Recovery of ophthalmoplegia after endovascular treatment of intracranial aneurysms

Abstract

Background and purpose: Recovery of aneurysm induced CNP after endosaccular coiling has been reported in the literature. The aim of this study was to assess in detail the parameters that affect the outcome after endovascular treatment of ophthalmoplegic aneurysms due CNP.

Materials and methods: Between November 1999 and March 2008, 30 consecutive patients (8 men, 22 women; mean age, 54.9 years) presenting with CNP underwent endosaccular coiling with or without additional use of stents in the parent artery. Subarachnoid hemorrhage was present in 10 patients, whereas 20 patients had unruptured aneurysms. The mean size of the aneurysms was 10 mm. Initial CNP was complete in 11 patients and partial in 19. Mean follow-up after coiling was 19 months.

Results: The mean interval between the onset of CNP and aneurysm embolization was 48 days. Fifteen patients (50%) had complete recovery of oculomotor function, 12 had incomplete recovery (40%), and 3 (10%) remained unchanged after treatment. In 4 aneurysms (13.3%), 1 additional embolization was performed, whereas in 4 other aneurysms, 2 additional embolization procedures were necessary. Procedure-related permanent morbidity occurred in 2 patients (6.6%).

Conclusions: Endosaccular coiling is an effective and safe method for the treatment of ophthalmoplegic aneurysms. Age, neck size, and time of treatment do not seem to constitute prognostic factors with respect to CNP recovery, though patients with small aneurysms, unruptured status, and/or location in the posterior circulation showed a tendency for better outcome. The degree of initial CNP was the only statistically significant prognostic factor concerning the final outcome, resulting in better recovery, in case of incomplete initial CNP.

Fig 1.

Graph shows that smaller aneurysms (≤10 mm) have a higher but not statistically significant tendency for better CNP recovery (complete recovery, 11/20; 55%) compared with larger aneurysms (>10 mm) (complete recovery, 4/10; 40%).

Fig 2.

Graph shows that more patients achieve a complete recovery of CNP in cases of unruptured aneurysms (12/18, 67%) than in cases of ruptured aneurysms (3/12, 25%). The difference is not statistically significant.

Fig 3.

Graph shows that the degree of preinterventional CNP (ie, complete or partial) is the only parameter that affects significantly (P = .009) the recovery of ophthalmoplegia. Patients with incomplete initial CNP have a statistically significant higher degree of CNP recovery.

Fig 4.

Unruptured cavernous aneurysm of the left ICA causing partial sixth cranial nerve paresis for 2 months. Anteroposterior (A and B, early and middle arterial phase) and lateral arteriograms (C and D, early and middle arterial phase) before intervention. Anteroposterior (E) and lateral arteriograms (F) after stent-supported coiling. The white arrows in the insert of the anteroposterior arteriogram (E) show the stent struts.