Steroids in the Management of Synkinesis after Traumatic Oculomotor Palsy in India

MacIntosh, Peter W.; Shah, Virna M

doi:10.1080/01658107.2017.1370654

Cited by 2 publications

(1 citation statement)

References 11 publications

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“…Currently, traumatic oculomotor nerve palsy is mainly treated via steroid hormones, eye movement rehabilitation and botulinum toxin treatment, lacking an established treatment plan and standardized surgical method (4,5). This lack of standarised treatment can lead to a long recovery time, with often uncertain outcome, failing to completely cure the disease (6). The symptoms of ptosis and diplopia affect the daily life of the patient, and some require reoperation by an ophthalmologist or a plastic surgeon.…”

Section: Introductionmentioning

confidence: 99%

Traumatic oculomotor nerve palsy treated with transnasal endoscopic decompression through the optic strut

Wang

Wang²,

Wu³

et al. 2023

Front. Surg.

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ObjectiveTo present a surgical treatment regimen of transnasal endoscopic decompression through the optic strut for traumatic oculomotor nerve palsy based on the anatomical study of the superior orbital fissure and the oculomotor nerve fissure segment.MethodsThe bone structure of the oculomotor nerve fissure segment and the important bone anatomical landmarks of the lateral wall of the sphenoidal sinus were identified on a dried skull and a cadaveric head, respectively, using a nasal endoscope, and a surgical plan was determined. Decompression was conducted on the orbital apex, the superior orbital fissure, the optic canal and the optic strut of the two patients in sequence, after which the degree and range of decompression were identified by three-dimensional (3D) computed tomography (CT).ResultsThe oculomotor nerve had a close correlation with the lateral surface of the optic strut. The transnasal endoscope was employed to identify the lateral optic-carotid recess (LOCR), as well as the positions of the optic nerve, internal carotid artery (ICA), and superior orbital fissure, collectively called the “optic strut triangle”. The surgical plans for decompression of the orbital apex, superior orbital fissure, optic canal, and optic strut and the necessity of optic strut drilling were determined, and the surgical procedures for safe drilling of the optic strut were elaborated. After surgery, the two patients had significantly improved symptoms, without complications. In addition, their postoperative CT showed that the medial margin of the superior orbital fissure was fully decompressed.ConclusionThe optic strut triangle is a crucial anatomical landmark in the decompression of the oculomotor nerve, and optic strut drilling is necessary for such decompression. For patients with traumatic oculomotor nerve palsy and fractures of the medial wall of the superior orbital fissure on CT, the oculomotor nerve fissure segment can be decompressed in an effective, complete and safe manner as per the surgical plan of decompressing the orbital apex, superior orbital fissure, optic canal and optic strut in turn under a transnasal endoscope, conducive to the recovery of neurological function of patients.

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Section: Introductionmentioning

confidence: 99%