Recovery from oculomotor nerve palsy due to posterior communicating artery aneurysms: results after clipping versus coiling in a single-center series

Abstract

Despite the small number of patients, our study suggests that both surgical clipping and embolization are safe and effective methods in regards to functional recovery (complete ONP recovery in about 85 % of the cases). However, coiling may lead to delayed recurrence of third cranial nerve (CN) palsy at long-term follow-up, requiring additional treatment.

Oculomotor nerve palsy induced by internal carotid artery aneurysm: prognostic factors for recovery

“…As in cases of subarachnoid hemorrhage associated with oculomotor nerve palsy, the standard procedure is to treat the ruptured aneurysm. We found only one report in the literature [3] describing the case of an 82-year-old female with severe comorbidities who presented with PCoA aneurysm rupture and 6 months later showed spontaneous ONP recovery, without having undergone aneurysm exclusion. It is, however, impossible to draw any conclusions or pathophysiological hypotheses on the natural history of ONP after aneurysm rupture.…”

“…The difference between the two groups was not significant. In 2014, Brigui et al [3] compared the outcomes of 7 surgically treated patients with 14 treated by embolization. Again, post-treatment ONP recovery did not differ significantly between the two groups.…”

“…Moreover, in spite of the publication of six previous retrospective comparative studies and two meta-analyses, the superiority of either treatment modality remains controversial, with two series [7,24] showing a better recovery rate after surgery and four [1,3,19,21] showing no significant difference between the two treatments. Both meta-analyses available [9,14] are in favor of surgical treatment.…”

“…Equally, the positive prognostic value of subarachnoid hemorrhage (SAH) [15] and surgical treatment versus endovascular management of ONP-inducing aneurysm [1,3,7,9,14,19,21,24] remains uncertain.…”

“…Although all published series are retrospective and use small samples, thus undermining the validity of their conclusions, both treatments of aneurysm (i.e., endovascular techniques and surgical clipping) appear capable of inducing recovery from third cranial nerve palsy [2,3,6,8,10,15,16,18,22,23,25].…”