Posterior communicating aneurysm with oculomotor nerve palsy: Predictors of nerve recovery

Abstract

The recovery of oculomotor nerve palsy (ONP) due to posterior communicating aneurysm (PComAA) remains largely undefined. This retrospective study was undertaken to investigate predictors of nerve recovery in patients with ONP due to PComAA. A total of 102 patients with ONP due to PComAA who had undergone either endovascular coiling (63 cases) or surgical clipping (39 cases) between 2012 and 2017 were retrospectively analyzed. Patients consisted of 85 women and 17 men with a mean age of 59.8 years (range, 34-82 years), including 55 un-ruptured and 47 ruptured PComAAs. There were 62 complete and 40 partial ONPs before intervention. The mean interval between ONP onset and treatment was 17.7 days (range, 1-180 days). Fifty-seven (55.9%) cases showed complete recovery and 43 (42.2%) cases showed partial recovery, while two (1.9%) cases showed no sign of oculomotor nerve recovery at the last follow-up. Although initial palsy severity, preoperative palsy time, and the presence of subarachnoid hemorrhage (SAH) were significant predictors for ONP recovery in a univariate analysis, a multivariate analysis did not confirm subarachnoid hemorrhage as an independent predictor for recovery. In addition, the aneurysm treatment modality was not correlated with nerve recovery in either analysis. In conclusion, initial palsy severity and preoperative palsy times are important predictors for ONP recovery, early treatment is recommended to achieve complete recovery of ONP, regardless of the presence or absence of SAH. Prospective randomized studies should be performed to determine the influence of different therapeutic strategies (coiling vs. clipping) on nerve recovery.

Keywords: Oculomotor nerve palsy; Posterior communicating aneurysm; Subarachnoid hemorrhage.