In a patient with superior oblique myokymia, a contact is visualised between the right trochlear nerve and a vascular structure by high resolution thin slices magnetic resonance images coupled to angio-MR. A similar contact is not visualised on the left side. This suggests that the neuro-vascular contact is the cause of this superior oblique myokymia and offers the possibility of neuro-surgical decompression if necessary.
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Trochlear Nerve Decompression by Endoscopic Suboccipital Supracerebellar Infratentorial Approach: A Technical Note: 2-Dimensional Operative Video.
Oper Neurosurg (Hagerstown)
January 2025
Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA.
Background And Importance: Superior oblique myokymia (SOM) is a rare, acquired aberration of the innervation of the superior oblique, resulting in episodic monocular contraction of the superior oblique muscle characterized by intermittent rotatory eye movement causing diplopia and oscillopsia. Several treatment modalities have been described to treat SOM, including medication and surgical interventions. There is a paucity of reports describing microvascular decompression (MVD) of the trochlear nerve near the root entry zone for the treatment of a neurovascular conflict.
View Article and Find Full Text PDFCommentary: Fully Endoscopic Microvascular Decompression of the Trochlear Nerve for Treatment of Medically Refractory Superior Oblique Myokymia: Technical Case Instruction and Operative Video.
Oper Neurosurg (Hagerstown)
December 2024
Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA.
Fully Endoscopic Microvascular Decompression of the Trochlear Nerve for Treatment of Medically Refractory Superior Oblique Myokymia: Technical Case Instruction and Operative Video.
Oper Neurosurg (Hagerstown)
December 2024
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Background And Importance: We describe, to our knowledge, the first report of fully endoscopic microvascular decompression (MVD) of the trochlear nerve in a patient with superior oblique myokymia (SOM).
Clinical Presentation: A 51-year-old female presented with multiple years of intermittent, "jumpy," and "shimmering" visual disturbances. She was diagnosed with SOM.
Introduction: The treatment options available for Superior Oblique Myokymia (SOM) previously included surgery and systemic drugs, with the addition of beta blockers from the early 1990's. This case review aims to examine the efficacy of topical timolol (0.5%) as a treatment for SOM in the short and long term.
View Article and Find Full Text PDFTeaching Video NeuroImage: Monocular Rotational Nystagmus Caused by Superior Oblique Myokymia.
Neurology
January 2024
From the Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
A 61-year-old man presented with 2 days of "flickering" vision. The symptom resolved with closure of the left eye. Examination demonstrated involuntary high-frequency, low-amplitude intorting movements of the left eye, consistent with superior oblique myokymia (Video 1).
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