Intracranial sympathetic pathways associated with the sixth cranial nerve

1974 ◽  
Vol 40 (2) ◽  
pp. 236-243 ◽  
Author(s):  
J. A. Johnston ◽  
Dwight Parkinson
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Abducens Nerve ◽  
Sixth Cranial Nerve ◽  
Content Type ◽  
Photographic Documentation ◽  
Parasellar Region ◽  
Fine Print

✓ During a continuing study of the anatomy of the parasellar region, a macroscopically identifiable nerve has been observed to leave the foramen lacerum and join the abducens nerve within the cavernous sinus. A description and photographic documentation of this sympathetic branch to the fifth cranial nerve by way of the sixth cranial nerve are presented.

The abducens nerve

1974 ◽  
Vol 41 (5) ◽  
pp. 561-566 ◽  
Author(s):  
Hilel Nathan ◽  
Georges Ouaknine ◽  
Isaac Z. Kosary
Keyword(s):  
Cavernous Sinus ◽  
Subarachnoid Space ◽  
Cranial Nerve ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
The Other ◽  
Sixth Cranial Nerve ◽  
Content Type ◽  
Lateral Rectus Muscle ◽  
Fine Print

✓ The authors describe the origins and course of the sixth cranial nerve in 62 cadaver or autopsy cases and describe three patterns. In Pattern 1 the nerve originates and runs all its way as a single trunk. In Pattern 2 it originates as a single trunk, but splits into two branches in the subarachnoid space, while in Pattern 3 it originates as two separate trunks. In both Patterns 2 and 3 the trunks perforate the dura mater independently and enter the cavernous sinus by passing one above and the other below the petrosphenoidal ligament. In the sinus the two trunks fuse into a single trunk which then continues to the lateral rectus muscle. The practical neurological importance of these variations is discussed.

Dorello's canal: a microanatomical study

1991 ◽  
Vol 75 (2) ◽  
pp. 294-298 ◽  
Author(s):  
Felix Umansky ◽  
Josef Elidan ◽  
Alberto Valarezo
Keyword(s):  
Cranial Nerve ◽  
Venous Blood ◽  
Abducens Nerve ◽  
Microsurgical Anatomy ◽  
Sixth Cranial Nerve ◽  
Content Type ◽  
Dorello’S Canal ◽  
Pathological Conditions ◽  
Anatomical Relationship ◽  
Fine Print

✓ The microsurgical anatomy of Dorello's canal has been studied in 20 specimens obtained from 10 cadaver heads fixed in formalin. The bow-shaped canal through which courses the abducens nerve before reaching the cavernous sinus is located inside a venous confluence which occupies the space between the dural leaves of the petroclival area. The petrosphenoidal ligament (Gruber's ligament), which forms the posteromedial wall of the canal, appears as a fibrous trabecula surrounded by venous blood. Canal measurements were performed and its anatomical relationship with the sixth cranial nerve is described. Angulations of variable degrees were observed in the course of the nerve inside and outside the canal. The influence of this relatively tortuous course of the abducens nerve upon its vulnerability in some pathological conditions is discussed.

Transsphenoidal approach to infrasellar tumors involving the cavernous sinus

1990 ◽  
Vol 73 (4) ◽  
pp. 513-517 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Haruhiko Kikuchi
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Transsphenoidal Approach ◽  
Skull Base Tumors ◽  
Content Type ◽  
Operating Field ◽  
Cranial Nerve Palsies ◽  
Operative Complications ◽  
Fine Print

✓ The authors review their 2-year experience with a rhinoseptal transsphenoidal approach to skull-base tumors of various pathologies involving both the sphenoid and cavernous sinuses. Eight patients with cranial nerve palsies attributable to compression of the contents of the cavernous sinus and/or optic canal are included in this report. Among these patients, a total of 17 cranial nerves were affected. Postoperative normalization was achieved in eight nerves, significant improvement in seven nerves, and no improvement in two nerves. There were no operative complications of aggravation of cranial nerve palsies in this series. In spite of the limited operating field, the results demonstrate the effectiveness and safety of this approach. The authors recommend that this approach be considered before more aggressive surgery is undertaken.

Sixth nerve schwannomas

1991 ◽  
Vol 75 (4) ◽  
pp. 638-641 ◽  
Author(s):  
Howard Tung ◽  
Thomas Chen ◽  
Martin H. Weiss
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Obstructive Hydrocephalus ◽  
Surgical Excision ◽  
Type I ◽  
Sixth Cranial Nerve ◽  
Content Type ◽  
Sixth Nerve Palsy ◽  
Sixth Nerve

✓ Two cases of sixth cranial nerve schwannoma are presented with a review of four other cases from the literature. The clinical spectrum, neuroradiological findings, and surgical outcome of the six cases are discussed. There are two distinct clinical presentations for sixth cranial nerve schwannomas. Type I sixth nerve schwannomas present with sixth nerve palsy and diplopia and arise from the cavernous sinus. In contrast, type II sixth nerve schwannomas have a more severe presentation with obstructive hydrocephalus, raised intracranial pressure, sixth nerve palsy, and diplopia. This type arises along the course of the sixth cranial nerve in the prepontine area. Cavernous sinus involvement in either type may preclude total surgical excision and indicate an increased possibility for recurrence.

