Sawamura Y, Ikeda J, Miyamachi K, Abe H
Department of Neurosurgery, University of Hokkaido, School of Medicine, Sapporo, Japan.
Neurosurgery. 1997 Mar;40(3):605-7; discussion 607-8.
Results of surgical repair of the injured abducens nerve are rarely reported in the literature. A full functional recovery of a completely resected abducens root may be exceptional. We describe a patient who obtained normal ocular alignment and binocular vision after surgical reconstruction of a transected abducens nerve.
A 56-year-old woman with a petroclival meningioma was presented. She underwent total removal of the tumor through a combined supra/infratentorial transpetrosal approach. The abducens nerve was tightly attenuated by the tumor and thickened dura. During dissection, the nerve was completely transected just behind the entrance to Dorello's canal.
The abducens nerve was the single root type and inevitably required surgical repair. To obtain a sufficient length of the distal stump for trimming, part of the petrosphenoidal ligament was cut and the superior border of the petrous bone was exposed. The proximal stump of the nerve was also trimmed to obtain healthy tissue, and reconstruction was performed with five 10-0 nylon sutures. Five months later, esodeviation began to improve. Nine months after the surgery, the patient did not complain of diplopia and an objective assessment reported normal ocular alignment and estimated binocular function as "excellent" according to Biglan's system. Overcorrection of abduction did not occur.
The result in our patient confirms the possibility of full functional recovery after surgical repair of a totally transected abducens nerve.
文献中很少报道外展神经损伤的手术修复结果。完全切除的外展神经根实现完全功能恢复可能极为罕见。我们描述了一名患者，其在横断的外展神经手术重建后获得了正常的眼位和双眼视觉。
一名56岁患有岩斜脑膜瘤的女性患者前来就诊。她通过经颞下/幕上联合经岩骨入路接受了肿瘤全切术。外展神经被肿瘤和增厚的硬脑膜紧密压迫。在分离过程中，神经在进入Dorello管的入口后方完全横断。
外展神经为单根型，不可避免地需要进行手术修复。为了获得足够长度的远端残端进行修剪，切断了部分岩蝶韧带并暴露了岩骨上缘。神经近端残端也进行了修剪以获取健康组织，并用5根10-0尼龙缝线进行了重建。五个月后，内斜视开始改善。术后九个月，患者无复视主诉，客观评估显示眼位正常，根据Biglan系统评估双眼功能为“优秀”。未出现外展过矫。
我们患者的结果证实了完全横断的外展神经手术修复后实现完全功能恢复的可能性。
