The cranial nerve lesions can occur from a stroke, traumatic brain injury or direct cervical injury, and can produce various functional problems of the craniofacial structures. Usually the cranial nerve injury can be diagnosed by a simple clinical manifestation, and physical or neurological examination. Electrophysiologic study and imaging study such as MRI are frequently used as the sequential follow up studies for the objective evaluation of neurologic regeneration process. We report a case of multiple cranial nerve injuries, of the fifth, seventh, tenth, eleventh and twelfth cranial nerves from a single deep cervical stab wound of 4 cm in length from 0.5 cm anterior of the tragus to 1 cm posterior to the mandibular angle. Electrophysiologic study including an electromyography of tongue and vocal cord, blink reflex and facial nerve conduction study were used for the diagnosis and follow up.
Blinking ; Brain Injuries ; Cranial Nerve Injuries* ; Cranial Nerves* ; Diagnosis ; Electromyography ; Facial Nerve ; Follow-Up Studies ; Hypoglossal Nerve ; Magnetic Resonance Imaging ; Neurologic Examination ; Regeneration ; Stroke ; Tongue ; Vocal Cords ; Wounds, Stab*

Oblique basal skull fractures resulting from lateral crushing injuries involving both clivus and occipital condyle are rare due to their deep locations. Furthermore, these fractures may present clinically with multiple cranial nerve injuries because neural exit routes are restricted in this intricate region. The authors present an interesting case of basal skull fractures involving the clivus and occipital condyle and presenting with sixth and contralateral twelfth cranial nerve deficits. Clinico-anatomic correlations and the courses of cranial nerve deficits are reiterated. To the authors' knowledge, no other report has been previously issued on concomitant sixth and contralateral twelfth cranial nerve palsies following closed head injury.
Cranial Fossa, Posterior ; Cranial Nerve Diseases ; Cranial Nerve Injuries ; Cranial Nerves ; Head Injuries, Closed ; Hypoglossal Nerve ; Paralysis ; Skull ; Skull Fractures

BACKGROUND: The laryngeal mask airway (LMAⓇ) Protector™ (Teleflex Medical Co., Ireland) is the latest innovation in the second generation of LMA devices. One distinguishing feature of this device is its integrated, color-coded cuff pressure indicator (Cuff ™ technology) which enables continuous cuff pressure monitoring and allows adjustments when necessary; this ensures patient safety due to better monitoring.CASE: We report a case of postoperative unilateral hypoglossal nerve palsy after uncomplicated use of the LMA Protector. To the best of our knowledge, this could be the second reported case.CONCLUSIONS: This case demonstrates that anesthetists need to routinely measure cuff pressure and that the Cuff Pilot™ technology is not a panacea for potential cranial nerve injury after airway manipulation.
Cranial Nerve Injuries ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve ; Laryngeal Masks ; Patient Safety

The authors analysed 147 cases of basal skull fracture which were treated in the Department of Neurosurgery, Chungnam National University Hospital from January 1989 to December 1992. These fractures are difficult to diagnose by ordinary X-ray examination and are frequently inferred by clinical signs. The clinical features and radiological findings were reviewed. The results of the analysis are summarized as follows : 1) The basal skull fractures were more common in men than women-the ratio being 6 : 1. 2) In decreasing order of cause of basal skull fractures were traffic accidents(77%), fall down, assault and slipping. 3) The minor head injury, Glasgow Coma Scale Score(GCS) of 13 to 15, was 79 cases(54%), the moderate head injury 40 cases(27%) and the severe head injury 18 cases(19%). 4) In decreasing order of clinical features were otorrhea(71%) rhinorrhea(48%) and raccoon eye(33%) etc. 5) In decreasing order of the combined pathologies were skull fracture(55%), subdural hematoma(17%), epidural hematoma(16%) and intracerebral hematoma(12%) etc. 6) The facial nerve, vestibulo-cochlear nerve and optic nerve were the most commonly injured cranial nerve. 7) CSF leakage was noted in 139 cases and among them immediate type was far more common(96%) than the delayed type. 8) The incidence of meningitis was 5.4% and most of them associated with CSF leakage and the prophylatic antibiotic treatment has no effect to decrease infection rate. 9) In decreasing order of the frequency associated injuries were facial bone fracture(47%), clavicle fracture(19%), lower extremities fracture(9%) and upper extremities fracture(7%) etc.
Chungcheongnam-do ; Clavicle ; Cranial Nerve Injuries ; Cranial Nerves ; Craniocerebral Trauma ; Facial Bones ; Facial Nerve ; Glasgow Coma Scale ; Humans ; Incidence ; Lower Extremity ; Male ; Meningitis ; Neurosurgery ; Optic Nerve ; Pathology ; Raccoons ; Skull Fractures* ; Skull* ; Upper Extremity

