INTRACRANIAL REPAIR OF A DIVIDED TROCHLEAR NERVE - CASE-REPORT

The authors report the case of a 37-year-old woman in whom the trochle ar nerve was transected during removal of a meningioma in the cavernou s sinus and subsequently repaired by using microsurgical techniques. T his patient presented with a tumor in the posterior part of the right cavernous sinus with expansion over the tentorium. Preoperatively, she suffered from partial deficit of the right trochlear nerve. Intraoper atively, the trochlear nerve was noted to be completely encased by the tumor and was totally divided during removal of the lesion. After tum or resection, the trochlear nerve was repaired by using a sural nerve fascicle secured with sutures and fibrin glue. Six months after the op eration, trochlear nerve regeneration became evident as the patient's binocular vision gradually improved. The patient regained normal funct ioning of the superior oblique muscle 3.5 years after surgery. It is c oncluded that repair of a divided trochlear nerve is worthwhile and ca n be followed by successful regeneration and an excellent functional r ecovery of the superior oblique muscle.