both macroscopic and microscopic evaluations comparing the two sides through the wilcoxon paired test. Results: macroscopic appearance was not uniform among animals, nor was it different between the right and left knees (p=0.3125), and in no case the regenerated tissue was equal to the normal surrounding cartilage. At histological examination, apparently normal cartilage was not detected in any knee, but a poorly differentiated cartilage was present in 7 right knees, compared to 3 left knees. Fibrocartilaginous tissue was present in most of the remaining knees, with a significant difference in the overall score between right and left knees (p=0.0313). conclusion: the pRp as used in this study has reparative properties of the joint cartilage of sheep knees, mostly by stimulating the formation of a fibrocartilaginous tissue. Laboratory Investigation.

A novel simple real-time electrooculographic monitoring system during transsphenoidal surgeries to prevent postoperative extraocular motor nerve dysfunction.

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.

Reconstrucción de defecto troclear lateral traumático con autoinjerto de cabeza radial / Reconstruction of a traumatic lateral trochlear defect with a radial head autograft

Objetivo. Presentar el resultado de la reparación de un defecto troclear severo en el codo mediante un autoinjerto óseo con la cabeza radial ipsilateral, como una alternativa a la artroplastia total. Caso clínico. Presentamos el caso de un paciente, que sufrió una fractura abierta de codo con pérdida ósea importante en la región humeral distal, y que precisó tras la estabilización inicial una cirugía de reconstrucción mediante autoinjerto ipsilateral de cabeza radial. Discusión. Las fracturas abiertas de codo son infrecuentes. Cuando existe un defecto troclear severo, las alternativas quirúrgicas son la artroplastia total de codo, con unos resultados a corto y medio plazo que parecen ser insuficientes, o la artrodesis. Creemos que la reconstrucción del defecto empleando un autoinjerto de cabeza radial homolateral es una alternativa más funcional que los otros procedimientos descritos. Conclusión. La reconstrucción con cabeza radial ipsilateral de los defectos trocleares laterales es una técnica, que al contrario que la artrodesis, conserva la funcionalidad sin los inconvenientes de la artroplastia total de codo (AU)

Objective. To report the result of a severe articular defect secondary to a complex open fracture of the distal humerus, using the ipsilateral radial head as a bone autograft for the trochclear region as an alternative to total arthroplasty. Case report. We describe a patient who suffered an open fracture of the elbow with bone loss in the distal humeral region and, after the initial stabilisation surgery, needed a reconstruction with an ipsilateral radial head autograft. Discussion. Open fractures of elbow are rare. When there is a severe trochlear defect, surgical options are total elbow arthroplasty, where the short and medium term results appear to be insufficient, or elbow arthrodesis. We believe that reconstruction of the defect using an ipsilateral radial head autograft is a more functional alternative than the other procedures described. Conclusion. Radial head reconstruction with ipsilateral lateral trochlear defects is a technique that, unlike fusion, preserves functionality without the problems of total elbow arthroplasty (AU)

Fourth cranial nerve palsy in a collegiate lacrosse player: a case report.

OBJECTIVE: To present the case of a National Collegiate Athletic Association Division I men's lacrosse athlete with fourth cranial nerve injury as the result of a minor traumatic blow. BACKGROUND: The athlete was struck on the right side of his head during a lacrosse game. On-field evaluation revealed no cervical spine involvement or loss of consciousness. He complained of headache and dizziness, with delayed reports of visual disturbance. Sideline visual acuity and cranial nerve screenings appeared within normal limits. Consultation with the team physician indicated that immediate referral to the emergency department was unnecessary. DIFFERENTIAL DIAGNOSIS: Concussion, third cranial nerve palsy, fourth cranial nerve palsy. TREATMENT: The certified athletic trainer safely removed the athlete from the playing field and monitored him on the sideline. After being seen by the team physician, the patient was referred to a neurologist, ophthalmologist, and finally a neuro-ophthalmologist before a definitive diagnosis was made. The palsy did not necessitate surgical intervention, resolving with conservative treatment. The athlete was able to return to full athletic ability at his preinjury level by 8 months postinjury. UNIQUENESS: Superior oblique palsy as the result of fourth cranial nerve injury is the most frequent isolated cranial nerve palsy; however, these palsies are often underdiagnosed by health professionals. Such palsies are uncommon within the athletic realm, making timely diagnosis even less likely. CONCLUSIONS: Cranial nerve palsy may present very subtly in patients. Therefore, on-field health care providers should be aware of the descriptions and types of compensations that signal nerve injury.

Aetiology and outcomes of adult superior oblique palsies: a modern series.

