Asymptomatic Penetration of the Oculomotor Nerve by a De Novo Aneurysm Associated with Severe Atherosclerotic Stenosis of the Supraclinoid Internal Carotid Artery

A 70-year-old woman presented with headaches and recurrent stroke symptoms. During five years, the patient has been treated for cerebral infarction associated with severe atherosclerotic stenosis of the internal carotid artery. Three-year follow-up magnetic resonance angiography showed a tiny de novo aneurysm arising from the distal part of atherosclerotic internal carotid artery. And 5-year follow-up three-dimensional CT angiogram demonstrated a definite aneurysm enlargement as large as requiring treatment. During dissection of aneurysm, the oculomotor nerve was found to be penetrated with the growing de novo aneurysm. The authors report a case of a de novo aneurysm, which resulted from atherosclerotic stenosis of the internal carotid artery at the supraclinoid portion, that was found to be penetrating the oculomotor nerve with no ocular palsy.     

Fibrolipomatous hamartoma of the median nerve: A cause of acute bilateral carpal tunnel syndrome in a three-year-old child: A case report and comprehensive literature review

A three-year-old boy was investigated for inexplicable incessant crying. On examination, his left wrist was mildly swollen (three to four months) and sensitive. Exploration and carpal tunnel decompression of the left wrist with incisional biopsy was performed for the presence of a fusiform swelling intimately associated with the median nerve. Histopathology revealed the presence of enlarged nerve bundles admixed with mature fat cells and diffuse fibroblastic proliferation. Three months later, he underwent urgent contralateral carpal tunnel decompression for a similar presentation. The final diagnosis was bilateral fibrolipomatous hamartoma (FLH) of the median nerves causing acute bilateral compression neuropathy.FLH of the median nerve is an extremely unusual cause of acute bilateral carpal tunnel syndrome in a young child presenting with ‘incessant crying’. A comprehensive review of FLH including epidemiology, etiology, clinical presentation, differential diagnosis, imaging, pathology, treatment and prognosis is discussed.     

High division of the spinal accessory nerve and communication with a C2 branch of the cervical plexus: a previously unreported anatomical variant

Anatomical variations of the spinal accessory nerve are well known. We describe a previously unreported variant in which the nerve divided high in level II after crossing the internal jugular vein and before entering the sternomastoid muscle. Both branches were joined by a communication from the C2 cervical root. We discuss the clinical implications of this finding.     

How do I manage an acute injury to the facial nerve?

Paralysis of the facial nerve is a cause of considerable functional and aesthetic disfigurement. Damage to the upper trunk can result in eye complications with the risk of exposure keratitis. Numerous factors influence the therapeutic strategy: the cause of the injury, the time elapsed since injury, functional impairment, and the likelihood of recovery. We discuss the management of an acute injury to the facial nerve and focus on the surgical options.     

Conservative surgical and microsurgical techniques for the management of dental implants that impinge on the inferior alveolar nerve

Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant.