Dourado Leite Ricardo, Freitas Cristina, Guimaraes Sandra
Department of Ophthalmology, Hospital de Braga, Braga, Portugal.
Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga; Portugal.
BMJ Case Rep. 2016 Dec 14;2016:bcr2016216722. doi: 10.1136/bcr-2016-216722.
A woman aged 60 years developed a Millard-Gubler syndrome after a diagnosis of a cavernous angioma in the median and paramedian areas of the pons. In this context, she presented a right VI nerve palsy, right conjugate gaze palsy, facial palsy and left hemiparesis. To improve the complete VI nerve palsy, we planned a modified transposition approach, in which procedure we made a partial transposition of vertical rectus with a silicone band that was fixated posteriorly. After the procedure, the patient gained the ability to slightly abduct the right eye. We found no compensatory torticollis in the primary position of gaze. There was also an improvement of elevation and depression movements of the right eye. We obtained satisfactory results with a theoretically reversible technique, which is adjustable intraoperatively with no need of muscle detachment, preventing anterior segment ischaemia and allowing simultaneous recession of the medial rectus muscles, if necessary.
一名60岁女性在被诊断为脑桥正中及旁正中区域海绵状血管瘤后出现了Millard-Gubler综合征。在此情况下，她表现出右侧外展神经麻痹、右侧同向凝视麻痹、面瘫和左侧偏瘫。为改善完全性外展神经麻痹，我们计划采用改良转位手术方法，在此手术中，我们用一条硅胶带对垂直直肌进行部分转位，并将其固定在后方。手术后，患者获得了右眼轻微外展的能力。我们发现在第一眼位时没有代偿性斜颈。右眼的上抬和下压运动也有改善。我们用一种理论上可逆的技术取得了满意的效果，该技术在术中可调节，无需肌肉分离，可防止眼前节缺血，必要时还可同时内直肌后徙。
