Microvascular decompression for abducens nerve palsy associate with neurovascular conflict.

Abducens nerve palsy caused by neurovascular conflicts is rare and requires further exploration. This study aimed to investigate the clinical features and surgical outcomes of abducens palsy caused by neurovascular conflict. Twenty-six patients with abducens palsy caused by neurovascular conflict were included in present study. The clinical data and treatment outcomes were retrospectively analyzed. Symptom improvement score was used to evaluate the changes in diplopia, which include five grades: complete remission, significant relief, partial relief, no improvement, and worsening of symptoms. Neurovascular conflict was determined in 26 patients (12 male and 14 female) with a mean age of 60.54 ± 13.55 years (range, 35 to 84 years). The mean duration of symptoms was 10.19 ± 11.30 months (range, 1 to 60 months). Ten patients underwent microvascular decompression (MVD) while 16 patients received observation and drug therapy. No fatal complications occurred in any patient. In the MVD group, 9 patients achieved remission of diplopia, while 1 patient showed no change in symptoms. In observation group, only 4 patients achieved symptom relief and 12 patients showed no improvement or worsened. The symptom improvement score of MVD group was significantly higher than that of observation group at last follow-up (3.50 ± 0.97 vs. 1.38 ± 0.95, P < 0.001). Neurovascular compression, although rare, should be considered as a possible underlying cause of isolated abducens nerve palsy. Microvascular decompression can be considered a treatment option based on the comprehensive preoperative evaluation. Patients with significant atrophy of the extraocular muscles are unsuitable for MVD surgery.