School of Clinical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu.
School of Life Science, Beijing Institute of Technology, Beijing, China.
Neurologist. 2020 Nov;25(6):157-161. doi: 10.1097/NRL.0000000000000290.
Pituitary apoplexy (PA)-induced oculomotor palsy, although rare, can be caused by compression on the lateral wall of the cavernous sinus. This study aimed to visualize PA-induced oculomotor nerve damage using diffusion tensor imaging (DTI) tractography.
We enrolled 5 patients with PA-induced isolated oculomotor palsy (patient group) and 10 healthy participants (control group); all underwent DTI tractography preoperatively. Fractional anisotropy (FA) and mean diffusion (MD) values of the cisternal portion of the bilateral oculomotor nerve were measured. DTI tractography was repeated after the recovery of oculomotor palsy.
While no statistical difference was observed in FA and MD values of the bilateral oculomotor nerve in the control group (P>0.05), the oculomotor nerve on the affected side was disrupted in the patient group, with a statistical difference in FA and MD values of the bilateral oculomotor nerve (P<0.01). After the recovery of oculomotor palsy, the FA value of the oculomotor nerve on the affected side increased, whereas the MD value decreased (P<0.01). Meanwhile, no significant difference was observed in FA and MD values of the bilateral oculomotor nerve (P>0.05). DTI tractography of the oculomotor nerve on the affected side revealed restoration of integrity. Furthermore, the symptoms of oculomotor palsy improved in all patients 7 days postoperatively.
DTI tractography could be a helpful adjunct to the standard clinical and paraclinical ophthalmoplegia examinations in patients with PA; thus, this study establishes the feasibility of DTI tractography in this specific clinical setting.
尽管垂体卒中（PA）引起的动眼神经麻痹较为罕见，但可能是由于海绵窦外侧壁受压所致。本研究旨在使用弥散张量成像（DTI）纤维束示踪技术可视化 PA 引起的动眼神经损伤。
我们纳入了 5 例 PA 引起的孤立性动眼神经麻痹患者（患者组）和 10 名健康参与者（对照组）；所有参与者均在术前接受 DTI 纤维束示踪检查。测量双侧动眼神经池段的各向异性分数（FA）和平均扩散（MD）值。在动眼神经麻痹恢复后，重复进行 DTI 纤维束示踪检查。
对照组双侧动眼神经的 FA 和 MD 值无统计学差异（P>0.05），而患者组患侧动眼神经受损，双侧动眼神经的 FA 和 MD 值存在统计学差异（P<0.01）。动眼神经麻痹恢复后，患侧动眼神经的 FA 值增加，MD 值降低（P<0.01）。同时，双侧动眼神经的 FA 和 MD 值无统计学差异（P>0.05）。患侧动眼神经的 DTI 纤维束示踪显示完整性恢复。此外，所有患者术后 7 天动眼神经麻痹症状均有所改善。
DTI 纤维束示踪术可作为 PA 患者标准临床和辅助性眼肌麻痹检查的辅助手段；因此，本研究证实了 DTI 纤维束示踪术在这一特定临床环境下的可行性。
