Improvement of Isolated Abducens Nerve Palsy with Hydrocephalus after CSF Diversion: A Possible Evaluative Role of Retroclival-pontomedullary Distance

Kento Tsuburaya ¹, Naoki Ikegaya ¹, Jun Suenaga ¹

⁰Department of Neurosurgery, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan.

Nmc Case Report Journal +

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December 6, 2024

View abstract on PubMed

Summary

Isolated abducens nerve palsy (IANP) due to hydrocephalus is rare. Cerebrospinal fluid (CSF) diversion via ventriculoperitoneal shunt effectively treated a patient with bilateral IANP by correcting an enlarged retroclival space.

Area Of Science

Neuroscience
Neurosurgery
Ophthalmology

Background

Isolated abducens nerve palsy (IANP) secondary to communicating hydrocephalus is infrequently documented.
The underlying mechanisms and optimal treatments for this condition remain poorly understood.
This report details a unique case to elucidate these aspects.

Observation

A 62-year-old male with a history of recurrent right parieto-occipital brain tumor presented with bilateral IANP.
Imaging revealed tumor recurrence, ventriculomegaly, and an enlarged retroclival cisternal space.
The patient underwent tumor resection and cerebrospinal fluid (CSF) diversion.

Findings

Bilateral IANP resolved within 7 days after initial CSF diversion (external ventricular drain).
Subsequent ventriculoperitoneal (VP) shunt surgery provided sustained symptom control.
The retroclival-pontomedullary distance (RPD) decreased significantly after VP shunt placement.

Implications

VP shunt surgery is an effective treatment for IANP associated with communicating hydrocephalus.
Measuring the retroclival-pontomedullary distance (RPD) may aid in evaluating IANP in hydrocephalic patients.
This case expands understanding of IANP etiologies and management strategies.

Keywords:

VP shunt hydrocephalus isolated abducens nerve palsy