The hypoglossal nerve palsy receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less common. A literature review revealed that in most cases, isolated hypoglossal nerve palsy indicates the presence of an intracranial or extracranial space occupying lesion, head and neck injury, vascular abnormality, infection, autoimmune disease or neuropathy. Reports of idiopathic cases are rare and treated with steroid therapy. We report a 38-year-old woman with isolated hypoglossal nerve palsy improved spontaneously without steroid use. Considering our experience with isolated hypoglossal nerve palsy, we believe that no therapy is required in the patients with hypoglossal nerve palsy of probably idiopathic causes.
Adult ; Autoimmune Diseases ; Cranial Nerve Diseases ; Female ; Head ; Humans ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve* ; Neck Injuries ; Paralysis

Neurologic complications after shoulder surgery may result from surgical procedures or anesthesia. Hypoglossal nerve is a pure motor nerve that supplies mylohyoid and hyoglossus muscles. Isolated hypoglossal nerve injury may be caused by direct trauma, head malposition (hyperextension or hyperflexion), and indirect compression or traction during intubation. We report a case of left hypoglossal nerve palsy after arthroscopic left shoulder surgery in the beach chair position under general anesthesia combined with brachial plexus block.
Anesthesia ; Anesthesia, General* ; Brachial Plexus Block* ; Brachial Plexus* ; Cranial Nerves* ; Craniocerebral Trauma ; Equipment and Supplies ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve Injuries ; Hypoglossal Nerve* ; Intubation ; Muscles ; Paralysis* ; Shoulder* ; Traction

OBJECTIVE: To determine the feasibility of translabyrinthine approach in the vestibular schwannoma patients, the authors reviewed eighteen consecutive cases, focusing at their functional outcome and operative complications. MATERIALS AND METHOD: To evaluate the functional outcome, we reviewed preoperative radiological findings such as size of tumors and location of jugular bulb as well as the preoperative neurological status including audiometric analysis and cranial nerve function in 18 patients, diagnosed as vestibular schwannoma. Also the surgical outcome was evaluated according to the functional preservation of facial nerve and incidence of the surgical complication as well as the extent of surgical resection. RESULTS: The age of patients ranged from 21 to 62 years, with a mean of 50 years. Of 18 patients operated in our center by the translabyrinthine approach, wide exposure with total removal of the mass was possible in 16 cases (88.8%). The facial nerve was anatomically preserved in 88.8%. At six-month follow-up, facial nerve function was good(Grade I-II) in 15 patients(83%) and acceptable(I-IV) in all patients. Although the jugular bulb was highly placed is five patients, gross total resection was possible without facial nerve injury in all patients by the translabyrinthine approach. One patient experienced CSF leakage after surgery, but there was no patient with disabling deficit. CONCLUSION: Use of the translabyrinthine approach for removal of vestibular schwannomas resulted in good anatomical and functional preservation of the facial nerve, with minimal incidence of morbidity and no mortality. In cases of high jugular bulb impacted into mastoid bone, total removal was possible by displacing the jugular bulb with Surgicel cellulose and placement of bone wax.
Cellulose ; Cranial Nerves ; Facial Nerve ; Facial Nerve Injuries ; Follow-Up Studies ; Humans ; Incidence ; Mastoid ; Mortality ; Neuroma, Acoustic*

OBJECTIVE: Jugular foramen schwannomas are uncommon pathological conditions. This article is constituted for screening these tumors in a wide perspective. MATERIALS: One-hundred-and-ninty-nine patients published in 19 articles between 1984 to 2007 years was collected from Medline/Index Medicus. RESULTS: The series consist of 83 male and 98 female. The mean age of 199 operated patients was 40.4 years. The lesion located on the right side in 32 patients and on the left side in 60 patients. The most common presenting clinical symptoms were hearing loss, tinnitus, disphagia, ataxia, and hoarseness. Complete tumor removal was achieved in 159 patients. In fourteen patients tumor reappeared unexpectedly. The tumor was thought to originate from the glossopharyngeal nerve in forty seven cases; vagal nerve in twenty six cases; and cranial accessory nerve in eleven cases. The most common postoperative complications were lower cranial nerve palsy and facial nerve palsy. Cerebrospinal fluid leakage, meningitis, aspiration pneumonia and mastoiditis were seen as other complications. CONCLUSION: This review shows that jugular foramen schwannomas still have prominently high morbidity and those complications caused by postoperative lower cranial nerve injury are life threat.
Accessory Nerve ; Ataxia ; Cranial Nerve Diseases ; Cranial Nerve Injuries ; Cranial Nerves ; Facial Nerve ; Female ; Glossopharyngeal Nerve ; Hearing Loss ; Hoarseness ; Humans ; Male ; Mass Screening ; Mastoid ; Mastoiditis ; Meningitis ; Neurilemmoma ; Paralysis ; Pneumonia, Aspiration ; Postoperative Complications ; Tinnitus

