Kaeser P-F, Klainguti G
Jules Gonin Eye Hospital, Lausanne, Switzerland.
Klin Monbl Augenheilkd. 2008 May;225(5):507-9. doi: 10.1055/s-2008-1027312.
Diplopia related to neurosurgical procedures is often consecutive to oculomotor nerve lesions. We hereby report an oculomotor dysfunction secondary to an orbital roof effraction and its treatment.
Following surgery for a left anterior communicating artery aneurysm, a 45-year-old woman reported vertical diplopia associated with a left orbital hematoma. The diagnosis of third cranial nerve palsy was excluded by orbital imaging which revealed an orbital roof defect with incarceration of the levator palpebrae and superior rectus.
As neurosurgeons advised against muscle adhesiolysis, diplopia was corrected by a two-step procedure on the oculomotor muscles. We first corrected horizontal and torsional deviations by operating on the healthy eye, before correcting the vertical deviation on the fellow eye. This two-step extraocular muscle surgery allowed restoration of binocular single vision in a useful field of gaze.
Diplopia can occur as a rare orbital complication during neurosurgical procedures. Surgery of extraocular muscles can provide good functional results.
与神经外科手术相关的复视通常继发于动眼神经损伤。我们在此报告一例因眶顶骨折继发的动眼功能障碍及其治疗情况。
一名45岁女性在接受左前交通动脉瘤手术后，出现垂直性复视并伴有左眼眶血肿。眼眶影像学检查排除了第三脑神经麻痹的诊断，该检查显示眶顶缺损，提上睑肌和上直肌嵌顿。
由于神经外科医生不建议进行肌肉粘连松解术，因此通过对动眼肌进行两步手术来矫正复视。我们首先通过对健眼进行手术来矫正水平和扭转偏差，然后再矫正患眼的垂直偏差。这种两步眼外肌手术能够在有用的注视视野内恢复双眼单视。
复视可能作为神经外科手术期间罕见的眼眶并发症出现。眼外肌手术可提供良好的功能效果。
