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. 2024 Jun 21:15:207.
doi: 10.25259/SNI_379_2024. eCollection 2024.

Intracranial aneurysms and abducent nerve palsy

Samer S Hoz  1 , Li Ma  1 , Mustafa Ismail  2 , Alhamza R Al-Bayati  3 , Raul G Nogueira  3 , Michael J Lang  1 , Bradley A Gross  1
Affiliations

Intracranial aneurysms and abducent nerve palsy

Samer S Hoz et al. Surg Neurol Int. .

Abstract

Background: Cranial nerve (CN) palsy may manifest as an initial presentation of intracranial aneurysms or due to the treatment. The literature reveals a paucity of studies addressing the involvement of the 6th CN in the presentation of cerebral aneurysms.

Methods: Clinical patient data, aneurysmal characteristics, and CN 6th palsy outcome were retrospectively reviewed and analyzed.

Results: Out of 1311 cases analyzed, a total of 12 cases were identified as having CN 6th palsy at the presentation. Eight out of the 12 were found in the unruptured aneurysm in the cavernous segment of the internal carotid artery (ICA). The other four cases of CN 6th palsy were found in association with ruptured aneurysms located exclusively at the posterior inferior cerebellar artery (PICA). For the full functional recovery of the CN 6th palsy, there was 50% documented full recovery in the eight cases of the unruptured cavernous ICA aneurysm. On the other hand, all four patients with ruptured PICA aneurysms have a full recovery of CN 6th palsy. The duration for recovery for CN palsy ranges from 1 to 5 months.

Conclusion: The association between intracranial aneurysms and CN 6th palsy at presentation may suggest distinct patterns related to aneurysmal location and size. The abducent nerve palsy can be linked to unruptured cavernous ICA and ruptured PICA aneurysms. The recovery of CN 6th palsy may be influenced by aneurysm size, rupture status, location, and treatment modality.

Keywords: Abducent nerve; Cranial nerve palsy; Intracranial aneurysms.

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Conflict of interest statement

Dr. Gross is a consultant for Medtronic, Stryker, and MicroVention. Dr. Nogueira reports consulting fees for advisory roles with Stryker Neurovascular, Cerenovus, Medtronic, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, Imperative Care, and stock options for advisory roles with Brainomix, Viz-AI, Corindus Vascular Robotics, Vesalio, Ceretrieve, Astrocyte, and Cerebrotech.

Figures

Figure 1:
Figure 1:
Summary of cases with abducent nerve palsy at presentation in the setting of intracranial aneurysms. ICA: Internal carotid artery, PICA: Posterior inferior cerebellar artery.
Figure 2:
Figure 2:
Example of catheter cerebral angiography for intracranial aneurysm cases that were presented with abducent nerve palsy. (a) Left cavernous internal carotid artery aneurysm. (b) Right posterior inferior cerebellar artery aneurysm.
Figure 3:
Figure 3:
Illustrative depiction of the abducent nerve relation to various aneurysms: (a) cavernous ICA aneurysm (white asterisk) and (b) PICA aneurysm (black asterisk). BA: Basilar artery, VI: Abducent nerve, PICA: Posterior inferior cerebellar artery, ICA: Internal carotid artery, CS: Cavernous sinus. Illustration prepared by Ahmed Muthana and courtesy of Samer Hoz.
See this image and copyright information in PMC

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