Summary
Intact aneurysms of the carotid siphon at the point of take-off of the posterior communicating artery may exhibit orbital pain, whether associated with oculomotor palsy or not as a warning symptom prior to rupture. In order to explain this symptom the hypothesis of a sensory pathway within the third cranial nerve, which is liable to compression by the enlarging aneurysm sac, has been investigated.
Data from human autopsy material show evidence of sensory ganglion cells within the rootlets of the oculomotor nerve; furthermore, studies in animals prove that the third nerve contains sensory fibers which run proximally along the nerve bundles, enter the brainstem and reach the spinal trigeminal nucleus. These fibers come from the ophthalmic division of the fifth nerve and join the third nerve at the level of the lateral wall of the cavernous sinus.
Although a number of questions remain to be solved, the presence of a sensory pattern within the third nerve could account for frontoorbital pain from enlarging aneurysms impinging on the third nerve itself.
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References
Bortolami R, Veggetti A, Callegari Eet al (1977) Afferent fibers and sensory ganglion cells within the oculomotor nerve in some mammals and man. I. Anatomical investigation. Arch Ital Biol 115: 355–385
Botterell EH, Lloyd LA, Hoffman HJ (1962) Oculomotor palsy due to supraclinoid internal carotid artery berry aneurysm. A long term study of the results of surgical treatment on the recovery of third-nerve function. Am J Ophthalmol 54: 600–616
Brazis PW (1991) Localization of lesions of the oculomotor nerve: recent concepts. Mayo Clin Proc 66: 1029–1035
Fox JL (1983) Intracranial aneurysms, Vol 1. Springer, New York Berlin Heidelberg Tokyo, pp 163
France JF (1846) Examples of ptosis with illustrative remarks. Guy's Hosp Rep 4: 37–63
Harris P, Udvarhelyi GB (1957) Aneurysms arising at the internal carotid-posterior communicating artery junction. J Neurosurg 14: 180–191
Jefferson G (1947) Isolated oculomotor palsy caused by intracranial aneurysm. Proc Roy Soc Med 40: 419–432
Locksley HB (1966) Natural history of subarachnoid hemorrhage. Intracranial aneurysms and arteriovenous malformations, Section V, Part II. J Neurosurg 25: 321–368
Lucchi ML, Bortolami R, Callegari E (1972) Ultrastructural features of mesencephalic trigeminal nucleus cells in cat, rabbit, and pig. J Submicr Cytol 4: 7–18
Manni E, Bortolami R, Desole C (1968) Peripheral pathway of eye muscle proprioception. Exp Neurol 22: 1–12
Manni E, Bortolami R, Pettorossi VEet al (1987) Influence of oculomotor nerve afferents on central endings of primary trigeminal fibers. Arch Ital Biol 126: 29–39
Okawara SH (1973) Warning signs prior to rupture of an intracranial aneurysm. J Neurosurg 38: 575–580
Soni SR (1974) Aneurysms of the posterior communicating artery and oculomotor paresis. J Neurol Neurosurg Psychiatry 37: 475–484
Winckler G (1959) À propos de la technique de l'imprégnation argentique de Marsland, Glees et Erikson. Arch Anat Histol Embriol 42: 231–241
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Lanzino, G., Andreoli, A., Tognetti, F. et al. Orbital pain and unruptured carotid-posterior communicating artery aneurysms: The role of sensory fibers of the third cranial nerve. Acta neurochir 120, 7–11 (1993). https://doi.org/10.1007/BF02001462
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DOI: https://doi.org/10.1007/BF02001462