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Papers of the Week

2020 May

No Shinkei Geka



[Microvascular Decompression to Treat Abducens Nerve Paralysis Caused by Compression of the Anterior Inferior Cerebellar Artery:A Case Report].


Tega J, Kobayashi H, Kozaki Y, Fukumoto H, Matsumoto N, Fujihara F, Takemoto K, Abe H, Inoue T
No Shinkei Geka. 2020 May; 48(5):429-434.
PMID: 32434954.


Microvascular decompression(MVD)is an effective treatment for hemifacial spasm and trigeminal neuralgia. However, there are few reports regarding its use with abducens nerve palsy. Here, we report the case of a 77-year-old male who presented with diplopia and was admitted to our facility for right abducens nerve palsy. MRI constructive interference in steady-state(CISS)showed that the right anterior inferior cerebellar artery(AICA)was curved in a posterior-superior direction at the beginning of the region of origin, causing compression of the root exit zone of the right abducens nerve. In addition, MRI showed an unruptured fusiform aneurysm(5.3mm×7.1mm)of the vertebral artery(VA)involving the posterior inferior cerebellar artery(PICA). However it was not related to abducens nerve paralysis. The aneurysm was successfully treated with an occipital artery-posterior inferior cerebellar artery(OA-PICA)bypass and clipping of the proximal VA and PICA origin. The position of the offending artery was moved using a Teflon<sup>®</sup> felt fibrin glue and the retrosigmoid transcondylar fossa approach. The patient recovered from abducens nerve paralysis with no new neurological deficit. We emphasize the importance of choosing an appropriate approach as this increases the possibility of treating abducens nerve paralysis in a timely manner.