Desai Shilpa J, Lawton Michael T, McDermott Michael W, Horton Jonathan C
Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
Department of Neurosurgery, University of California, San Francisco, San Francisco, California.
Ophthalmology. 2015 Mar;122(3):631-8. doi: 10.1016/j.ophtha.2014.09.011. Epub 2014 Nov 4.
To describe a newly recognized clinical syndrome consisting of ptosis, diplopia, vertical gaze limitation, and abduction weakness that can occur after orbital roof removal during orbito-zygomatic-pterional craniotomy.
Case series.
Eight study patients (7 women), 44 to 80 years of age, with neuro-ophthalmic symptoms after pterional craniotomy.
Case description of 8 study patients.
Presence of ptosis, diplopia, and gaze limitation.
Eight patients had neuro-ophthalmic findings after pterional craniotomy for meningioma removal or aneurysm clipping. The cardinal features were ptosis, limited elevation, and hypotropia. Three patients also had limitation of downgaze and 2 patients had limitation of abduction. Imaging showed loss of the fat layers that normally envelop the superior rectus and levator palpebrae superioris. The muscles appeared attached to the defect in the orbital roof. Ptosis and diplopia developed in 2 patients despite Medpor titanium mesh implants. Deficits in all patients showed spontaneous improvement. In 2 patients, a levator advancement was required to repair ptosis. In 3 patients, an inferior rectus recession using an adjustable suture was performed to treat vertical diplopia. Follow-up a mean of 6.5 years later revealed that all patients had a slight residual upgaze deficit, but alignment was orthotropic in primary gaze.
After pterional craniotomy, ptosis, diplopia, and vertical gaze limitation can result from tethering of the superior rectus-levator palpebrae superioris complex to the surgical defect in the orbital roof. Lateral rectus function sometimes is compromised by muscle attachment to the lateral orbital osteotomy. This syndrome occurs in approximately 1% of patients after removal of the orbital roof and can be treated, if necessary, by prism glasses or surgery.
描述一种新认识的临床综合征，其表现为上睑下垂、复视、垂直凝视受限及外展无力，这些症状可在眶颧翼点开颅术切除眶顶后出现。
病例系列研究。
8例研究患者（7例女性），年龄44至80岁，在翼点开颅术后出现神经眼科症状。
对8例研究患者进行病例描述。
上睑下垂、复视及凝视受限的存在情况。
8例患者在因切除脑膜瘤或夹闭动脉瘤而行翼点开颅术后出现神经眼科表现。主要特征为上睑下垂、上抬受限及下斜视。3例患者还存在下视受限，2例患者存在外展受限。影像学检查显示正常包绕上直肌和提上睑肌的脂肪层缺失。肌肉似乎附着于眶顶缺损处。尽管植入了Medpor钛网，仍有2例患者出现上睑下垂和复视。所有患者的缺损均有自发改善。2例患者需要行提上睑肌前移术修复上睑下垂。3例患者采用可调节缝线行下直肌后徙术治疗垂直性复视。平均6.5年后的随访显示，所有患者均有轻微的上视残留缺损，但第一眼位时眼位正位。
翼点开颅术后，上直肌-提上睑肌复合体与眶顶手术缺损处的粘连可导致上睑下垂、复视及垂直凝视受限。外侧直肌功能有时会因肌肉附着于外侧眶骨切开处而受损。该综合征在切除眶顶的患者中发生率约为1%，必要时可通过棱镜眼镜或手术治疗。
