PMC8168646_01
(a) T1-weighted imaging with gadolinium enhancement at the initial presentation showing a large right sphenoidal tumor. (b) T1-weighted imaging after Gamma Knife radiosurgery for recurrent tumor showing a residual tumor around the right anterior clinoid process. (c) T1-weighted imaging during the occurrence of ocular neuromyotonia (ONM) showing a rapid growth of the posterior part of the tumor (arrow). (d) Heavily T2-weighted imaging during the occurrence of ONM showing the right oculomotor nerve involvement (arrowhead). (e) ONM symptom. The position of the eyes in the normal status (upper) and ONM (lower).
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F1
The magnetic resonance imaging (MRI) results revealed a large sphenoidal tumor [Figure 1a]. After the GK radiosurgery, residual tumor was controlled for the next 3 years [Figure 1b]. MRI revealed a rapid growth of the posterior part of the residual tumor [Figure 1c], and heavily T2-weighted imaging showed the involvement of the right oculomotor nerve within the tumor [Figure 1d]. His symptom was intermittent involuntary diplopia, an involuntary inward deviation of his right eye, which resolved within 1 min [Figure 1e, Video 1].
(a) Hess chart showing restricted right eye movement during upward and medial gaze. (b) Visual field examination revealing nasal hemianopia.
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F2
The ophthalmological examination of the right eye showed restricted eye movement during upward and medial gaze [Figure 2a]. The results of the ophthalmological examination also revealed worsening of the right vision and nasal hemianopia [Figure 2b]. A transient worsening of the right oculomotor nerve palsy occurred, which gradually recovered in the preoperative level [Figure 3c, Video 2].
(a) An intraoperative view of the right oculomotor nerve after tumor removal (arrow). (b) T1-weighted imaging with gadolinium enhancement after surgery showing that most of the tumor was removed. (c) Eye movement after surgery showing a resolution of the right ONM with only a slight disturbance of the inward movement of the right eye.
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F3
After the removal of the tumor occupying the right retrocarotid space, the oculomotor nerve was found within the tumor and was preserved [Figure 3a]. Most of the tumor was removed, except for the part that was tightly adhered to the right optic nerve and optic chiasm, achieving a sufficient neural decompression [Figure 3b]. A transient worsening of the right oculomotor nerve palsy occurred, which gradually recovered in the preoperative level [Figure 3c, Video 2].