Abducent nerve palsy treated by microvascular decompression: a case report and review of the literature

Abstract

Too few cases of isolated abducent nerve palsy caused by neurovascular compression syndrome have been reported. We here report on a case of abducent nerve palsy caused by neurovascular compression syndrome that was successfully treated by microvascular decompression (MVD). A 46-year-old male presented with a 6-month history of right-sided persistent abducent nerve palsy. High-resolution magnetic resonance imaging revealed a neurovascular contact of the vertebral artery with the right abducent nerve. MVD was performed via a retrosigmoid craniotomy, with remarkable improvement of the palsy. Our report suggests that MVD might be considered as an optional treatment if the symptoms progress or persist.

Magnetic resonance imaging findings of isolated abducent nerve palsy induced by vascular compression of vertebrobasilar dolichoectasia

“…[4,5,11,15] As recent reports showed, heavy T2-weighted imaging (WI), constructive interference in steady state (CISS), and FIESTA are essential to demonstrate vascular compression of the abducent nerve. [3,[6][7][8][9][10][12][13][14] Additional MRA source images may be useful to distinguish the compressed abducent nerve from AICA, which was shown in our report.…”

“…To the best of our knowledge, 15 cases with abducent nerve palsy due to nonaneurysmal vascular compression have been reported. [3][4][5][6][7][8][9][10][11][12][13][14][15] We summarize them in Table 1 in chronological order. Interestingly, all cases except for Case No.…”

“…Microvascular decompression (MVD) was performed for only two cases in which abducent nerve palsy was completely resolved, and Yamazaki et al and De Ridder and Menovsky similarly mentioned MVD as a treatment option. [3,14] In their reports, the cisternal portion of the abducent nerve is more difficult to reach than the trigeminal or facial nerves, which are easily detected in MVD for trigeminal neuralgia and hemifacial spasm. King et al reported that about 70% of cases with isolated abducent nerve palsy of an undetermined etiology resolved spontaneously within 4-6 months.…”

“…[2] Therefore, Yamazaki et al stated the importance of considering the surgical indication, for example, the age or daily activity of patients. [14] Four cases did not have descriptions of treatments or outcomes. [7,11,13] Ophthalmological treatment was performed in two cases.…”

“…In such cases, diabetes mellitus or hypertension is a possible cause; however, some cases show no potential causes of isolated abducent nerve palsy. [1,2] Recently, patients with abducent nerve palsy due to neurovascular compression have been reported; [3][4][5][6][7][8][9][10][11][12][13][14][15] however, only a few report showed neurovascular compression clearly. Here, we report a patient with isolated abducent nerve palsy induced by neurovascular compression of vertebrobasilar dolichoectasia, which MRI with fast imaging employing steady-state acquisition (FIESTA) and magnetic resonance angiography (MRA) source images clearly showed.…”