J Cerebrovasc Endovasc Neurosurg.  2020 Jun;22(2):85-89. 10.7461/jcen.2020.22.2.85.

Microvascular decompression of the posterior cerebral artery for treatment of oculomotor nerve palsy

• Pomeraniec IJ
• Ding D
• Ksendzovsky A
• Liu KC

• KMID: 2503821
• DOI: http://doi.org/10.7461/jcen.2020.22.2.85

Abstract

Oculomotor nerve palsy resulting from non-aneurysmal vascular compression is extremely rare. Microvascular decompression (MVD) has been previously shown to improve oculomotor nerve palsy (ONP) secondary to arterial compression. A 71-year-old female, with a history of Cushing’s disease previously treated with two transsphenoidal resections and Gamma Knife radiosurgery, presented with one year of progressive left eye diplopia and was diagnosed with a partial left oculomotor nerve palsy. We performed an orbitozygomatic craniotomy for MVD of the left posterior cerebral artery, which was found to be compressing the oculomotor nerve against the tentorium. Unfortunately, the patient’s partial ONP remained unchanged at one year follow-up. The present case suggests inconsistent outcomes of MVD for ONP. Patients with prior sellar or parasellar irradiation may be less likely to benefit from this treatment approach.

Keyword

Microsurgery; Microvascular decompression; Oculomotor nerve; Posterior cerebral artery; Skull base

Figure

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  Fig. 1 (A) Preoperative brain MRI, axial 3D-sampling perfection with application optimized contrasts using different flip-angle evolution (SPACE) sequence, shows compression of the left CN III between the PCA and SCA at the P1–P2 junction. Beyond this point of compression, the nerve is decreased in volume (not shown). (B) Intraoperative photograph, from a transsylvian approach through a left-sided modified orbitozygomatic craniotomy, shows compression of CN III, which appears flattened, by the PCA (elevated by an instrument) against the tentorium. (C) Intraoperative photograph after placement of a cottonoid buffer (asterisk) between CN III and the PCA. (D) Postoperative MRI, axial 3D-SPACE sequence, shows a small cerebrospinal fluid space between CN III and the left PCA and SCA. MRI, magnetic resonance imaging; PCA, posterior cerebral artery; SCA, superior cerebellar artery, PCOM, posterior communicating artery; ICA, internal carotid artery; MCA, middle cerebral artery; ACA, anterior cerebral artery.

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