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. 2014 Aug;28(4):483-7.
doi: 10.3109/02688697.2013.857007. Epub 2013 Nov 11.

Recovery of oculomotor nerve palsy secondary to posterior communicating artery aneurysms

Krunal Patel  1 , Mathew R Guilfoyle, Diederik O Bulters, Ramez W Kirollos, Nagui M Antoun, J Nicholas P Higgins, Peter J Kirkpatrick, Rikin A Trivedi
Affiliations

Recovery of oculomotor nerve palsy secondary to posterior communicating artery aneurysms

Krunal Patel et al. Br J Neurosurg. 2014 Aug.

Abstract

Background: Recent studies suggest more favourable recovery of oculomotor nerve palsy (ONP) caused by posterior communicating artery (PComA) aneurysms with microsurgical clipping compared to endovascular coiling. We describe a consecutive series of patients with ONP from PComA aneurysms treated by microsurgical clipping or endovascular coiling.

Methods: We retrospectively reviewed medical records of all patients from 2005 to 2009 with complete or partial ONP from PComA aneurysms.

Results: Twenty patients were identified, three with unruptured aneurysms. Two patients with ruptured aneurysms were unfit for treatment and therefore excluded. Of the 18 patients included (15 female), 9 underwent microsurgical clipping and 9 received endovascular coiling. Patients treated by surgical clipping were significantly younger compared to those treated by endovascular coiling (mean 52.3 vs. 67.9 years; p = 0.039). Five patients had incomplete ONP (3 clipped, 2 coiled) and thirteen had complete ONP. At 6 months, six of nine patients treated with clipping and five of nine patients treated with coiling had complete resolution of their ONP (p = 1.0); the remainder had partial improvement. There was no significant difference in duration of pre-treatment ONP, age, sex or status of aneurysm (ruptured or unruptured) between patients in the two groups or between those with full or partial recovery. However, all 5 patients with incomplete ONP at presentation recovered fully, compared with 6 of 13 patients who presented with complete ONP.

Conclusions: We found no significant difference between clipping and coiling in the recovery of ONP due to PComA aneurysms. Patient who present with incomplete ONP are more likely to have a full recovery of ONP following either treatment modality than those who present with complete ONP.

Keywords: endovascular coiling; oculomotor nerve; posterior communicating artery; subarachnoid haemorrhage; surgical clipping.

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