• Journal of Korean Neurosurgical Society
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• 제48권4호
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• pp.360-362
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• 2010

A sphenoid mucocele often presents late due to its deep seated anatomical site. And it has varied presentation due to its loose relationship to the cavernous sinus and the base of the skull. We describe a case of large sphenoid sinus mucocele. A middle aged old man suddenly developed third cranial nerve palsy. Brain imaging study revealed an isolated sphenoid sinus mucocele, compressing right cavernous sinus. Endoscopic marsupialization of the mucocele via transnasal approach led to complete resolution of the third cranial nerve palsy. Involvement of the third cranial nerve in isolated mucocele is rare but important neurosurgical implications which must be excluded. In addition, proper and timely treatment must be performed to avoid permanent neurologic deficit.

• 한방안이비인후피부과학회지
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• 제16권1호
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• pp.168-178
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• 2003

Strabismus refers to a extra-ocular muscle imbalance that results in improper alignment of the visual axes of two eyes. It may be divided into paralytic and non-paralytic strabismus. Paralytic strabismus is primarily a neurological problem: non-paralytic strabismus is more strictly an ophthalmologic problem. This case report focuses on paralytic strabismus resulting from palsies of the third and the sixth cranial nerves, respectively. Oculomotor nerve palsies result in binocular diplopia with characteristic patterns of strabismus. Oculomotor nerve provides motor and parasympathetic innervation to the eyes. Acquired oculomotor nerve palsies are not uncommon. Injury to the third nerve may result in complete or partial dysfunction. Complete third nerve palsy is manifested by ptosis, dilated pupil, an eye that is deviated down and out in primary position, and limited adduction, elevation, and depression. Patients with unilateral sixth nerve palsy complain of binocular, horizontal diplopia esotropia in the primary position due to unopposed action of the medial rectus and limitation of abduction due to weakness of the lateral rectus. Diplopia is worse in the direction of the paretic lateral rectus muscle. Paralytic strabismus are treated, based on the theory of Oriental medicine. with berbal medicines having gun-bi(健脾), bae-to(培土), gue-pung(祛風) effect of acupuncture around the eyes and etc. We describe a 63-year-old woman with complete the 3rd cranial nerve palsy and a 32-year-old woman with the unilateral 6th cranial nerve palsy who treated with acupuncture and herbal medicines and showed complete recovery.

• Annals of Clinical Neurophysiology
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• 제24권2호
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• pp.59-62
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• 2022

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a chronic recurrent acquired immune-mediated disease of the peripheral nerves that presents with progressive sensory and motor deficits in all four limbs. Cranial nerve involvement is not as common as in Guillain-Barre syndrome, and central nervous system involvement including optic neuritis has rarely been reported in patients with CIDP. We recently experienced a case with classic CIDP involving bilateral facial and trigeminal nerves, right lower cranial nerves, and the right optic nerve.

• Journal of Korean Neurosurgical Society
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• 제30권9호
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• pp.1094-1102
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• 2001

Objective : During the trans-condylar or trans-jugular approach for the lesion of cranio-cervical junction(CCJ), its necessary to identify the accurate locations of vertebral artery(VA), internal jugular vein(IJV) and its related lower cranial nerves. These neurovascular structures can also be damaged during the operation for vascular tumor or traumatic aneurysm around extra-jugular foramen, because of their changed locations. To reduce the neurovascular injury at the operation for CCJ, morphometric relationship of its surrounding neurovascular structures based on the tip of the transverse process of atlas(C1 TP), were studied. Materials & Methods : Using 10 adult formalin fixed cadavers, tip of mastoid process(MT) and TPs of atlas and axis were exposed bilaterally after removal of occipital and posterior neck muscles. Using standard caliper, the distances were measured from the C1 TP to the following structures : 1) exit point of VA from C1 transverse foramen, 2) branching point of muscular artery from VA, 3) entry point of VA into posterior atlanto-occipital membrane(AOM), 4) branching point of C-1 nerve. In addition, the distances were measured from the mid-portion of the posterior arch of atlas to the entry point of the VA into AOM and to the exit point of the VA from C1 transverse foramen. After removal of the ventrolateral neck muscles, neurovascular structures were exposed in the extra-jugular foraminal region. Distances were then measured from the C1 TP to the following structures : 1) just extra-jugular foraminal IJV and lower cranial nerves, 2) MT and branching point of facial nerve in parotid gland. In addition, distance between MT and branching point of facial nerve was measured. Results : The VA was located at the mean distance of 12mm(range, 10.5-14mm) from the C1 transverse foramen and entered into the AOM at the mean distance of 24mm(range, 22.8-24.4mm) from the C1 TP. The mean distance from the mid portion of the C1 posterior arch was 20.6mm(range, 19.1-22.3mm) to the entry point of the VA into AOM and 38.4mm(range, 34-42.4mm) to the exit point of the VA from C1 transverse foramen. Muscular artery branched away from the posterior aspect of the transverse portion of VA below the occipital condyle at the mean distance of 22.3mm(range, 15.3-27.5mm) from the C1 TP. The C-1 nerve was identified in all specimens and ran downward through the ventroinferior surface of the transverse segment of VA and branched at the mean distance of 20mm(range, 17.7-20.3mm) from the C1 TP. The IJV was located at the mean distance of 6.7mm(range, 1-13.4mm) ventromedially from the lateral surface of the C1 TP. The XI cranial nerve ran downward on the lateral surface of the IJV at the mean distance of 5mm(range, 3-7.5mm) from the C1 TP. Both IX and X cranial nerves were located in the soft tissue between the medial aspect of the internal carotid artery(ICA) and the medial aspect of the IJV at the mean distance of 15.3mm(range, 13-24mm) and 13.7mm(range, 11-15.4mm) from the C1 TP, respectively. The IX cranial nerve ran downward ventroinferiorly crossing the lateral aspect of the ICA. The X cranial nerve ran downward posteroinferior to the IX cranial nerve and descended posterior to the ICA. The XII cranial nerve was located between the posteroinferior aspect of the IX cranial nerve and the posterior aspect of the ICA at the mean distance of 13.3mm(range, 9-15mm) ventromedially from the C1 TP. The distance between MT and C1 TP was 17.4mm(range, 12.5-23.9mm). The VII cranial nerve branched at the mean distance of 10.2mm(range, 6.8-15.3mm) ventromedially from the MT and at the mean distance of 17.3mm(range, 13-21mm) anterosuperiorly from the C1 TP. Conclusion : This study facilitates an understanding of the microsurgical anatomy of CCJ and may help to reduce the neurovascular injury at the surgery around CCJ.

• Journal of Korean Neurosurgical Society
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• 제40권2호
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• pp.125-127
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• 2006

Facial nerve schwannomas are uncommon tumors. A 40-year-old female presented with left-side facial weakness. Computed tomography[CT] imaging showed a $3\;{\times}\;2cm$ lesion on the posterior portion of the left middle cranial fossa. The mass abutted the anterior aspect of the left petrous bone with a wide erosive change involving the area of the left facial nerve ganglion [geniculate ganglion]. A well-circumscribed extra-axial mass was seen on magnetic resonance imaging[MRI]. The tumor was completely removed through subtemporal approach and the patient was discharged without additional neurological deficit. This rare case is discussed and a review of the relevant literature is presented.

• Journal of Korean Neurosurgical Society
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• 제45권2호
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• pp.103-106
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• 2009

Intracranial schwannomas preferentially arise from the vestibular branch of the eighth nerve, and rarely from the trigeminal nerve, facial nerve, and lower cranial nerves. Anterior cranial fossa schwannomas are extremely uncommon and few details about them have been reported. The patient was a 39-year-old woman whose chief complaints were anosmia and frontal headache for 2 years. The gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed an extra-axial mass from ethmoid sinus to right frontal base region near the midline, with solid enhancement in lower portion and multicystic formation in upper portion. The tumor was totally resected via basal subfrontal approach. At operation, the tumor had cystic portion with marginal calcification and the anterior skull base was destructed by the tumor. The olfactory bulb was involved, and the tumor capsule did not contain neoplastic cells. The histopathological diagnosis was schwannoma. We report a rare case of anterior cranial fossa schwannoma with literature review.

• 대한청각학회지
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• 제24권3호
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• pp.157-160
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• 2020

A 38-year-old woman presented with a week's history of binocular horizontal double vision and acute vertigo with gaze-induced nystagmus. We considered a diagnosis of one of the six syndromes of the sixth cranial nerve and evaluated several causes. She had history of severe anemia, vitamin B12 deficiency, and hypertension. Magnetic resonance imaging with angiography showed stenosis of the right vertebral artery and hyperintensity on both basal ganglia. As we describe here, we should consider vertebrobasilar insufficiency as a cause for sixth cranial nerve palsy if a patient has high risk for microvascular ischemia, even in the absence of acute brain hemorrhage or infarction.

• Journal of Audiology & Otology
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• 제24권3호
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• pp.157-160
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• 2020

A 38-year-old woman presented with a week's history of binocular horizontal double vision and acute vertigo with gaze-induced nystagmus. We considered a diagnosis of one of the six syndromes of the sixth cranial nerve and evaluated several causes. She had history of severe anemia, vitamin B12 deficiency, and hypertension. Magnetic resonance imaging with angiography showed stenosis of the right vertebral artery and hyperintensity on both basal ganglia. As we describe here, we should consider vertebrobasilar insufficiency as a cause for sixth cranial nerve palsy if a patient has high risk for microvascular ischemia, even in the absence of acute brain hemorrhage or infarction.

• 한방안이비인후피부과학회지
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• 제7권1호
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• pp.143-147
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• 1994

We report one case with paralysis of the sixth cranial nerve, which was diagnosed at Kyung Hee Unversity Hospital. The patient was happened with traffic accident. He showed disorder of both abduction eye movement, headache, double vision and dizziness. We have experienced good improvement to recover paralytic strabismus by the Oriental Medicine.

• Journal of Korean Neurosurgical Society
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• 제52권4호
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• pp.288-292
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• 2012

Objective : Microvascular decompression (MVD) for hemifacial spasm (HFS) is a safe and effective treatment with favorable outcomes. The purpose of this study was to evaluate the incidence of delayed cranirve (VI, VII, and VIII) palsy following MVD and its clinical courses. Methods : Between January 1998 and December 2009, 1354 patients underwent MVD for HFS at our institution. Of them, 100 patients (7.4%) experienced delayed facial palsy (DFP), one developed sixth nerve palsy, and one patient had delayed hearing loss. Results : DFP occurred between postoperative day number 2 and 23 (average 11 days). Ninety-two patients (92%) completely recovered; however, House-Brackmann grade II facial weakness remained in eight other patients (8%). The time to recovery averaged 64 days (range, 16 days to 9 months). Delayed isolated sixth nerve palsy recovered spontaneously without any medical or surgical treatment after 8 weeks, while delayed hearing loss did not improve. Conclusion : Delayed cranial nerve (VI, VII, and VIII) palsies can occur following uncomplicated MVD for HFS. DFP is not an unusual complication after MVD, and prognosis is fairly good. Delayed sixth nerve palsy and delayed hearing loss are extremely rare complications after MVD for HFS. We should consider the possibility of development of these complications during the follow up for MVD.