Fukushima Yuta, Imai Hideaki, Yoshino Masanori, Kin Taichi, Takasago Megumi, Saito Kuniaki, Nakatomi Hirofumi, Saito Nobuhito
Department of Neurosurgery, The University of Tokyo Hospital.
Neurol Med Chir (Tokyo). 2014;54(3):214-8. doi: 10.2176/nmc.cr2012-0383. Epub 2013 Nov 8.
Oculomotor nerve palsy (ONP) due to internal carotid-posterior communicating artery (PcomA) aneurysm generally manifests as partial nerve palsy including pupillary dysfunction. In contrast, infundibular dilatation (ID) of the PcomA has no pathogenic significance, and mechanical compression of the cranial nerve is extremely rare. We describe a 60-year-old woman who presented with progressive ptosis due to mechanical compression of the oculomotor nerve by an ID of the PcomA. Three-dimensional computer graphics (3DCG) accurately visualized the mechanical compression by the ID, and her ptosis was improved after clipping of the ID. ID of the PcomA may cause ONP by mechanical compression and is treatable surgically. 3DCG are effective for the diagnosis and preoperative simulation.
颈内动脉-后交通动脉(PcomA)动脉瘤所致动眼神经麻痹(ONP)通常表现为包括瞳孔功能障碍在内的部分神经麻痹。相比之下,PcomA的漏斗状扩张(ID)无致病意义,且对脑神经的机械性压迫极为罕见。我们描述了一名60岁女性,她因PcomA的ID对动眼神经的机械性压迫而出现进行性上睑下垂。三维计算机图形(3DCG)准确地显示了ID的机械性压迫,在ID夹闭后她的上睑下垂得到改善。PcomA的ID可能通过机械性压迫导致ONP,且可通过手术治疗。3DCG对诊断和术前模拟有效。