Mobilization of the Transcavernous Oculomotor Nerve During Basilar Aneurysm Surgery: Biomechanical Bases for Better Outcome

Author:

Basma Jaafar1,Ryttlefors Mats12,Latini Francesco3,Pravdenkova Svetlana1,Krisht Ali1

Affiliation:

1. Arkansas Neuroscience Institute, St. Vincent's Infirmary, Little Rock, Arkansas

2. Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden

3. Division of Neurosurgery, Department of Neuroscience and Rehabilitation, Santa Anna University Hospital, Ferrara, Italy

Abstract

Abstract BACKGROUND: The transcavernous approach adds a significant exposure advantage in basilar aneurysm surgery. However, one of its frequently reported side effects is postoperative oculomotor nerve palsy. OBJECTIVE: To present the technique of mobilizing the oculomotor nerve throughout its intracranial course and to analyze its consequences on the nerve tension and clinical outcome. METHODS: The oculomotor nerve is mobilized from its mesencephalic origin to the superior orbital fissure. Its degree of mobility, related to the imposed pulling force, was measured in 11 cadaveric nerves. Tension was mathematically deduced and compared before and after mobilizing of the cavernous segment. One hundred four patients treated for basilar aneurysms with the orbitozygomatic pretemporal transcavernous approach were followed up for a 1-year period and evaluated for postoperative oculomotor nerve palsy. RESULTS: Releasing the transcavernous segment compared to cisternal mobilization alone resulted in a significant increase in freedom of mobility from 4 to 7.9 mm (P < .001) and in a significant decrease in tension from 0.8 to 0.5 N (P = .006). Ninety-nine percent of aneurysms treated with this technique were amenable to neck clipping, and a total of 84% of patients had a good postoperative outcome (modified Rankin Scale score, 0-2). All patients showed direct postoperative palsy; however, 97% had a complete recovery by 9 months. Only 3 patients had a persistent diplopia on medial gaze, which was corrected with prism glasses. CONCLUSION: Mobilization of the transcavernous oculomotor nerve results in better maneuverability and less tension on the nerve, which lead to successful surgical treatment and favorable oculomotor outcome.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

Reference49 articles.

1. A transcavernous-transsellar approach to the basilar tip aneurysms;Dolenc;Br J Neurosurg,1987

2. Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region;Day;J Neurosurg,1994

3. Pterional craniotomy via a transcavernous approach for the treatment of low-lying distal basilar artery aneurysms;Nutik;J Neurosurg,1998

4. The pretemporal transcavernous approach to the interpeduncular and prepontine cisterns: microsurgical anatomy and technique application;Seoane;Neurosurgery,2000

5. Anatomical and quantitative description of the transcavernous approach to interpeduncular and prepontine cisterns: technical note;Figueiredo;J Neurosurg,2006

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3