The oculomotor neurovascular conflict: Literature review and proposal of management

Belotti, Francesco; Zanin, Luca; Fontanella, Marco Maria; Panciani, Pier Paolo

doi:10.1016/j.clineuro.2020.105920

Cited by 8 publications

(8 citation statements)

References 38 publications

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“…However, high-resolution thin-sliced MRI has been found to be increasingly accurate in identifying and correlating symptoms with the extent of neurovascular compression, and thus should remain a differential diagnosis . This is of clinical significance, as cases with extensive negative workup are often labeled as idiopathic or attributed to microvascular causes, which are conservatively managed with observation, whereas the treatment options of neurovascular conflict causing oculomotor nerve palsy ranges from the use of steroids to microvascular decompression …”

Section: Discussionmentioning

confidence: 99%

A Conflicting Case of Ophthalmoparesis

Cheng

2022

JAMA Neurol

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Section: Discussionmentioning

confidence: 99%

A Conflicting Case of Ophthalmoparesis

Cheng

2022

JAMA Neurol

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“…However, some studies suggest that mechanical compression caused by abnormal structures, such as aneurysms and intracranial lesions, can result in axonal membrane instability and nerve ischemia, which would further induce segmental demyelination and ephaptic neural transmission hyperexcitability[ 4 ]. Additionally, an acute reaction of pulsations on the ON may clarify the acute presentation of ONP[ 5 ], whereas the ischemic effect of pulsations and the atherosclerotic deformation associated with aging may explain the chronic and persistent forms of this condition[ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Reviewing the related literature, we identified that ONP caused by non-aneurysmal vascular compression has for long been defined as persistent palsy or as oculomotor neuromyotonia (ONM) with an intermittent presentation[ 7 ]. We identified 43 cases ( and Table 1 ) of oculomotor involvement attribute to isolated neurovascular conflict, whereas only 12 cases, including our current case, were treated with MVD (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…MVD is only considered applicable for some patients with ONP who did not respond well to conservative treatment[ 22 ]. Additionally, MVD is also available for ONM, but it should be avoided when risks exceed benefits[ 7 ]. Until now, just anecdotal evidence recommended that MVD is an effective operative method (Table 1 ), and there are still some controversial opinions regarding the use of surgical approaches.…”

Section: Discussionmentioning

confidence: 99%

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Microvascular decompression for a patient with oculomotor palsy caused by posterior cerebral artery compression: A case report and literature review

Zhang¹,

Wei²,

Wang³

et al. 2022

WJCC

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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.

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“…After a year, the patient’s optic nerve palsy had completely resolved, and the aneurysm wall enhancement had greatly diminished. Belotti et al reported a case of ONP caused by neurovascular conflict [ 28 ]. In this case, the posterior communicating artery caused a compression of the ipsilateral oculomotor nerve.…”

Section: Discussionmentioning

confidence: 99%

Effects of endovascular treatment and prognostic factors for recovery of oculomotor nerve palsy caused by posterior communicating artery aneurysms: a multi-center retrospective analysis

Wang

Liu²,

Na³

et al. 2022

BMC Neurol

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Background Oculomotor nerve palsy (ONP) may result from posterior communicating artery (PcomA) aneurysms. We aimed to evaluate the resolution of ONP after endovascular treatment with the intention of clarifying predictors of nerve recovery in a relatively large series. Methods A total of 211 patients with ONP caused by PcomA aneurysms underwent endovascular coiling between May 2010 and December 2020 in four tertiary hospitals. We evaluated the demographics, clinical characteristics, aneurysm morphology parameters and ONP resolution to analyze the predictors of ONP recovery using univariate and multivariate analyses. Results At the last available clinical follow-up, ONP resolution was complete in 126 (59.7%) patients, partial in 73 (34.6%) patients, and no recovery in 12 (5.7%) patients. The median resolution time after endovascular treatment was 55 days (interquartile range: 40–90 days). In multivariate analysis, degree of ONP (incomplete palsy) on admission (OR 5.396; 95% CI 2.836–10.266; P < 0.001), duration of ONP (≤ 14 days) before treatment (OR 5.940; 95% CI 2.724–12.954; P < 0.001) were statistically significant predictors of complete recovery of ONP. In the subgroup analysis of patients with unruptured aneurysms, aspirin showed a higher complete recovery rate in univariate analysis (OR 2.652; 95% CI 1.057–6.656; P = 0.038). Conclusion Initial incomplete ONP and early management might predict better recovery of ONP after endovascular treatment.

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The oculomotor neurovascular conflict: Literature review and proposal of management

Cited by 8 publications

References 38 publications

A Conflicting Case of Ophthalmoparesis

A Conflicting Case of Ophthalmoparesis

Microvascular decompression for a patient with oculomotor palsy caused by posterior cerebral artery compression: A case report and literature review

Effects of endovascular treatment and prognostic factors for recovery of oculomotor nerve palsy caused by posterior communicating artery aneurysms: a multi-center retrospective analysis

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