Departments of Ophthalmology (HSB, TMJ, NJV) and Radiology (EJR), Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Department of Ophthalmology and Visual Sciences (HSB), University of Maryland School of Medicine, Baltimore, Maryland.
J Neuroophthalmol. 2024 Jun 1;44(2):242-246. doi: 10.1097/WNO.0000000000001983. Epub 2023 Sep 1.
Arachnoid cysts (ACs) are benign lesions typically believed to not cause neurologic defects in the adult population and are most often found incidentally on imaging. We describe 2 patients with ACs potentially leading to isolated cranial nerve (CN) dysfunction.
We describe 2 patients, 1 with a fourth nerve palsy and the other with a sixth nerve palsy found to have ACs on MRI brain imaging in locations that potentially caused a compressive CN palsy. We review previous literature of ACs presenting with CN III, IV, or VI palsy.
Patient 1 was a 62-year-old man who presented with a 22-year history of diplopia with strabismus examination consistent with a congenital CN IV palsy. Despite multiple surgeries, his CN IV palsy insidiously worsened. An AC in the posterior fossa with mass effect on the quadrigeminal plate and asymmetric atrophy of the right superior oblique was identified on imaging. Patient 2 was an 80-year-old man who presented with an 18-year history of diplopia and was found to have a left esotropia and abduction deficit consistent with complete CN VI palsy. An AC in the left cavernous sinus was identified on imaging. He underwent strabismus surgery with satisfactory resolution of diplopia. We identified a total of 18 previously published cases: 8 reports of CN III palsy, 4 reports of CN IV palsy, and 6 reports of CN VI palsy. Patient ages ranged from 1 to 67 with a median of 34.5. In 16/18 (89%) cases, the diagnosis of ACs was made within 1 year of symptom onset. Surgical removal of the AC was successful in resolving diplopia in 7/12 (58%) cases. In no case was strabismus surgery performed as primary treatment.
Although ACs are typically congenital asymptomatic lesions, we present a case series of 2 patients with ACs in anatomic locations that potentially caused chronic, progressive, isolated CN palsies leading to strabismus. Our literature review revealed that most published cases detailing this clinical scenario resulted in neurosurgical fenestration of ACs with mixed results. Our cases represent 2 patients with AC-associated CN palsy treated with strabismus surgery.
蛛网膜囊肿（AC）是良性病变，通常认为不会导致成年人群体的神经功能缺陷，并且最常偶然在影像学检查中发现。我们描述了 2 例可能导致孤立颅神经（CN）功能障碍的 AC 患者。
我们描述了 2 例患者，1 例为第四神经麻痹，另 1 例为第六神经麻痹，在 MRI 脑成像中发现位于可能导致 CN 麻痹的位置的 AC。我们回顾了以前关于表现为 III、IV 或 VI 颅神经麻痹的 AC 文献。
患者 1 为 62 岁男性，有 22 年的复视病史，斜视检查符合先天性 CN IV 麻痹。尽管进行了多次手术，但他的 CN IV 麻痹逐渐恶化。在后颅窝中发现一个有质量效应的 AC，影响四叠体板，右侧上斜肌不对称萎缩。患者 2 为 80 岁男性，有 18 年的复视病史，发现左眼内斜视和外展功能障碍，符合完全 CN VI 麻痹。在影像学上发现左侧海绵窦中有一个 AC。他接受了斜视手术，复视得到了满意的缓解。我们共发现了 18 例以前发表的病例：8 例 CN III 麻痹报告，4 例 CN IV 麻痹报告，6 例 CN VI 麻痹报告。患者年龄从 1 岁到 67 岁，中位数为 34.5 岁。在 18 例（89%）中，AC 的诊断是在症状出现后 1 年内做出的。12 例中的 7 例（58%）通过手术切除 AC 成功解决了复视。在没有情况下，斜视手术作为主要治疗方法。
尽管 AC 通常是先天性无症状病变，但我们报告了 2 例位于可能导致慢性、进行性、孤立性 CN 麻痹导致斜视的解剖位置的 AC 病例。我们的文献回顾显示，大多数详细描述这种临床情况的已发表病例结果是通过神经外科 AC 开窗术，结果不一。我们的病例代表了 2 例 AC 相关 CN 麻痹患者接受斜视手术治疗。
