Department of Neurosurgery, APHP, Hôpital de La Pitié-Salpêtrière, Paris, France; Sorbonne Universités, UPMC, Paris, France.
Department of Neurosurgery, APHP, Hôpital de La Pitié-Salpêtrière, Paris, France.
World Neurosurg. 2020 Aug;140:1-3. doi: 10.1016/j.wneu.2020.05.046. Epub 2020 May 11.
Isolated bilateral hypoglossal palsy is a rare condition that has never been described after surgery in the lower part of the fourth ventricle. In this article, we discuss various possible etiologies and relevant anatomy considerations of the rhomboid fossa.
We describe a case of bilateral hypoglossal palsy with tongue ptosis following surgery of an ependymoma in the lower part of the fourth ventricle. Immediate postoperative imaging showed ischemic lesions in both hypoglossal nuclei, not compatible with any known arterial territory. Two etiologies could be identified: a venous medullary infarct of the medulla oblongata or direct injury of both hypoglossal nuclei due to their midline position. Finally, the patient improved progressively and returned to normal.
Intraoperative neurophysiologic monitoring of hypoglossal nerves, in addition to facial nerves, should be performed for tumors in this location.
孤立性舌下神经麻痹是一种罕见的病症，从未在第四脑室下部手术后描述过。本文讨论了菱形窝的各种可能病因和相关解剖学考虑因素。
我们描述了一例第四脑室下部室管膜瘤手术后出现双侧舌下神经麻痹伴舌下垂的病例。术后即刻影像学显示双侧舌下神经核有缺血性病变，与任何已知的动脉区域均不相符。有两种病因可以确定：延髓静脉性髓内梗死或由于位于中线位置而直接损伤双侧舌下神经核。最终，患者逐渐改善并恢复正常。
对于该部位的肿瘤，除面神经外，还应进行舌下神经的术中神经生理监测。
