A 61-year-old female presented with 4 years history of left-sided hemifacial spasm. Head MRI and angiography indicated left vertebral artery dissecting aneurysm which compressed ipsilateral cranial nerves Ⅶ and Ⅷ. Microvascular decompression was performed. The dissecting aneurysm was pushed apart and the distal part of the parent artery was adhered to the dura on the petrosum. The compressed nerves were totally decompressed. The symptom of facial spasm was completely resolved immediately after surgery and did not recur during 6 months of follow up.
Cerebral Angiography ; Facial Nerve ; pathology ; Female ; Hemifacial Spasm ; surgery ; Humans ; Magnetic Resonance Imaging ; Microvascular Decompression Surgery ; Middle Aged ; Nerve Compression Syndromes ; diagnosis ; etiology ; surgery ; Vertebral Artery Dissection ; diagnostic imaging ; surgery ; Vestibulocochlear Nerve ; pathology

Aged ; Aged, 80 and over ; Arthroplasty ; methods ; Hip Joint ; surgery ; Hip Prosthesis ; adverse effects ; Humans ; Male ; Nerve Compression Syndromes ; etiology ; Sciatic Neuropathy ; etiology

A few of patients with lumbar disk herniation having a separation of clinical symptoms and signs and imaging features, can be found in clinic, but the traditional theory of direct mechanical compression of nerve roots by herniated nucleus pulposus can't be used to explain this abnormal protrusion of lumbar intervertebral disc. The clinical symptoms and signs of the atypical lumbar disk herniation are affected by multiple factors. The indirect mechanical compression and distraction effect of spinal nerve roots may play an important role in the occurrence of the separation, and the appearance of abnormal clinical symptoms and signs is closely related to the migration of herniated nucleus pulposus tissue, transmission of injury information in the nervous system, and the complex interactions among the nucleus pulposus, dural sac and nerve roots. Moreover,the changes of microcirculation and inflammation secondary to the herniated nucleus pulposus tissue, the hyperosteogeny in the corresponding segment of the lumbar vertebrae and the posture changes all results in a diversity of symptoms and signs in patients with lumbar intervertebral disc herniation. Besides, there exist congenital variation of lumbosacral nerve roots and vertebral bodies in some patients, and the misdiagnosis or missed diagnosis of imaging finding may occur in some cases. However, the appearance of a separation of clinical symptoms and signs and imaging examination in patients may be caused by a variety of reasons in clinic. The exact mechanism involved in the interaction among nucleus pulposus tissue, dural sac and nerve root, secondary changes of pathophysiology and biomechanics around the nucleus pulposus, the determination of lesioned responsible segments, and how to overcome the limitations of imaging all need the further researches.
Humans ; Intervertebral Disc Displacement ; complications ; diagnosis ; Lumbar Vertebrae ; Nerve Compression Syndromes ; etiology

OBJECTIVEAlthough most of nerve injuries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment, surgical exploration of the involved nerve is always required in the cases with the entrapment of posterior interosseous nerve (PIN). However, the necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. The aim of the report is to observe and understand the pathology of PIN injury associated with Monteggia fracture-dislocation in children, and to propose the possible indication for the exploration of nerve.

METHODSEight cases, six boys and two girls, with Monteggia fracture-dislocation complicated by PIN injury, managed operatively at the authors?Hospital from 2007 to 2008 were retrospectively reviewed. All the patients underwent the attempted closed reduction before they received exploration of PIN, with open reduction and internal fixation or successful closed reduction.

RESULTSThe PIN was found to be trapped acutely posterior to the radiocapitellar joint in 4 out of 5 Type III Bado's Monteggia fractures. In the remaining cases, since there were longer time intervals from injury to operation, chronic compressive changes and epineural fibrosis of radial nerve were visualized. After a microsurgical neurolysis performed, the complete recovery in the nerve function was obtained in all the cases during the follow-up.

CONCLUSIONThe findings from this study suggest that every case of type III Monteggia fracture-dislocation with decreased or absent function of muscles innervated by PIN and an irreducible radial head in children should be viewed as an indication for immediate surgical exploration of the involved nerve to exclude a potential PIN entrapment.

Female ; Fingers ; innervation ; Fracture Fixation, Internal ; Humans ; Male ; Monteggia's Fracture ; complications ; Muscle, Skeletal ; innervation ; Nerve Compression Syndromes ; etiology ; surgery ; Recovery of Function ; Retrospective Studies ; Thumb ; innervation ; Wrist ; innervation

OBJECTIVETo investigate the causes and operations for entrapment syndrome of posterior interosseous nerve caused by elbow cyst.

