Eyelid and eye movements following fourth to third nerve anastomosis

A 34-year-old woman presented with brainstem compression from a large third nerve schwannoma although third nerve function was intact. At surgery, preservation of the proximal third nerve was not possible. Because of preexisting amblyopia of the contralateral eye, an attempt was made to surgically reinnervate the affected third nerve. The fourth nerve was divided at its entry into the tentorium and anastomosed to the distal stump of the third nerve. Partial recovery of third function occurred over several months and is still present 6 years later. Successful long-term reinnervation of the third nerve by direct anastomosis with the fourth nerve may be useful when third repair is not possible.