Background/Objectives: Oculomotor nerve palsy (OMNP) is a clinically significant condition that may represent the earliest manifestation of life-threatening intracranial pathology, particularly aneurysmal compression or neoplasia. Despite its neurosurgical relevance, comprehensive meta-analytic evidence synthesizing OMNP etiologies, clinical presentation, and contemporary diagnostic pathways remains limited. Methods: Following PRISMA 2020 guidelines, MEDLINE, Scopus, and Web of Science were systematically searched for studies reporting quantitative data on OMNP. Pooled prevalence estimates were calculated using random-effects models for causes and symptoms, while a structured narrative synthesis was performed for diagnostic modalities because outcome reporting was heterogeneous and unsuitable for meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute (JBI) risk of bias tool. Results: Twenty-four studies involving 5541 patients were included. Using a multivariate multilevel model to account for within-study dependence, the most common etiological category was vascular disorders (35.62%), followed by idiopathic (16.47%) and neoplastic (12.10%). Head trauma and aneurysms accounted for 11.26% and 10.08% of cases, respectively. Diplopia (60.63%) and ptosis (54.12%) remained the predominant clinical symptoms, while pupil involvement was identified in 40.62% of the pooled population. Diagnostic paradigms have shifted decisively toward non-invasive neuroimaging, with magnetic resonance imaging reported in 66% of included studies and magnetic resonance or computed tomographic angiography increasingly employed to identify surgically relevant vascular lesions. Conclusions: Although vascular disorders represented the most common etiological category, the notable prevalence of aneurysmal and neoplastic causes underscores the importance of prompt high-resolution neuroimaging and early neurosurgical assessment. Early recognition and etiological stratification remain essential to optimize management and prevent irreversible neurological morbidity.

The styloid process (SP), a component of the stylohyoid complex (SHC), demonstrates considerable anatomic variability in length, angulation, ossification, and morphology. Although elongation has traditionally been regarded as the principal feature of Eagle syndrome, growing evidence suggests that 3-dimensional orientation may be equally important. We report a dry skull specimen demonstrating a markedly elongated unilateral SP with a tortuous shaft and pronounced anteromedial angulation. The osseous contour was continuous throughout its course, without evidence of fracture, segmentation, or pseudoarticulation. The distal tip projected medially toward the expected parapharyngeal space. An ipsilateral complete pterygoalar bar was also identified, creating a rare combination of skull base variants. This case highlights the importance of evaluating SP morphology beyond simple length measurements and underscores the potential influence of angulation and curvature on adjacent neurovascular and pharyngeal structures. Recognition of such variants is relevant for anatomists, radiologists, otolaryngologists, oral and maxillofacial surgeons, and skull base surgeons.