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Isolated Trochlear Nerve Palsy caused by Mixed Dural-pial Arteriovenous Malformation of the Anterior Cranial Fossa: A case report Masaaki YAMAMOTO 1 , Takeo FUKUSHIMA 1 , Seisaburo SAKAMOTO 1 , Takahisa HASHIMOTO 1 , Masamichi TOMONAGA 1 , Katsuya GOTO 2,3 1Departments of Neurosurgery, School of Medicine, Fukuoka University 2Departments of Radiology,School of Medicine, Fukuoka University Keyword: Isolated trochlear nerve palsy , Mixed dural-pial AVM , Anterior cranial fossa , Orbital branch of middle meningeal artery pp.177-181
Published Date 1993/2/10
DOI https://doi.org/10.11477/mf.1436900607
  • Abstract
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A 62-year-old male was admitted to our hospital in May, 1985, with double vision, which had persisted for 1 month. The neurological examination revealed left troch-lear nerve palsy. A cerebral angiogram showed an arter-iovenous malformation at the anterior cranial fossa. The malformation was mainly fed by the left anterior ethmoidal artery which branched off from the orbital branch of the left middle meningeal artery. There was a marked enlargement of anastomosis between the orbital branch of the middle meningeal artery and the recurrent meningeal branch of the lacrimal artery. Bilateral distal branches of the internal maxillary arteries, bilateral anterior falx arteries and the left fronto-orbital artery were also involved in supplying the AVM. The dilated fronto-orbital vein was the main drainer which emptied into the pterygoid plexus via the uncal vein and the sphe-noparietal vein. In June 1985, the nidus involving the dura at the region of the cribriform plate and olfactory bulb was totally removed through a left frontal cra-niotomy. Postoperatively, the isolated left trochlear nerve palsy improved completely within a few days. This is the first reported case of isolated trochlear nerve palsy caused by a mixed dural-pial arteriovenous malformation of the anterior cranial fossa.

We concluded that the etiology of isolated trochlear nerve palsy consisted of nerve compression due to the di-lated orbital branch of the middle meningeal artery within the superior orbital fissure.


Copyright © 1993, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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