Outcome of aggressive removal of cavernous sinus meningiomas

1994 ◽  
Vol 81 (2) ◽  
pp. 245-251 ◽  
Author(s):  
Franco DeMonte ◽  
Harold K. Smith ◽  
Ossama Al-Mefty
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
The Other ◽  
Surgical Removal ◽  
Content Type ◽  
Formidable Challenge ◽  
Acute Hypothyroidism ◽  
Total Tumor Removal ◽  
Subtotal Removal ◽  
Fine Print

✓ Despite recent advances in surgery of the cavernous sinus, meningiomas in that area offer a formidable challenge. The rationale for aggressive surgical removal of cavernous sinus meningiomas is based on the presumption that the extent of removal is inversely related to the rate of recurrence. Over the past 10 years, 41 patients with histologically benign meningiomas involving the cavernous sinus underwent aggressive surgery. Total removal, as confirmed by intraoperative inspection and postoperative radiological studies, was achieved in 31 patients (76%). Twelve patients have been followed for more than 5 years; 10 underwent total tumor removal and only one of these experienced recurrence (5 years after surgery). The other two patients underwent subtotal removal and had symptomatic and radiological evidence of regrowth 3 and 4 years after surgery. Pre-existing cranial nerve deficits improved in only 14% of the patients, remained unchanged in 80%, and worsened permanently in 6%. Seven patients experienced a total of 10 new cranial nerve deficits, four of which involved the nerves subserving ocular motor function. Extraocular muscle function did not worsen in the 25 patients with a seeing eye ipsilateral to the tumor, and no instance of visual worsening occurred. Two patients died 4 months after surgery, one from severe delayed vasospasm and hypothalamic infarction and the other because of a myocardial infarction. Another patient died from a pulmonary embolus on the 9th postoperative day. There were three instances of cerebral ischemia; one was transient, lasting less than 24 hours, while two were related to injury of the middle cerebral artery and resulted in residual hemiplegia. Other complications included three cases of nonfatal pulmonary emboli, two cerebrospinal fluid leaks, and one instance each of exposure keratitis, acute hypothyroidism, and cerebral edema.

Tumors of the lateral wall of the cavernous sinus

1992 ◽  
Vol 77 (4) ◽  
pp. 508-514 ◽  
Author(s):  
Magdy El-Kalliny ◽  
Harry van Loveren ◽  
Jeffrey T. Keller ◽  
John M. Tew
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Tumor Resection ◽  
Lateral Wall ◽  
Content Type ◽  
Nerve Preservation ◽  
Membranous Layer ◽  
Microsurgical Approach ◽  
Dural Wall ◽  
Fine Print

✓ The lateral dural wall of the cavernous sinus is composed of two layers, the outer dural layer (dura propria) and the inner membranous layer. Tumors arising from the contents of the lateral dural wall are located between these two layers and are classified as interdural. They are in essence extradural/extracavernous. The inner membranous layer separates these tumors from the venous channels of the cavernous sinus. Preoperative recognition of tumors in this location is critical for selecting an appropriate microsurgical approach. Characteristics displayed by magnetic resonance imaging show an oval-shaped, smooth-bordered mass with medial displacement but not encasement of the cavernous internal carotid artery. Tumors in this location can be resected safely without entering the cavernous sinus proper by using techniques that permit reflection of the dura propria of the lateral wall (methods of Hakuba or Dolenc). During the last 5 years, the authors have identified and treated five patients with interdural cavernous sinus tumors, which included two trigeminal neurinomas arising from the first division of the fifth cranial nerve, two epidermoid tumors, and one malignant melanoma presumed to be primary. The pathoanatomical features that make this group of tumors unique are discussed, as well as the clinical and radiological findings, and selection of the microsurgical approach. A more favorable prognosis for tumor resection and cranial nerve preservation is predicted for interdural tumors when compared with other cavernous sinus tumors.

