Zhang J, Wei ZJ, Wang H, Yu YB, Sun HT. Microvascular decompression for a patient with oculomotor palsy caused by posterior cerebral artery compression: A case report and literature review . World J Clin Cases 2022; 10(20): 7138-7146 [PMID: 36051142 DOI: 10.12998/wjcc.v10.i20.7138]
Corresponding Author of This Article
Hongtao Sun, Doctor, Chief Doctor, Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience, Characteristic Medical Center of Chinese People’s Armed Police Force, No. 220 Chenglin Road, Tianjin 300162, China. 1019702546@qq.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 16, 2022; 10(20): 7138-7146 Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.7138
Microvascular decompression for a patient with oculomotor palsy caused by posterior cerebral artery compression: A case report and literature review
Jian Zhang, Zheng-Jun Wei, Hang Wang, Yan-Bing Yu, Hong-Tao Sun
Jian Zhang, Zheng-Jun Wei, Hang Wang, Hong-Tao Sun, Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin 300162, China
Yan-Bing Yu, Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100069, China
Author contributions: Wei ZJ and Zhang J contributed equally to this work; Wei ZJ was the patient’s surgeon and collected the data; Zhang J and Wei ZJ reviewed the literature and contributed to manuscript drafting; Wang H analyzed and interpreted the imaging findings; Yu YB and Sun HT were responsible for the revision of the manuscript for important intellectual content; All authors have read and approved the final manuscript.
Supported byNational Natural Science Foundation of China, No. 32070791; and the Key Scientific Research Projects of Military Logistics, No. BWJ20J002.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hongtao Sun, Doctor, Chief Doctor, Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience, Characteristic Medical Center of Chinese People’s Armed Police Force, No. 220 Chenglin Road, Tianjin 300162, China. 1019702546@qq.com
Received: January 20, 2022 Peer-review started: January 20, 2022 First decision: March 16, 2022 Revised: April 8, 2022 Accepted: May 27, 2022 Article in press: May 27, 2022 Published online: July 16, 2022
Abstract
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.
Core Tip: We report a rare case of typical oculomotor nerve palsy caused by neurovascular conflicts. Magnetic resonance imaging of the cranial nerve showed that the right posterior cerebral artery loop was in direct contact with the cisternal segment of the oculomotor nerve. We performed microvascular decompression to decompress the neurovascular compression excluding myasthenia gravis, aneurysm, and other eye diseases. Furthermore, the ocular symptoms were significantly relieved 3 mo after surgery. Additionally, we conducted a systematic review of the studies on oculomotor palsy and put forward our own interpretations of related results.
