Prognosis for sixth nerve palsy arising from paranasal sinus disease
Prognosis for sixth nerve palsy arising from paranasal sinus disease
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DOI：
10.2500/ajra.2013.27.3943
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发表时间：
2013-09-01
影响因子：
2.6
通讯作者：
Chiu, Alexander G.
中科院分区：
文献类型：
--
作者：
Miller, Craig;Suh, Jeffrey D.;Chiu, Alexander G.
背景：外表神经，颅神经VI（CNVI）是海绵窦中最大的神经。它靠近蝶鼻窦，使其容易受到脊椎病理学的伤害，入侵或压缩，导致水平注视。各种各样的文献描述了CNVI麻痹的无数原因，但是缺乏参考文献，表明旁那鼻窦病理学是一种病因，以及预后和解决的时间表。在这里，我们描述了一系列患有CNVI麻痹的患者，其管理和恢复预后。这项研究旨在评估和理解预测疾病病程的预后因素和外表神经麻痹的患者的可能性。分析了放射学特征，治疗方案和疾病课程。回报：四个机构的15名患者是确定。七名患者患有肿瘤，起源于旁叶鼻窦，三名患有过敏真菌鼻窦炎，三名患者患有侵入性真菌鼻窦炎，一名患者患有纤维颅骨碱基发育异常，其中1例患有慢性细菌鼻窦炎。演讲的平均随访时间为9个月（范围为1-16个月）。 13名患者接受了手术，3例接受了化学疗法，四名接受了放射治疗。 CNVI麻痹在50％的病例中解决，平均分辨率为6周（范围为2-12周）。判断：副窦病理学是CNVI麻痹的罕见原因。许多因素可能有助于预测这些患者的预后。大量压缩，但不破坏或入侵，海绵窦具有最佳的后治疗后果，最早发生了完全分辨率。侵入CNVI及其脉管系统的破坏性病变，即侵入性真菌，是恢复的负面指标。了解影响恢复的因素可以帮助临床医生预测疾病病程和预后解决缺陷。
Background: The abducens nerve, cranial nerve VI (CNVI), is the medial-most nerve in the cavernous sinus. Its close proximity to the sphenoid sinus makes it susceptible to injury, invasion, or compression from a sphenoid pathology leading to horizontal gaze diplopia. A wide range of literature describes myriad causes for CNVI palsy, but there is a lack of references that point to paranasal sinus pathology as an etiology, as well as the prognosis and timeline for resolution. Here, we describe a series of patients that presented with CNVI palsy, their management, and prognosis for recovery. This study was designed to evaluate and understand prognostic factors predicting disease course and likelihood of resolution in patients with abducens nerve palsy.Methods: A multi-institutional retrospective review was performed of all patients presenting with CNVI palsy between 2009 and 2012. The demographic data, radiological features, treatment regimens, and disease courses were analyzed.Results: Fifteen patients at four institutions were identified. Seven patients had neoplasms originating from the paranasal sinuses, three suffered from allergic fungal sinusitis, three patients had invasive fungal sinusitis, one patient had fibrous skull base dysplasia, and one had chronic bacterial sinusitis. The average follow-up time from presentation was 9 months (range, 1-16 months). Thirteen patients underwent surgery, three received chemotherapy, and four had radiation therapy. CNVI palsy resolved in 50% of the cases, with an average time to resolution of 6 weeks (range, 2-12 weeks).Conclusion: Paranasal sinus pathology is a rare cause of CNVI palsy. A number of factors may help to predict prognosis in these patients. Masses compressing, but not destroying or invading, the cavernous sinus had optimal posttreatment outcomes with full resolution occurring as early as 2 weeks. Destructive lesions that invaded CNVI and its vasculature, i.e., invasive fungus, were negative indicators for recovery. Knowledge of factors that affect recovery can help clinicians predict disease course and prognosis for resolution of the defect.