- Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Quebec, Canada
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
Michel W. Bojanowski
Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Quebec, Canada
DOI:10.4103/2152-7806.137754Copyright: © 2014 Obaid S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Obaid S, Li S, Denis D, Weil AG, Bojanowski MW. Resection of an oculomotor nerve cavernous angioma. Surg Neurol Int 30-Jul-2014;5:
How to cite this URL: Obaid S, Li S, Denis D, Weil AG, Bojanowski MW. Resection of an oculomotor nerve cavernous angioma. Surg Neurol Int 30-Jul-2014;5:. Available from: http://sni.wpengine.com/surgicalint_articles/resection-of-an-oculomotor-nerve-cavernous-angioma/
Background:Cavernous angiomas (CAs) of cranial nerves are rare, and their occurrence on the third cranial nerve is particularly rare. Surgical management of such CAs involving the third nerve is controversial. We describe a case of a symptomatic CA of the oculomotor nerve and review the literature in order to ascertain the relevance of surgical intervention.
Case Description:A 71-year-old male patient presented with a 2-month history of progressive oculomotor nerve paralysis. CA of the oculomotor nerve was suspected on magnetic resonance imaging (MRI). The patient underwent complete resection of the CA through a subtemporal approach, preserving the integrity of the nerve. Histopathological analysis confirmed the diagnosis of CA. Despite optimal resection, the patient did not improve postoperatively.
Conclusion:CAs of cranial nerves can cause rapid or progressive neurological deterioration. Whereas delayed treatment often leads to irreversible deficits, early nerve-sparing surgical excision of the CAs may potentially restore function.
Keywords: Cavernoma, cavernous angioma, oculomotor nerve, third nerve palsy
Cavernous angiomas (CAs) are common cerebrovascular malformations often diagnosed in the fourth or fifth decade of life.[
We describe a case of a symptomatic CA of the oculomotor nerve presenting with acute nerve palsy that failed to improve following surgical resection. We review the literature on surgical cases of the oculomotor nerve CA and discuss the outcome in terms of recovery of nerve function.
A 71-year-old male without significant medical history presented with sudden binocular diplopia and left frontal headache. Physical examination 48 h after onset of symptoms revealed a partial third cranial nerve palsy on the left side. Initial cerebral magnetic resonance imaging (MRI) demonstrated an 8 mm oval lesion in the anterior left interpeduncular cistern that was hyperintense on T1 and heterogeneous on T2-weighted images [
Surgery was performed 2 months after onset of symptoms. Through a left subtemporal approach, exposure of the interpeduncular cistern revealed a raspberry-like lesion bulging from the third cranial nerve, anterolateral to the left cerebral peduncle [
(a) Intraoperative image disclosing a raspberry-like lesion arising within the left oculomotor nerve in the interpeduncular cistern. (b,c) Postresection image revealing the decompressed third nerve with preservation of nerve continuity despite its deformity (arrow head) and the intact contralateral oculomotor nerve (long arrow). (d) Postoperative CT scan showing gross total resection
Postoperative computed tomography (CT) scan showed no complication [
We found eight surgical cases of oculomotor nerve CA [
In the six patients with oculomotor nerve palsy, three cases presented acutely with complete oculomotor nerve palsy in less than 24 h,[
Seven of the eight cases of oculomotor nerve CA had partial or total resection of the lesion [
Cerebral CAs are circumscribed, mulberrry-like lesions consisting of thin hyalinized capillary channels without intervening parenchyma.[
Our review of this rare pathology showed that the clinical presentation of oculomotor nerve CA is variable. A third cranial nerve CA located in the oculomotor triangle can compress the optic nerve superomedially[
Including our case, five patients underwent CA resection with preservation of nerve integrity. Two of these had recovery of oculomotor nerve function. As seen in the case reported by Park et al. in 2005, slowly progressive and incomplete oculomotor nerve deficit at presentation might allow a better chance of neurological recovery after surgery if the nerve is preserved. Although the completeness of oculomotor palsy may be a negative prognostic factor for nerve function recovery, one case reveals that early complete oculomotor palsy can be totally reversed with prompt total resection.[
CAs of the third cranial nerve can cause rapid and progressive neurological deterioration. Whereas delayed treatment often leads to irreversible deficits, early surgical intervention with preservation of the nerve may potentially allow for improvement of nerve function.
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