Publication: Kronik altıncı sinir felci nedeni ile botulinum toksini kemodenervasyon ve transpozisyon cerrahisi uygulanan üç olgunun sunumu
Abstract
Amaç: Kronik altıncı sinir felci olan üç olguda botulinum toksin kemodenervasyonu ile transpozisyon cerrahisi sonuçlarını değerlendirmek. Yöntem: Kronik altıncı sinir felci nedeni ile botulinum toksini kemodenervasyonu ve transpozisyon cerrahisi uygulanan üç olguya ait kayıtlar incelendi. Tüm olgularda etkilenen gözün abdüksiyonunda kısıtlılık, primer pozisyonda diplopi ve anormal baş pozisyonu mevcuttu. Görme keskinlikleri bilateral tamdı ve biyomikroskopik ve fundoskopik muayenelerinde özellik yoktu. Hiçbir olguda ilave ekstraoküler sinir felci yoktu ve hiçbir olguya altıncı sihir felci nedeni ile girişim yapılmamıştı. Tüm olgularda felcin başlangıcından itibaren en az 6 ay geçmişti. Bulgular: İki olguya (olgu 1 ve 2) transpozisyon cerrahisi sırasında direkt olarak ekspoze edilen medial rektus kasma botulinum toksini enjekte edilmişti. Üçüncü olguda medial rektus kasına botulinum toksini elektromiyografi altında transpozisyon cerrahisinden 1 ay önce ve 2 ay sonra olmak üzere 2 kez uygulanmıştı. Olgu 1: 50 yaşında bayan, kavernöz sinüs meningiomu nedeni ile beyin cerrahisi girişimi sonrası sağ altıncı sinir felci gelişmişti. Preoperatif kayma açısı uzak ve yakın fiksasyon için 55 PD idi. Postoperatif erken dönemde ekzotropya görüldü. İkinci ayda ortoforya gelişti. Olgu 2.13 yaşında bayan, trafik kazası sonucu sağ altıncı sinir felci gelişmişti. Preoperatif kayma açısı uzak ve yakın fiksasyon için 75 PD'den büyük ölçülen olguda postoperatif erken ekzotropya sonrası üçüncü ayda ortoforya sağlandı. Erken postoperatif dönemde olguda ptozis gözlendi. Olgu 3: 60 yaşında erkek, hipertansif atak sonucu sol altıncı sinir felci gelişmişti. Preoperatif kayma açısı uzak ve yakın fiksasyon için 60 PD idi. İkinci botulinum toksini enjeksiyonu sonrası ortoforya ve sonrasında ezotropya gelişti. Sonuç: Sonuçlar, kronik 6. sinir felcinde uygulanan botulinum toksini kemodenervasyonu ve transpozisyon cerrahisi ile Jdinik olarak yeterli sonuçlar elde edildiğini göstermektedir. Ayrıca kronik 6.sinir felci olan hastalarda botulinum toksini kemodenervasyonunun antagonist kasta kontraktürü önleyerek yapılacak cerrahiyi kolaylaştırma ve sonuçları güçlendirmede, uygulanması kolay ve komplikasyon riski az alternatif bir tedavi olarak düşünülebileceğini göstermektedir.
Purpose : To evaluate our experience in the treatment of chronic sixth nerve palsy with botulinum toxin chemodenervation combined with transposition surgery. Methods : The medical records of three patients were reviewed. All three patients had inability to abduct one eye. diplopia in primary position and face turn in the direction of the paralyzed muscle. All had a visual acuity of 1.0 and normal biomicroscopic and fundoscopic examinations. Patients had no additional extraocular nerve palsy. They had a history of onset of sixth nerve palsy for at least 6 months from onset and had no history of previous treatment with botulinum toxin and/or surgery. Results : Botulinum toxin injection was done directly into the exposed medial rectus muscle during transposition surgery in cases 1 and 2. Case 3 had two botulinum toxin injections. The first. one month before the surgery and the second two months after the surgery under electromyography guidance. Case 1: 50 years old female developed sixth nerve palsy of the right eye following a neurosurgical procedure for right cavernous sinus meningioma. Preoperative angle of deviation was 55 PD at distance and near fixation. She had exotropia during the early postoperative period. Orthophoria was restored at the second month of the procedure. Case 2: 13 years old female presented with right sixth nerve palsy following a traffic accident. Preoperative angle of deviation was larger than 75 PD at distance and near fixation. During the early postoperative period exotropia and mild ptosis was observed in the involved eye. The patient became ortophoric three months after surgery. Case 3: 60 years old male developed sixth nerve palsy of the left eye following a systemic hypertension crisis. Preoperative angle of deviation was 60 PD at distance and near fixation. After the second injection of botulinum toxin initial orthophoria was followed by esotropia. Conclusion : Clinically sufficient results were achieved by botulinum toxin chemodenervation combined with transposition surgery in the treatment of chronic sixth nerve palsy. Botulinum toxin chemodenervation could be an alternative treatment for chronic sixth nerve palsy because it is an easy procedure. has minimum risk of complication and makes surgery easier by preventing contracture of antagonist muscle.
Purpose : To evaluate our experience in the treatment of chronic sixth nerve palsy with botulinum toxin chemodenervation combined with transposition surgery. Methods : The medical records of three patients were reviewed. All three patients had inability to abduct one eye. diplopia in primary position and face turn in the direction of the paralyzed muscle. All had a visual acuity of 1.0 and normal biomicroscopic and fundoscopic examinations. Patients had no additional extraocular nerve palsy. They had a history of onset of sixth nerve palsy for at least 6 months from onset and had no history of previous treatment with botulinum toxin and/or surgery. Results : Botulinum toxin injection was done directly into the exposed medial rectus muscle during transposition surgery in cases 1 and 2. Case 3 had two botulinum toxin injections. The first. one month before the surgery and the second two months after the surgery under electromyography guidance. Case 1: 50 years old female developed sixth nerve palsy of the right eye following a neurosurgical procedure for right cavernous sinus meningioma. Preoperative angle of deviation was 55 PD at distance and near fixation. She had exotropia during the early postoperative period. Orthophoria was restored at the second month of the procedure. Case 2: 13 years old female presented with right sixth nerve palsy following a traffic accident. Preoperative angle of deviation was larger than 75 PD at distance and near fixation. During the early postoperative period exotropia and mild ptosis was observed in the involved eye. The patient became ortophoric three months after surgery. Case 3: 60 years old male developed sixth nerve palsy of the left eye following a systemic hypertension crisis. Preoperative angle of deviation was 60 PD at distance and near fixation. After the second injection of botulinum toxin initial orthophoria was followed by esotropia. Conclusion : Clinically sufficient results were achieved by botulinum toxin chemodenervation combined with transposition surgery in the treatment of chronic sixth nerve palsy. Botulinum toxin chemodenervation could be an alternative treatment for chronic sixth nerve palsy because it is an easy procedure. has minimum risk of complication and makes surgery easier by preventing contracture of antagonist muscle.