Session: Poster session B

Surgical management of 3rd and 6th nerves palsies

Introduction

Paralytic strabismus is one of the most common oculomotor disorders in adults. The purpose of our study is to describe a population of patients operated for OMP and to detail the surgical procedures and their results.

Methods

We retrospectively studied the cases of patients operated for 3rd and 6th nerves palsies between 2014 and 2019 at a tertiary center. We analyzed the demographic features, the etiologies of the OMP, the surgical protocols and the postoperative results based on medical files. 

Results

101 patients were included : 30 were operated for an oculomotor nerve palsy (=group1), 68 for an abducens palsy (group2)  and 3 patients for complex palsy. Median age at surgery was 49.6 years (5-89 Y). Diplopia and torticollis were present in 88.3% and 57.5 % of cases respectively. The palsy was unilateral in 88.3% of patients.

The main etiologies were: vascular (26.6%) and tumor (16.6%) compression, stroke (16.6%), trauma (16.6%) and congenital palsy (13.3%) in group1, and trauma (25%), tumor (23.52%) and vascular (17.64%) compression and complicated neurosurgical procedures (16.17%) in group2. No identified etiology was noticed in 17.6% of group 2 patients.

Surgery was performed 48 months after the onset of the palsy. In group 1, a muscle recession/ plication surgery was performed in 66.6% of cases and a transposition procedure in 23,3%. In group 2, 66.2% patients had a muscle recession/ plication surgery, and a transposition procedure was the surgical choice in 33.8%.

Two months after surgery, torticollis resolved in 33% and 36% of patients in group 1 and group2 respectively. 32% and 68% of patients had no longer diplopia in group 1and group 2 respectively. Patients were satisfied in 35% in group 1 and 65% in group 2. At least 1 surgical re-intervention was indicated in 37 patients (36.6%).

Discussion and conclusion

Surgery is an important choice and treatment when managing a paralytic strabismus.