Bratton Monica L, Hoehn Mary Ellen, Morris Brannon, Merchant Thomas E, Gajjar Amar, Patel Rutviben, Kerr Natalie C
From the Ophthalmology Consultants, PA, Dallas, Texas;
From the Hamilton Eye Institute, Department of Ophthalmology, University of Tennessee Health and Science Center, Memphis, Tennessee; From the Department of Oncology, St. Jude Children's Research Hospital, Memphis and
Am Orthopt J. 2015;65:87-93. doi: 10.3368/aoj.65.1.87.
Children with brain neoplasms often develop cranial nerve palsies (CNP) affecting ocular ductions. Duction deficits may improve or resolve with treatment of their intracranial disease. However, these children may be left with residual strabismus.
We identified 104 children with third, fourth, and/or sixth cranial nerve palsies who were treated for central nervous system (CNS) neoplasms. A retrospective chart review was conducted to determine the presence or absence of residual strabismus following resolution of duction deficits.
Of the 104 children with CNP secondary to an intracranial neoplasm, forty-five had improvement or resolution of their duction deficit with treatment of their CNS lesion. Of these forty-five children, one had a third cranial nerve palsy, six had fouth cranial nerve palsies (one was bilateral), thirty-seven had sixth cranial nerve palsies (thirteen were bilateral), and one had two different cranial nerve palsies in the same eye (fourth and sixth). Of the eighteen children with improved (but not resolved) duction deficits, only three (17%) experienced resolution of their strabismus. Of the twenty-seven children with resolved duction deficits, nine (33%) experienced resolution of their strabismus. For the children with residual strabismus, the average angle of strabismus before duction deficits improved or resolved was 33.2Δ; while for those children without residual strabismus, it was 20Δ.
Our findings indicated that the majority of children with improved or resolved duction deficits from CNP after treatment for CNS neoplasms are left with residual strabismus. Therefore, we suggest children with CNP secondary to CNS neoplasms need ophthalmic care after duction deficits resolve, as they are likely to have residual strabismus.
患有脑肿瘤的儿童常出现影响眼球运动的颅神经麻痹（CNP）。随着颅内疾病的治疗，眼球运动障碍可能会改善或消失。然而，这些儿童可能会遗留残余斜视。
我们确定了104例因中枢神经系统（CNS）肿瘤接受治疗的第三、第四和/或第六颅神经麻痹患儿。进行回顾性病历审查，以确定眼球运动障碍消失后是否存在残余斜视。
在104例继发于颅内肿瘤的CNP患儿中，45例随着CNS病变的治疗，其眼球运动障碍得到改善或消失。在这45例患儿中，1例为第三颅神经麻痹，6例为第四颅神经麻痹（1例为双侧），37例为第六颅神经麻痹（13例为双侧），1例同一只眼有两种不同的颅神经麻痹（第四和第六）。在18例眼球运动障碍改善（但未消失）的患儿中，只有3例（17%）斜视消失。在27例眼球运动障碍消失的患儿中，9例（33%）斜视消失。对于有残余斜视的患儿，眼球运动障碍改善或消失前的平均斜视角度为33.2Δ；而对于没有残余斜视的患儿，平均斜视角度为20Δ。
我们的研究结果表明，大多数因CNS肿瘤接受治疗后眼球运动障碍得到改善或消失的CNP患儿仍有残余斜视。因此，我们建议继发于CNS肿瘤的CNP患儿在眼球运动障碍消失后需要眼科护理，因为他们很可能有残余斜视。
