Etiological Analysis Of Oculomotor Nerve Palsy And New Treatment Of Traumatic Oculomotor Nerve Palsy

Objective:To analyse the etiology,clinical features,treatment and prognosis of oculomotor nerve palsy of each cause,and to restore the function of the oculomotor nerve in three patients with traumatic oculomotor nerve palsy by a new surgical treatment,endoscopic regional decompression of supraorbital fissure.Methods:The clinical data of 216 patients diagnosed with oculomotor nerve palsy and admitted to the Second Hospital of Jilin University throughout 2013-2020 were collected,the etiology,clinical characteristics,treatment and prognosis were analyzed,and a case report of three patients with traumatic actinic nerve palsy who underwent regional decompression of the supraorbital fissure via nasal endoscopy was performed.Result:The top four causes in the 216 patients were trauma(32.87%),diabetes mellitus(21.3%),intracranial aneurysm(13.89%)and ischemic cerebrovascular lesions(13.42%).Other causes include painful ophthalmoplegia,space occupying lesions,infection and so on.The causes of trauma are most often seen in young and middle-aged people,the causes of diabetes is common in the elderly,and ischemic cerebrovascular disease is common in the elderly over 60 years old.In the complete paralysis,trauma and intracranial aneurysm account for the majority and are easy to be associated with pupil dysfunction;diabetic and ischemic cerebrovascular disease are less;all patients with intracranial aneurysm are isolated paralysis.Traumatic causes are more likely to involve the optic nerve,trochlear nerve and abducens nerve,while diabetes are easy to be associated with abducens nerve.In terms of localization,traumatic lesions were most often found in the subarachnoid space and the orbital apex region;all intracranial aneurysm causes were in the subarachnoid space;all patients with painful ophthalmoplegia had lesions in the cavernous sinus region;32 patients had unknown localization,of which traumatic patients accounted for the majority.The top four causes of improvement rate at discharge were,in descending order,diabetes mellitus(86.9%),ischemic cerebrovascular disease(65.5%),intracranial aneurysm(50%)and trauma(45.1%).The difference between the groups was statistically significant when comparing the trauma group with the diabetic group;the diabetic group with both the trauma and intracranial aneurysm groups;and the intracranial aneurysm group with the diabetic group(p<0.05).The top four causes of recovery at 6months of discharge were,in descending order,diabetes(96.2%),intracranial aneurysm(93.3%),ischemic cerebrovascular disease(45.5%)and trauma(35.3%).There was a statistical difference between the two groups comparing the trauma group with the diabetic group and the intracranial aneurysm group;the diabetic group with the trauma group and the ischemic cerebrovascular lesion group;and the intracranial aneurysm group with the trauma group(p<α’,α’=0.0125).Among the three patients with traumatic oculomotor nerve palsy who underwent endoscopic regional decompression of supraorbital fissure,two patients had resolution of symptoms of oculomotor nerve palsy2 months postoperatively and one patient had significant improvement in ptosis,improved internal rotation of the eye and recovery of pupillary function 1.5 months postoperatively and is still in engaging in outpatient follow-up.Conclusion:The etiology of oculomotor nerve palsy is complex.Clinicians need to further improve the understanding of this disease and comprehensively analyze the etiology according to the clinical characteristics of patients.Effective interventions for the cause should be made as early as possible.The prognosis varies from one etiology to another,is generally poor,and much in-depth research is still needed to determine the best treatment options for each etiology.Trauma,diabetes,intracranial aneurysm and ischemic cerebrovascular disease are the main causes.The prognosis of trauma group is worse than that of other causes,while the prognosis of diabetes group is better.This study proposes a new mechanism for the pathogenesis of traumatic oculomotor nerve palsy and an innovative surgical approach,namely endoscopic regional decompression of supraorbital fissure,which can effectively restore oculomotor nerve function,but the number of cases studied is limited and further studies with larger sample sizes are still needed.