PURPOSE: To establish the contemporary aetiology of adult superior oblique palsy (SOP). MATERIALS AND METHODS: A retrospective consecutive case series of 150 persons diagnosed with SOP between 1 January 1999 and 31 May 2005 at a neuro-ophthalmology centre in the West Midlands, the United Kingdom. Interrogating two different hospital databases identified all cases. A case note review was performed on all participants to determine demographics and aetiology based on diagnostic criteria, neuroimaging used, and outcome. RESULTS: We identified 133 unilateral isolated, 7 unilateral associated with other cranial nerve involvement, and 10 bilateral cases of SOP. Eighty-six were acquired, 51 congenital, and 13 undetermined. Of the unilateral isolated cases, 38.3% were considered to be congenital, 29.3% followed trauma, 23.3% were presumed to be vasculopathic in origin, and no cause could be established in 7.5%. All presumed microvascular-associated palsies resolved within 6 months of presentation. Unilateral SOPs associated with other cranial nerve palsies were commonly caused by trauma (71.4%), followed by tumour and undetermined causes (both 14.3%). Trauma was the most frequent cause of bilateral SOP (50%), followed by tumours and undetermined causes (both 20%), with congenital causes being uncommon (10%). CONCLUSION: We present a contemporary aetiological spectrum for adult SOP, with the lowest incidence of undetermined cases published in the medical literature. Neuroimaging did not change the management for the vast majority of cases and should be prompted by atypical presentations.

Grado de desviación en posición primaria de la mirada (PPM) en lesión del III y VI nervio / Degree of deviation in primary position in III and VI nerve injury

Objetivo: Evaluar las características en el grado de desviación en las lesiones del II y VI nervio, para establecer correlación entre cada una de las situaciones clínicas. Materiales y métodos: Se estudiaron expedientes de pacientes con lesión del III y VI nervio en el Hospital Nuestra Señora de La Luz, desde enero de 2000 hasta enero de 2005. En todos los pacientes se realizó examen oftalmológico completo, donde se evidenciara limitación de -4 ó mayor en III nervio, y limitación de la abducción de -4 ó mayor en VI nervio. Resultados: Se analizaron 71 expedientes, 31 con lesión del III nervio (11 con parálisis, 20 con paresia); 40 con lesión del VI nervio (16 con parálisis y 24 con paresia). En cuanto a la desviación media y la moda según el grado de limitación, se evidenció mayor desviación en la lesión del III nervio. Conclusiones: Las desviaciones horizontales encontradas cuando existe daño al III nervio son en general de mayor magnitud que las encontradas cuando existe daño al VI nervio.

Purpose: To evaluate characteristics in the amount of deviation in III and VI nerve palsies, to establish a correlation between each one of clinical situations. Methods: Retrospective study where the files of patients with the diagnosis of III or VI nerve injury in the Hospital Nuestra Señora de La Luz were reviewed from january of 2000 to january of 2005. All patients had a complete ophthalmologic evaluation, in whitch the deviation was noticed, and in those with an affection of the III nerve the limitation of the adduction went from -4 or more, and in those with de VI nerve affected, the limitation of the abduction went from -4 or more. Results: 71 patients were included, 31 with III nerve injury and 40 with VI nerve injury. Conclusions: Horizontal deviations found in III nerve palsies are larger than those found in VI nerve palsies.

Fourth and sixth cranial nerve injury after halo traction in children: a report of two cases.

BACKGROUND: Spinal traction is the application of a longitudinal force to the spinal column as a means of stabilizing a damaged or abnormal spine. Although not well documented in the ophthalmic literature, complications include cranial nerve palsies, with the sixth nerve being most commonly affected. Fourth nerve palsies have not previously been reported to our knowledge. We present 2 cases of combined fourth and sixth palsies after cervical traction. METHODS: Retrospectively, we reviewed the ophthalmic findings in 2 children with diplopia after spinal traction. RESULTS: Case 1 suffered a traumatic rotatory atlantoaxial subluxation and underwent halo traction. Case 2 required traction to correct a scoliosis secondary to osteogenesis imperfecta. In both cases, sixth nerve palsies were apparent soon after traction. Careful orthoptic examination revealed additional fourth nerve involvement. After 3 months, both cases showed partial resolution of the cranial nerve injuries. CONCLUSIONS: Cranial nerve injury may occur with spinal traction. Fourth nerve palsy may be underreported because of masking by a coinciding sixth nerve palsy.

[Decompensated strabismus surso-adductorius]. / Strabisme surso-adducteur décompensé.

Strabismus surso-adductorius is a frequent unilateral or bilateral eye movement disorder. Its clinical features include eye elevation with concomitant vertical deviation in adduction, an abnormal head posture from which the patient is unaware (head turned and tilted towards the healthy side), a moderate subjective excyclotorsion, and a positive Bielschowsky head tilt test. Despite its anglo-saxon denomination as "congenital fourth nerve palsy", it is not a paretic disorder. Strabismus surso-adductorius differs from fourth nerve palsy both by etiology and by symptoms. A proper diagnosis is important as neuroradiological examination is mandatory in cases of acquired non-traumatic fourth nerve palsy, whereas decompensated strabismus surso-adductorius can be operated on without any further investigations. Early on, the oculomotor disorder is often well compensated and it does manifest at the adult age. Asthenopia and intermittent vertical diplopia appear as the fusional mechanisms fade out. The best surgical technique for strabismus surso-adductorius is an inferior oblique weakening procedure. In severe cases a combined shortening of the superior oblique tendon may be necessary.

Neurotization of oculomotor, trochlear and abducent nerves in skull base surgery.

OBJECTIVE: To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. METHODS: Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed. RESULTS: Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves. CONCLUSIONS: Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.

Neurotization of oculomotor, trochlear and abducent nerves in skull base surgery / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery.</p><p><b>METHODS</b>Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.</p><p><b>RESULTS</b>Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.</p><p><b>CONCLUSIONS</b>Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.</p>