case_images: PMC8168646_01
case_images: (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).
case_images: SNI-12-219-g001.jpg
case_images: PMC8168646_01_SNI-12-219-g001.jpg
case_images: F1
case_images: 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].
case_images: (a) Hess chart showing restricted right eye movement during upward and medial gaze. (b) Visual field examination revealing nasal hemianopia.
case_images: SNI-12-219-g002.jpg
case_images: PMC8168646_01_SNI-12-219-g002.jpg
case_images: F2
case_images: 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].
case_images: (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.
case_images: SNI-12-219-g003.jpg
case_images: PMC8168646_01_SNI-12-219-g003.jpg
case_images: F3
case_images: 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].