Abstract
Background
The clinical course of abducens nerve palsy associated with skull base tumour is rarely reported. In this study, we examined the post-operative course of abducens nerve palsies associated with various skull base tumours.
Method
Between January 2003 and December 2006, 240 patients with various skull base tumours underwent surgery at Kyushu University Hospital. Among them, nine patients presented with abducens nerve palsies (ten nerves) following surgery. The conditions included two pituitary adenomas, two trigeminal schwannomas and five meningiomas. We evaluated the function of the abducens nerves in these patients on admission, at discharge, and periodically in the outpatient clinic.
Findings
Four of the abducens nerve palsies already existed prior to surgery, and six of them developed post-operatively. In the four patients with pituitary adenomas and trigeminal schwannomas, all nerves were anatomically preserved and showed complete recovery of function within 6 months after surgery. In contrast, only two of the six palsies in patients with skull base meningiomas showed complete recovery. In three patients with petro-clival meningiomas, the abducens nerves were completely transected during surgery, and one was reconstructed using fibrin glue. This patient remarkably recovered from the abducens nerve palsy within 2 years.
Conclusions
The abducens nerve palsies in pituitary adenomas and trigeminal schwannomas showed a better clinical course compared to those in skull base meningiomas. The abducens nerve palsies that occur with skull base meningiomas are less likely to recover. Nevertheless, it is important to preserve the nerves and to perform surgical repair if the nerve is transected.
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Comment
Surgery of petroclival lesions is often extremely complicated due to the intrinsic anatomical complexity of the area. Every surgeon challenging with these lesions knows that. The paper written by Shono et al. reports their experience about sixth nerve palsy in nine patients operated on because of meningioma, neurinoma, and adenoma. Soft lesions like adenomas can slightly displace the nerve; hard lesions such as meningiomas very often damage the nerve permanently due to direct compression and stretching mechanism causing ischemia also because of the vasa nervorum injury. I found the paper well written and pertinent to other reports.
Giorgio Iaconetta
University of Naples, Italy
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Shono, T., Mizoguchi, M., Yoshimoto, K. et al. Clinical course of abducens nerve palsy associated with skull base tumours. Acta Neurochir 151, 733–738 (2009). https://doi.org/10.1007/s00701-009-0312-7
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DOI: https://doi.org/10.1007/s00701-009-0312-7