METHODSForm March 2005 to March 2012,5 patients with entrapment syndrome of posterior interosseous nerve caused by elbow cyst were treated with surgical excision and neurolysis including 3 males and 2 females with an average age of 50.4 years old ranging from 35 to 60 years old. The course was from 3 to 10 months with an average of 6.3 months. The main clinical symptoms were pain on the outside of the forearm. The extension muscle power of the metacarpophalangeal joints at the fingers and the wrist had decreased. The EMC showed neurogenic damage or nerve conduction slowing down. According to the functional neurological evaluation standard of British Medical Research Institute ,the motion and sensory function after nerve injury was assessed.

RESULTSPatients were followed up for 3 to 15 months with an average of 8.5 months. Wound healing in patients was good after the operations. There were no significant complications. Three patients were excellent (M4S3+) and 2 patients were good (M3S3). The hand joint function of 5 patients recovered well after operation.

CONCLUSIONThe surgical excision and neurolysis for treatment of entrapment syndrome of posterior interosseous nerve caused by elbow ganglions cyst can remove the entrapment syndrome of the posterior interosseous nerve thoroughly ,promote the neurological function recovery. According to the functional evaluation standard ,operations achieved better therapeutic effect.

Adult ; Bone Cysts ; complications ; Elbow ; innervation ; surgery ; Female ; Fingers ; physiopathology ; Humans ; Male ; Middle Aged ; Nerve Compression Syndromes ; etiology ; physiopathology ; surgery ; Wrist ; physiopathology

A 45 year old woman was diagnosed as having anteromedial radial head dislocation and distal radius fracture five months after her injury on right forearm. The radial head dislocation led to ulnar nerve compression. She had severe restriction of her elbow movements. She was treated with arthrolysis, decompression of the ulnar nerve and radial head resection. The reverse Essex Lopresti injury and radial head dislocation compressing the ulnar nerve has not been reported in English language literature to the best of our knowledge. A mechanism is proposed for the injury. In acute presentations, restoration of both the radioulnar joints should be done and neglected nature of such injury leads to suboptimal outcomes.
Female ; Humans ; Joint Dislocations ; complications ; Middle Aged ; Radius ; injuries ; Radius Fractures ; complications ; Ulna ; injuries ; Ulnar Nerve Compression Syndromes ; etiology

BACKGROUNDSome studies indicated that cases of idiopathic oculomotor nerve palsy can be explained by vascular compression of the oculomotor nerve. Vascular contact with or compression to the cisternal segment of the oculomotor nerve has been reported frequently in asymptomatic individuals. In this study, we retrospectively analyzed the relationship between the oculomotor nerve's cisternal segment and adjacent arteries in asymptomatic patients and the prevalence of this occurrence via magnetic resonance imaging (MRI).

METHODMRI of bilateral oculomotor nerves in 93 asymptomatic patients were reviewed. The oculomotor nerve-artery relationship was evaluated and classified from levels 1 to 3, representing the degrees of contact on oblique transverse and oblique sagittal reconstructed MRI. Prevalence of the nerve-artery relationship at each level was described. The correlation between the nerve-vessel relationship (levels) and the age was analyzed by Spearman's rank correlation analysis.

RESULTSCisternal segment of the oculomotor nerve did not have contact with any artery (level 1) in 27.4% (51/186) nerves. One hundred nerves made contact with at least one artery (level 2), but their shapes or configurations were not changed; 35 nerves (18.8%) were displaced or distorted due to artery compression (level 3). The posterior cerebral artery had the greatest incidence of making contact with or compressing the cisternal segment of the oculomotor nerve (58.1%). No significant correlation between nerve-vessel relationship (levels) and the age was found in this study.

CONCLUSIONSWhether oculomotor nerve contact with or compression by one or more arteries is of high prevalence in asymptomatic individuals as evidenced by MRI examination. There is no correlation with individual age. Discretion should be used when making an etiological diagnosis of vascular compression for patients with oculomotor nerve palsy. Further investigation of other causes is warranted.

Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Nerve Compression Syndromes ; complications ; pathology ; Oculomotor Nerve ; pathology ; Oculomotor Nerve Diseases ; etiology ; pathology ; Young Adult

Running through the infratemporal fossa is the lingual nerve (i.e. the third branch of the posterior trunk of the mandibular nerve). Due to its location, there are various anatomic structures that might entrap and potentially compress the lingual nerve. These anatomical sites of entrapment are: (a) the partially or completely ossified pterygospinous or pterygoalar ligaments; (b) the large lamina of the lateral plate of the pterygoid process; and (c) the medial fibers of the anterior region of the lateral pterygoid muscle. Due to the connection between these nerve and anatomic structures, a contraction of the lateral pterygoid muscle, for example, might cause a compression of the lingual nerve. Any variations in the course of the lingual nerve can be of clinical significance to surgeons and neurologists because of the significant complications that might occur. To name a few of such complications, lingual nerve entrapment can lead to: (a) numbness, hypoesthesia or even anesthesia of the tongue's mucous glands; (b) anesthesia and loss of taste in the anterior two-thirds of the tongue; (c) anesthesia of the lingual gums; and (d) pain related to speech articulation disorder. Dentists should, therefore, be alert to possible signs of neurovascular compression in regions where the lingual nerve is distributed.
Cranial Fossa, Middle ; Foramen Ovale ; pathology ; Humans ; Ligaments ; pathology ; Lingual Nerve ; pathology ; Nerve Compression Syndromes ; complications ; pathology ; Ossification, Heterotopic ; pathology ; Paresthesia ; etiology ; Pterygoid Muscles ; pathology ; Sphenoid Bone ; pathology ; Tongue ; innervation

OBJECTIVE: To explore the clinical characteristics, pathological mechanism, diagnose, differential diagnosis and the treatment of vascular compressive vestibular neuropathy. METHOD: The authors retrospectively studied 2 cases of vascular compressive vestibular neuropathy about clinical characteristics, auditory tests, vestibular tests and imaging examine results, pharmacotherapy results and reviewed the related documents. RESULT: There were some common clinical characteristics: (1) Vertigo and disequilibrium could be elicited by any physical activity and head movement and abated with complete bed rest; (2) Symptoms and signs can't be improved by vestibular suppressant medications; (3) When taken Dix-Hallpike test, true vertigo or a spinning sensation appeared during head movement, when head skilled at any position,the symptoms disappeared; (4) The suffering lateral often showed high frequency sensorineural hearing loss ,the ABR of the suffering lateral showed prolonged inter wave latency of I-III wave; (5) Vestibular tests showed central lesion; (6) Occupying lesion can be ruled out by CT and MRI, MRI showed neurovascular compression of vestibular nerve; (7) Taking carbamazepine plus baclofen or only Tegretol orally can alleviate symptoms. A great deal of surgeries confirmed neurovascular compression of cranial nerve U as a disease entity, the offending artery mainly anterior inferior cerebellar artery. Microvascular decompression of cranial nerve VIII can successfully relieve vertigo. CONCLUSION Neurovascular compression of cranial nerve VIII is a disease entity beyond question. It's major characters were vertigo and disequilibrium which elicited by any physical activity and head movement, magnetic resonance tomographic angiography can give valuable information for diagnosis and treatment. Microvascular decompression can effectively relieve vertigo.
Adult ; Decompression, Surgical ; Female ; Humans ; Microsurgery ; Middle Aged ; Nerve Compression Syndromes ; complications ; diagnosis ; surgery ; Retrospective Studies ; Vertigo ; etiology ; Vestibular Nerve ; pathology ; Vestibular Neuronitis ; diagnosis ; pathology ; surgery ; Vestibulocochlear Nerve ; pathology

OBJECTIVETo observe the pinching action to the nerve root by the lumbar disc herniation and facet or lamina (ligamentum flavum) and evaluate its clinical meaning.

METHODSSeventy-one patients were divided into 3 groups according to the size of distance between protrusion of nuclear and facet or lamina (ligamentum flavum). The degree of the straight leg raising of the affected side (SLR) and the sagittal index (SI) of lumbar disk herniation were measured and analyzed among them.

RESULTSThere was no corelation between the affected degree of SLR and sex, age and SI of patient (P > 0.05). The coefficient between distance group and the affected degree of SLR is-0.878 7 (P < 0.01).

CONCLUSIONThe degree of the surrounding compression by the protrusion of nuclear and facet or lamina (ligamentum flavum) reflects the injuried severity of the nerve root.

Adolescent ; Adult ; Female ; Humans ; Intervertebral Disc Displacement ; complications ; diagnostic imaging ; pathology ; Ligamentum Flavum ; pathology ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nerve Compression Syndromes ; etiology ; Spinal Nerve Roots ; injuries ; Tomography, X-Ray Computed