Endovascular management and recovery from oculomotor nerve palsy associated with aneurysms of the posterior communicating artery

Abstract

Objective: To report the ophthalmologic outcome of 13 patients with posterior communicating artery aneurysms (PcomAAs) associated with oculomotor nerve palsy (ONP), treated by endovascular embolization (coiling).

Methods: Data from 13 consecutively admitted patients with PcomAAs who presented with ONP and underwent endovascular treatment were retrospectively analyzed. Predictive recovery factors such as treatment timing, the degree of preoperative nerve deficit, aneurysm size, and association with subarachnoid hemorrhage (SAH) were analyzed.

Results: Among the 13 patients, 8 presented initially with complete nerve palsy, and 5 presented with partial palsy. Eight patients had SAH. The mean aneurysm size was 7.9 mm. Recovery was complete in seven patients and partial in six patients. The mean follow-up period was 8.2 months. One case of delayed recovery from ONP was observed at 16 months after treatment, and the patient underwent a second coiling procedure to treat a recanalization of her aneurysmal sac. Significant factors that influenced recovery from ONP included the severity of ONP at admission, clinical presentation with SAH, and early management (P = .020979021, P = .031857032, and P = .020979021). The size of aneurysm did not influence recovery (P = 1.00).

Conclusions: Endovascular treatment is highly efficacious in treating ONP-associated PcomAAs. Partial palsy, early treatment, and an association with SAH seem to promote recovery.