PURPOSE: To analyze the relationship between prognosis and the severity of associated injuries in traumatic isolated 3rd, 4th and 6th cranial nerve palsies. METHODS: The records of 39 patients (39 eyes) who were diagnosed with isolated 3rd, 4th or 6th cranial nerve palsy following trauma were reviewed retrospectively to analyze the etiology of trauma, the degree of associated injuries, the degree of paralysis, and the prognosis. RESULTS: The 4th cranial nerve was affected most frequently (19 patients, 48.7%), followed by the 6th nerve (12 patients, 30.8%) and the 3rd nerve (8 patients, 20.5%). Traffic accidents were the most frequent etiology of traumatic cranial nerve palsies. Loss of consciousness, intracranial hemorrhage, craniofacial fracture, c-spine injury, and optic nerve injury were among the most common accompanying conditions. The 3rd cranial nerve was the most severely paralyzed and showed the highest number of associated injuries. The recovery rate of the all cranial nerve palsies was 46.2%. By nerve, the 3rd cranial nerve palsy showed the lowest recovery rate of 25%, followed by the 4th nerve at 47.4%, and the 6th nerve at 58.3%. CONCLUSIONS: The prognosis was worse in patients with intracranial hemorrhage, compared with those without intracranial hemorrhage. There was a higher average number of associated injuries and the degree of paralysis was more severe in 3rd nerve palsies.
Accidents, Traffic ; Cranial Nerve Diseases* ; Cranial Nerves* ; Humans ; Intracranial Hemorrhages ; Optic Nerve Injuries ; Paralysis ; Prognosis* ; Retrospective Studies ; Unconsciousness

OBJECTIVE: During anterior clinoidectomy for aneurysms of ophthalmic artery or paraclinoidal lesions, not only optic nerve but also cranial nerves passing through the superior orbital fissure (SOF) can be damaged by mechanical or thermal injury. Particularly, revision for paraclinoidal lesions can give further damage to the cranial nerves because of the obscure anatomical structure resulting from the tight fibrous adhesion. Thus, to reduce the damage of the cranial nerves passing through the SOF during the anterior clinoidectomy or optic canal decompression via the extradural or intradural route, morphometric relationship of juxta-clinoidal cranial nerves were studied. MATERIALS AND METHODS: Using 15 adult formalin fixed cadavers, the anatomical landmarks for measurements were chosen as follows: lateral entry point of optic nerve into the optic canal (LON), tip of anterior clinoid process (ACP), tip of posterior clinoid process (PCP), upper border of lesser wing of sphenoid bone, and lateral end of SOF. The measurements were carried out as follows: 1) distance from the LON to the dural entry point (DEP) of the third (III), fourth (IV), and ophthalmic branch of the fifth (V1) nerves into the tentorium, 2) distance from the tip of PCP to the DEP of III and VI cranial nerves, 3) distance from the LON to the cranial nerves within intradural space before passing through SOF, 4) The shortest depth from the tip of ACP and the edge of lesser wing to the cranial nerves passing through the cavernous sinus, 5) distance from the lateral end of SOF to the cranial nerves just before passing through the annular tendon. RESULTS: The mean distance from the LON to the DEP of the III, IV, and V1 cranial nerves were 10.4 mm, 18.8 mm, and 23.4 mm, respectively. The mean distance from the tip of PCP to the DEP of the III and VI cranial nerves were 5.4 mm and 18.6 mm, respectively. DEP of the III cranial nerve was corresponded with the just anterior coronal plane of PCP. The mean distance from the LON to the III, IV, and V1 cranial nerves passing through the SOF were 7.2 mm, 10.0 mm, 10.5 mm and 10.6 mm, respectively. The III cranial nerve located at a mean depth of 3.4 mm from the tip of ACP. The IV, V1 , and VI cranial nerves located at a mean depth of 2.1 mm, 2.4 mm and 7.4 mm from the upper border of lesser wing of sphenoid bone, respectively. The III cranial nerve splitted into superior and inferior divisions at a mean distance of 1.51 mm from the lateral end of SOF, just before where it passes through the SOF. The mean distance from the lateral end of SOF to the lateral margins of the III, IV and frontal nerves of V1 were 12.5 mm, 11.0 mm and 10.2 mm, respectively. CONCLUSION: DEP of the III cranial nerve was corresponded with the just anterior coronal plane of PCP and was about a half distance from PCP than from LOP. DEP of the IV cranial nerve looks like same site as that of V1 cranial nerve, but IV cranial nerve located at just superior to V1. From the LON, III, IV, V1 , and VI CNs latero-inferiorly passed through the SOF. The III cranial nerve located at the most medial portion of SOF with a mean distance of 7 mm, and the IV, V1 and VI cranial nerves were arranged in the same order as vertical arrangement with a mean distance of 10 mm. The cranial nerves just before passing through SOF were located at a range of 7.8 to 20 mm from the lateral end of SOF. This study facilitates an understanding of the anatomy of juxta-sellar region and may help to reduce the cranial nerve injury at the surgery around juxta-clinoidal CNs.
Adult ; Aneurysm ; Cadaver ; Cavernous Sinus ; Cranial Nerve Injuries ; Cranial Nerves* ; Decompression ; Formaldehyde ; Humans ; Ophthalmic Artery ; Optic Nerve ; Orbit ; Sphenoid Bone ; Tendons