Remission of Superior Oblique Myokymia after Microvascular Decompression

Scharwey, Kerstin; Krzizok, Thomas; Samii, M; Rosahl, Steffen K.; Kaufmann, Herbert J.

doi:10.1159/000027537

Cited by 45 publications

(19 citation statements)

References 13 publications

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“…In refractory patients microvascular decompression may be taken into account [12]. Superior oblique myomykia was found associated with the vascular compression of the CNIV at the root entry zone [23]. In a case in which a branch of the SCA was found lying over the CNIV, a Teflon pad interposed between the artery and the nerve solved the superior oblique myokymia [10].…”

Section: Discussionmentioning

confidence: 99%

Variable relations of the trochlear nerve with the pontomesencephalic segment of the superior cerebellar artery

2014

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The superior cerebellar artery (SCA) is, perhaps, the most anatomically constant cerebellar artery which, in its lateral pontomesencephalic course, is crossed above by the trochlear nerve (CNIV). The SCA may determine, as an offending vessel, CNIV compression and superior oblique myokymia and thus surgical decompression may be indicated. In this regard an accurate knowledge of the variational possibilities of the SCA-CNIV is needed. Such rare neurovascular variants are reported here. The variables are determined by the length of the SCA, and the course of the CNIV as referred to the rostral (RT) and caudal (CT) trunks of the SCA. The CNIV may be pinched between the origins of the RT and CT, may pass above the RT or the SCA main trunk, and even between the primary branches of the RT. The CNIV was found compressed between the RT and the brainstem. Perhaps the most spectacular variation was a CNIV coursing through an arterial ring formed by the RT and CT which were anastomosed distally to the CNIV. The possibilities of neurovascular relations between the CNIV and the SCA should be considered when CNIV palsy, or surgical decompression, are estimated.

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Section: Discussionmentioning

confidence: 99%

Variable relations of the trochlear nerve with the pontomesencephalic segment of the superior cerebellar artery

2014

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“…2,14,20 Neurophysiological studies have suggested that SOM may result from defective supranuclear input to the trochlear nucleus, with secondary regeneration of motor neurons. 11,12,14,[21][22][23] In 1983 Bringewald 24 first postulated that SOM could result from vascular compression of the trochlear nerve and others have subsequently confirmed this hypothesis. [25][26] Since none of the patients in our series had magnetic resonance imaging performed in the manner necessary to document this finding, we cannot comment on whether any of our patients had neurovascular compression.…”

Section: Discussionmentioning

confidence: 99%

“…3 Many patients have spontaneous relapses and remissions over years and symptoms can be exacerbated by stress, caffeine, or nicotine. 3 Treatment options for patients with SOM are both medical 4-10 and surgical, 2,3,5,7,[11][12][13][14][15][16][17][18][19] with surgery being recommended only after medical treatment has failed. Although neurovascular decompression of the trochlear nerve has been reported as a treatment for SOM, [11][12][13] most reports of surgical management describe extraocular muscle surgery in the form of weakening the ipsilateral superior oblique and inferior oblique.…”

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confidence: 99%

Results of extraocular muscle surgery for superior oblique myokymia

Agarwal

Kushner

2009

Journal of American Association for Pediatric Ophthalmology and

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“…2 Other clinical syndromes such as spasmodic torticollis [15], cyclic oculomotor spasm with paresis [16], superior oblique myokymia [17,18], and abducens spasm [19] may also be initiated by vascular compressions of the respective cranial nerves (nerves intermedius, spinal accessory nerve, and oculomotor and trochlear nerves). The incidence of the different MVC syndromes seems to be related to the length of the central nervous system (CNS) segment [20].…”

Section: Signs and Symptoms Of Microvascular Compressionmentioning

confidence: 99%

Microvascular Compression of the Vestibulocochlear Nerve

Ridder

Møller²

2011

Textbook of Tinnitus

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Keypoints Microvascular contacts or compressions of the ves-tibulocochlear nerve can result in tinnitus. 2. For nonpulsatile tinnitus, the contact is most often at the central nervous system segment. 3. For pulsatile tinnitus and typewriter tinnitus, the contact is at the peripheral nervous system segment. The tinnitus is unilateral and characterized by intermittent paroxysms of tinnitus. 4. Associated symptoms are correlated with related contacts/compressions of nearby nerves and include overt or cryptogenic hemifacial spasms, geniculate neuralgia, optokinetically induced short bouts of disabling positional vertigo, and tinnitus frequencyspecific hearing loss. 5. Auditory brainstem responses (ABRs) correlate with disease progress and clinical symptoms and can be used diagnostically.(a) Tinnitus is causally related to a decrease in amplitude of peak II in the ipsilaterally elicited ABR. (b) Tinnitus frequency-specific hearing loss is causally related to prolongation of the ipsilateral interpeak latency (IPL) I-III. (c) Prolongation of contralateral IPL III-V occursand is a sign of slowed signal transmission in the brainstem. 6. Magnetic resonance imaging sequences with constructive interference in steady state can visualize most vascular contacts/compressions of the auditory nerve. 7. Microvascular decompression should be performed before irreversible nerve damage is induced; clinically, the procedure should be performed before 4-5 years. Keywords

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Remission of Superior Oblique Myokymia after Microvascular Decompression

Cited by 45 publications

References 13 publications

Variable relations of the trochlear nerve with the pontomesencephalic segment of the superior cerebellar artery

Variable relations of the trochlear nerve with the pontomesencephalic segment of the superior cerebellar artery

Results of extraocular muscle surgery for superior oblique myokymia

Microvascular Compression of the Vestibulocochlear Nerve

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