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. 2020;14(9):366-372.
doi: 10.5797/jnet.oa.2020-0001. Epub 2020 Jun 25.

Endovascular Treatment of Patients with Oculomotor Nerve Palsy Induced by Posterior Communicating Artery Aneurysms

Kentaro Shimoda  1 , Toshikazu Kano  1 , Genya Kurata  2 , Yu Kanazawa  2 , Makoto Furuichi  1 , Atsuo Yoshino  2
Affiliations

Endovascular Treatment of Patients with Oculomotor Nerve Palsy Induced by Posterior Communicating Artery Aneurysms

Kentaro Shimoda et al. J Neuroendovasc Ther. 2020.

Abstract

Objective: Whether coiling is the best treatment option for oculomotor nerve palsy (ONP) induced by posterior communicating artery (PComA) aneurysms remains controversial. In this study, we retrospectively analyzed the recovery of ONP caused by PComA aneurysms.

Methods: Between 2007 and 2019, 8 patients with PComA aneurysms and ONP underwent coiling at our institution. We retrospectively reviewed ONP recovery, duration from onset of ONP to treatment, and complications of procedures.

Results: At the last available clinical follow-up, ONP recovery was complete in 4 patients (50%) and partial in 4 patients (50%). Patients with partial recovery of ONP had sequelae of eye movement impairment that did not affect daily life. In 1 patient, hemiplegia developed due to cerebral infarction of the corona radiata the day after coiling, but it fully recovered 1 year after operation. The delay from the onset of ONP to coiling was significantly related to partial ONP recovery (r = -0.83, p = 0.01).

Conclusion: Endovascular treatment is a relatively safe and satisfactory treatment for PComA aneurysms with ONP.

Keywords: coil embolization; oculomotor nerve palsy; posterior communicating artery aneurysms.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1. Relationship between the degree of recovery from oculomotor nerve palsy and interval from the development of oculomotor nerve palsy until treatment. Partial palsy remained with the prolongation of the interval from the development of oculomotor nerve palsy until coiling (r = -0.83, p = 0.01). In all patients in whom coiling was performed within 1 week after symptom onset, complete recovery was achieved. CR: complete recovery; ONP: oculomotor nerve palsy; PR: partial recovery; VER: volume embolization rate
Fig. 2
Fig. 2. Relationship between the degree of recovery from oculomotor nerve palsy and VER. Partial palsy often remained with an increase in the VER, but there was no significant difference (r = -0.59, p = 0.12). In 2 patients with a VER of ≥35%, partial recovery was achieved. CR: complete recovery; ONP: oculomotor nerve palsy; PR: partial recovery; VER: volume embolization rate
Fig. 3
Fig. 3. Preoperative MRA in a representative case (Patient No. 7): (a) A right PComA aneurysm, measuring 7 mm, with bleb formation at its lateral area and end was detected. In addition, a cerebral aneurysm measuring 2 mm was observed in the right A1 area. (b) A left AChA aneurysm measuring 7 mm was detected. AChA: anterior choroidal artery; PComA: posterior communicating artery
Fig. 4
Fig. 4. Intra-/postoperative findings: (a) 3D-DSA, (b) DSA, A right PComA aneurysm, measuring 7.6 × 5.2 mm, with bleb formation at its lateral area and end, was detected. (c) Balloon-assisted embolization of the neck remnant was performed using 5 coils. Attention was paid in order for tight packing to not involve the bleb area at the aneurysmal end (arrow). (d) Postoperative MRI: Asymptomatic several small cortical infarctions involving the parietal/occipital lobes were detected. PComA: posterior communicating artery
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