{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:09:35Z","timestamp":1790258975333,"version":"4.1.0"},"reference-count":14,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,7]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Acquired oculomotor nerve palsy is most commonly due to microvascular ischaemia, while symptomatic non-aneurysmal neurovascular compression remains exceedingly rare and often underdiagnosed. We report the case of a woman with a 2-year history of left-sided ptosis and binocular horizontal diplopia. Imaging revealed a neurovascular conflict secondary to a fetal-type posterior communicating artery. Conservative treatments failed, and the patient underwent microvascular decompression (MVD) via a left pterional approach. Decompression was achieved using a dural sling affixed to the internal carotid artery with an aneurysm clip. Postoperative recovery was rapid, with resolution of symptoms by the third week. This case highlights the need to consider neurovascular compression in unexplained or apparent idiopathic third nerve palsy, even years after symptom onset. It also demonstrates that MVD can be effective even in long-standing cases.<\/jats:p>","DOI":"10.1136\/bcr-2025-269397","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:55:19Z","timestamp":1790258119000},"page":"e269397","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Microvascular decompression for long-standing oculomotor nerve palsy due to compression by fetal-type posterior communicating artery"],"prefix":"10.1136","volume":"19","author":[{"given":"Marco","family":"Cenzato","sequence":"first","affiliation":[{"name":"Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Petrella","sequence":"additional","affiliation":[{"name":"Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Iovino","sequence":"additional","affiliation":[{"name":"Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Boeris","sequence":"additional","affiliation":[{"name":"Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"2026092406550902000_19.9.e269397.1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1001\/jamaophthalmol.2016.4456","article-title":"Incidence and Etiologies of Acquired Third Nerve Palsy Using a Population-Based Method","volume":"135","author":"Fang","year":"2017","journal-title":"JAMA Ophthalmol"},{"key":"2026092406550902000_19.9.e269397.2","doi-asserted-by":"crossref","first-page":"105920","DOI":"10.1016\/j.clineuro.2020.105920","article-title":"The oculomotor neurovascular conflict: Literature review and proposal of management","volume":"195","author":"Belotti","year":"2020","journal-title":"Clin Neurol Neurosurg"},{"key":"2026092406550902000_19.9.e269397.3","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000199160.93257.49"},{"key":"2026092406550902000_19.9.e269397.4","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.wneu.2015.12.083","article-title":"Microvascular Decompression for Oculomotor Nerve Palsy: A Case Report and Literature Review","volume":"88","author":"Kheshaifati","year":"2016","journal-title":"World Neurosurg"},{"key":"2026092406550902000_19.9.e269397.5","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s10072-010-0342-1","article-title":"Complete oculomotor palsy caused by persistent trigeminal artery","volume":"31","author":"Bosco","year":"2010","journal-title":"Neurol Sci"},{"key":"2026092406550902000_19.9.e269397.6","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1974.00490400087011"},{"key":"2026092406550902000_19.9.e269397.7","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1080\/02688697.2020.1812522","article-title":"Posterior communicating artery infundibulum with oculomotor nerve palsy treated with microvascular decompression: a case report and 2-dimensional technical operative video","volume":"37","author":"Dowlati","year":"2023","journal-title":"Br J Neurosurg"},{"key":"2026092406550902000_19.9.e269397.8","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.wneu.2018.07.242","article-title":"Microvascular Decompression for Oculomotor Nerve Palsy Due to Compression by Infundibular Dilatation of Posterior Communicating Artery","volume":"119","author":"Fukami","year":"2018","journal-title":"World Neurosurg"},{"key":"2026092406550902000_19.9.e269397.9","doi-asserted-by":"crossref","DOI":"10.3389\/fnmol.2022.923089","article-title":"The Underlying Pathogenesis of Neurovascular Compression Syndromes: A Systematic Review","volume":"15","author":"Szmyd","year":"2022","journal-title":"Front Mol Neurosci"},{"key":"2026092406550902000_19.9.e269397.10","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s10072-015-2440-6","article-title":"Isolated unilateral ptosis due to neurovascular conflict","volume":"37","author":"Piccirillo","year":"2016","journal-title":"Neurol Sci"},{"key":"2026092406550902000_19.9.e269397.11","first-page":"989","article-title":"Prevalence of nerve-vessel contact at cisternal segments of the oculomotor nerve in asymptomatic patients evaluated with magnetic resonance images","volume":"123","author":"Wang","year":"2010","journal-title":"Chin Med J (Engl)"},{"key":"2026092406550902000_19.9.e269397.12","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.3171\/2009.1.JNS081185","article-title":"Anatomical features of the cisternal segment of the oculomotor nerve: neurovascular relationships and abnormal compression on magnetic resonance imaging","volume":"111","author":"Liang","year":"2009","journal-title":"J Neurosurg"},{"key":"2026092406550902000_19.9.e269397.13","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1053\/jscd.2001.25469","article-title":"Third nerve paresis caused by vascular compression by the posterior communicating artery","volume":"10","author":"Mulderink","year":"2001","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2026092406550902000_19.9.e269397.14","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.wneu.2020.08.215","article-title":"Microvascular Decompression for Oculomotor Nerve Palsy due to Nonaneurysmal Vascular Compression","volume":"145","author":"Onuma","year":"2021","journal-title":"World Neurosurg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269397","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:55:21Z","timestamp":1790258121000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":14,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,24]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2025-269397"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269397","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}