Operative management of tumors involving the cavernous sinus

1986 ◽  
Vol 64 (6) ◽  
pp. 879-889 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Aage R. Møller
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Preoperative Evaluation ◽  
Operative Procedure ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Petrous Apex ◽  
Content Type ◽  
The Third ◽  
Fine Print

✓ In the past, neurosurgeons have been reluctant to operate on tumors involving the cavernous sinus because of the possibility of bleeding from the venous plexus or injury to the internal carotid artery (ICA) or the third, fourth, or sixth cranial nerves. The authors describe techniques for a more aggressive surgical approach to neoplasms in this area that are either benign or locally confined malignant lesions. During the last 2 years, seven tumors involving the cavernous sinus have been resected: six totally and one subtotally. The preoperative evaluation included axial and coronal computerized tomography, cerebral angiography, and a balloon-occlusion test of the ICA. Intraoperative monitoring of the third, fourth, sixth, and seventh cranial nerves was used to assist in locating the nerves and in avoiding injury to them. The first major step in the operative procedure was to obtain proximal control of the ICA at the petrous apex and distal control in the supraclinoid segment. The cavernous sinus was then opened by a lateral, superior, or inferior approach for tumor resection. Temporary clipping and suture of the ICA was necessary in one patient. None of the patients died or suffered a stroke postoperatively. Permanent trigeminal nerve injury occurred in three patients; in two, this was the result of tumor invasion. One patient suffered temporary paralysis of the third, fourth, and sixth cranial nerves, and in another the sixth cranial nerve was temporarily paralyzed. Preoperative cranial nerve deficits were improved postoperatively in three patients. Radiation therapy was administered postoperatively to four patients. These seven patients have been followed for 6 to 18 months to date and none has shown evidence of recurrence of the intracavernous tumor.

Reconstruction of the third through sixth cranial nerves during cavernous sinus surgery

1992 ◽  
Vol 76 (6) ◽  
pp. 935-943 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Giuseppe Lanzino ◽  
Chandra N. Sen ◽  
Spiros Pomonis
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Recovery Of Function ◽  
Cranial Nerves ◽  
Sinus Surgery ◽  
Content Type ◽  
The Third ◽  
Successful Recovery ◽  
Cranial Nerve Function ◽  
Fine Print

✓ Sixteen reconstruction procedures of the third through sixth cranial nerves were carried out in 14 patients during operations on 149 tumors involving the cavernous sinus. A direct end-to-end anastomosis was performed in five nerves, whereas in 11 cases the nerve stumps were bridged by means of an interposing nerve graft. The sixth cranial nerve was most frequently reconstructed (nine cases). In four cases, the fifth nerve or root was repaired. The third nerve was reconstructed in two patients, and the fourth nerve was repaired in only one case. Recovery of function, either partial or complete, was observed in 13 nerves: the third in two instances, the fourth in one, the fifth in three, and the sixth in seven. No return of function occurred in three nerves. In patients with a successful recovery of cranial nerve function, either binocular function or the cosmetic result was improved. These results suggest that repair of the third through sixth cranial nerves injured during surgery should be pursued in suitable patients.

scholarly journals Abducens nerve schwannoma of the cavernous sinus: A case report and literature review

2020 ◽  
Vol 11 ◽  
pp. 402
Author(s):  
Zeyad M. Alhussain ◽  
Shatha K. Alharbi ◽  
Faisal Farrash
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Surgical Intervention ◽  
Abducens Nerve ◽  
Resonance Imaging ◽  
Sixth Cranial Nerve ◽  
Cranial Nerve Function ◽  
Facial Numbness ◽  
History Of ◽  
Favorable Neurological Outcome

Background: Schwannomas of the abducens nerve are a rare pathology and are encountered less within the cavernous sinus. We describe a case of sixth cranial nerve schwannoma, in the cavernous sinus. Case Description: A 50-year-old lady, presented with 2 years history of double vision and left facial numbness that started 6 months before presentation, found to have hyperintense lobulated mass at the left cavernous sinus extending into Meckel’s cave with bony remodeling on magnetic resonance imaging. She underwent left frontotemporal craniotomy, combined extra-intradural approach, gross total resection. She had a gradual recovery of the sixth cranial nerve function. Conclusion: Abducens nerve schwannoma of the cavernous sinus is a rare and challenging tumor. However amenable to surgical intervention with favorable neurological outcome.

Fibroblastic tumor of the abducens nerve

1985 ◽  
Vol 62 (2) ◽  
pp. 296-299 ◽  
Author(s):  
Daniel G. Nehls ◽  
Volker K. H. Sonntag ◽  
Alan R. Murphy ◽  
Peter C. Johnson ◽  
John D. Waggener
Keyword(s):  
Electron Microscopy ◽  
Case Report ◽  
Cranial Nerves ◽  
Abducens Nerve ◽  
Sixth Cranial Nerve ◽  
Content Type ◽  
The Third ◽  
Nerve Sheath ◽  
Pathological Material ◽  
Fine Print

✓ Tumors of the cranial nerves are uncommon, and are usually schwannomas or neurofibromas. The authors describe a case of a fibroblastic tumor involving the sixth cranial nerve. Based upon electron microscopy and immunohistochemistry, the tumor was not of nerve-sheath origin, but was comprised of fibroblasts. Clinical, radiographic, and pathological material are presented, and the literature is discussed. This represents the third case report of a tumor of the abducens nerve, and the first report of a fibroma of a cranial or peripheral nerve.

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