Abducens nerve palsy on a patient with sphenoid fungal rhinosinusitis and cavernous sinus meningioma – Case report


We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who was admitted in our clinic with diplopia. The cranio-facial CT scan revealed left sphenoid fungal rhinosinusitis and the patient underwent endoscopic surgery with complete removal of the fungal material. The immediate postoperative evolution of the patient was favourable, with partial improvement of diplopia. The first month follow-up visit revealed the recurrence of the diplopia, so the patient performed an MRI scan of the brain that showed a cavernous sinus meningioma. The patient was referred to a neurosurgeon who choose a “wait-and-see” strategy instead of surgery.

The paper presents the limits of computed tomography versus magnetic resonance imaging in the radiologic diagnosis of intracranial tumors.

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  • 1. Antoniades K, Karakasis D, Taskos N. Abducent nerve palsy following transverse fracture of the middle cranial fossa. J Craniomaxillo Surg. 1993;21(4):172-5.

  • 2. Lazow SK, Izzo SR, Feinberg ME, Berger JR. Bilateral abducens nerve palsy secondary to maxillofacial trauma: report of case with proposed mechanism of injury. J Oral Maxillofac Surg. 1995;53(10):1197-9.

  • 3. Ozveren MF, Sam B, Akdemir I, Aklan A, Tekdemir I, Deda H. Duplication of the abducens nerve at the petroclival region: an anatomic study. Neurosurgery. 2003;52(3):645-52; discussion 651-2.

  • 4. Ziyal IM, Ozcan OE, Deniz E, Bozkurt G, Ismailoglu O. Early improvement of bilateral abducens nerve palsies following surgery of an anterior communicating artery aneurysm. Acta Neurochir (Wien). 2003;145(2):159-61; discussion 161.

  • 5. Limnaios EE, Papageorgiou CT. Bilateral abducens nerve palsy. Ophthalmologica. 1980;181(6):326-9.

  • 6. Nathan H, Ouaknine G, Kosary IZ. The abducens nerve. J Neurosurg. 1974;41(5):561-6.

  • 7. Louis DN, Scheithauer BW, Budka H, von Deimling A, Kepes JJ. Meningiomas. In: Kleihues P, Cavenee WK, editors. Pathology and genetics. Tumours of the nervous system, WHO classification of tumors. Lyon: IARC Press; 2000, p.176–84.

  • 8. Rohringer M, Sutherland GR, Louw DF, Sima AA. Incidence and clinico-pathological features of meningioma. J Neurosurg. 1989;71(5 Pt 1):665-72.

  • 9. Abdel-Aziz KM, Froelich SC, Dagnew E, Jean W, Breneman JC, et al. Large sphenoid wing meningiomas involving the cavernous sinus: conservative surgical strategies for better functional outcomes. Neurosurgery. 2004;54(6):1375-83; discussion 1383-4. DOI: 10.1227/01.NEU.0000125542.00834.6D.

  • 10. Shrivastava RK, Sen C, Costantino PD, Della Rocca R. Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg. 2005;103(3):491-7.

  • 11. Oya S, Kim SH, Sade B, Lee JH. The natural history of intracranial meningiomas. J Neurosurg. 2011;114(5):1250-6. DOI: 10.3171/2010.12.JNS101623. Epub 2011 Jan 21.

  • 12. Rokni-Yazdi H, Sotoudeh H. Prevalence of “dural tail sign” in patients with different intracranial pathologies. Eur J Radiol. 2006;60(1):42-5. Epub 2006 May 3.

  • 13. Kuratsu J, Kochi M, Ushio Y. Incidence and clinical features of asymptomatic meningiomas. J Neurosurg. 2000;92(5):766-70.

  • 14. Olivero WC, Lister JR, Elwood PW. The natural history and growth rate of asymptomatic meningiomas: a review of 60 patients. J Neurosurg. 1995;83(2):222-4.

  • 15. Van Havenbergh T, Carvalho G, Tatagiba M, Plets C, Samii M. Natural history of petroclival meningiomas. Neurosurgery. 2003;52(1):55–62; discussion 62-4.

  • 16. Pendl G, Schrottner O, Eustacchio S, Ganz JC, Feichtinger K. Cavernous sinus meningiomas - what is the strategy: upfront or adjuvant gamma knife surgery? Stereotact Funct Neurosurg. 1998;70(Suppl 1):33-40.


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