Trochlear Nerve Palsy as the Sole Initial Sign of an Aneurysm of the Superior Cerebellar Artery

Collins, T. Edward; Mehalic, Thomas F.; White, Therese K.; Pezzuti, Roger T.

doi:10.1227/00006123-199202000-00020

Cited by 40 publications

(9 citation statements)

References 4 publications

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“…Since the proximal SCA is intimately related to cranial nerves III, IV, and V,19) aneurysms on the SCA may present with palsies of these nerves 1)7)17). One patient, with a 2.5 mm sized lateral-superior type of SCA aneurysm, showed third cranial nerve palsy, but this finding is relatively rare 1)7)17).…”

Section: Discussionmentioning

confidence: 98%

“…Clinical series of endovascular or surgical management in SCA aneurysms were usually limited in the distal segment of SCA aneurysms or incorporated in the literatures of basilar artery (BA) or posterior circulation aneurysms 1)4)7)10)13-16)18)22)24)25). Posterior circulation aneurysms including SCA aneurysms were regarded challenging to neurosurgeon due to narrow operative field, their intimate relationship to perforating vessels and cranial nerves, high morbidity and morbidity rates 2)18).…”

Section: Introductionmentioning

confidence: 99%

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Endovascular and Microsurgical Treatment of Superior Cerebellar Artery Aneurysms

Jin

Park

Kwon

et al. 2012

J Cerebrovasc Endovasc Neurosurg

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ObjectiveSuperior cerebellar artery (SCA) aneurysms are regarded as being as difficult to treat surgically as posterior circulation aneurysms. We describe here a series of 33 of these aneurysms treated with microsurgery or embolization.MethodsBetween June 1997 and August 2007, 33 patients (9 men, 24 women; age, 29 to 76 years) with SCA aneurysms underwent microsurgical (n = 12) or endovascular (n = 21) treatment. Twenty two patients presented with subarachnoid hemorrhage. Thirty aneurysms were located in the junction between the SCA and the basilar artery (BA), two in the proximal SCA (S1) and one in the distal SCA (S2-3).ResultsOf the 29 SCA aneurysms, located in the junction between the SCA and BA, which were available on conventional angiography, 20 were lateral-superior, six lateral-horizontal, two lateral inferior, and one posterior type. Of the 12 patients treated microsurgically, eight had clinically excellent or good outcomes. Causes of poor outcomes included initial poor clinical status (n = 2), infarction due to parent artery compromise (n = 1), and artery of Heubner injury due to surgery for a coexisting anterior communicating artery aneurysm (n = 1). Of the 21 patients treated endovascularly, 17 had clinical good or excellent outcomes. Causes of clinically poor outcomes included initial poor clinical status (n = 2) and infarction due to thrombosis of exposed coil mesh (n = 1). One patient underwent embolization resulted in death due to vasospasm. Three patients required additional embolization for coil compaction.ConclusionThere was no morbidity related to perforator injury, regardless of the treatment modality. Embolization or microsurgery is an effective modality, with relatively low procedural morbidity and mortality rates.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Endovascular and Microsurgical Treatment of Superior Cerebellar Artery Aneurysms

Jin

Park

Kwon

et al. 2012

J Cerebrovasc Endovasc Neurosurg

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“…Two cases of trochlear nerve palsy due to aneurysm of the superior cerebellar artery were reported by Agostinis et al 5 and Collins et al, 6 but, to our knowledge, trochlear palsy caused by an IC-PC aneurysm has not been previously reported. The present case is peculiar in that the trochlear nerve palsy was the predominant sign rather than the common manifestation of oculomotor nerve palsy in cases of IC-PC aneurysm.…”

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confidence: 59%

“…These aneurysms arise from the intracavernous portion 4 or the superior cerebellar artery. 5,6 In the patient discussed in the present paper, trochlear nerve palsy occurred as the initial sign of an internal carotid-posterior communicating artery (IC-PC) aneurysm.…”

mentioning

confidence: 83%

Fourth nerve palsy as an initial sign of internal carotid-posterior communicating artery aneurysm

Shimo‐Oku

Izaki

Shim-myo

1998

Neuro-Ophthalmology

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“…For example, a case was reported in which CNIV palsy and double vision occurred due to increased intracranial pressure after epiduroscopic laser discectomy and neural decompression in a patient with failed back surgery syndrome [29]. Among general and local causes leading to CNIV palsies, such as tumors [6], hemorrhages [11], infections [2] or aneurysms of the SCA [1,5], the variant neurovascular relations should be taken into attention during the clinical evaluation. The superior oblique myokymia may reflect a neurovascular conflict of the CNIV which innervates the superior oblique muscle (SOM) [25].…”

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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Trochlear Nerve Palsy as the Sole Initial Sign of an Aneurysm of the Superior Cerebellar Artery

Cited by 40 publications

References 4 publications

Endovascular and Microsurgical Treatment of Superior Cerebellar Artery Aneurysms

Endovascular and Microsurgical Treatment of Superior Cerebellar Artery Aneurysms

Fourth nerve palsy as an initial sign of internal carotid-posterior communicating artery aneurysm

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

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