Recovery of Ophthalmoplegia after Endovascular Treatment of Intracranial Aneurysms

Abstract

BACKGROUND AND PURPOSE:Recovery of aneurysm induced CNP after endosaccular coiling has been reported in the literature. The aim of this study was to assess in detail the parameters that affect the outcome after endovascular treatment of ophthalmoplegic aneurysms due CNP.

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

“…Furthermore, uncertainty surrounds the importance of negative prognostic factors reported in previous series, including old age, general vascular risk factors (tobacco use, high blood pressure, diabetes, chronic alcoholism) [1,23], initial complete palsy [1,7,8,10,13,14,20,25] and long delay before treatment (>3 or 5 days depending on the series) [1,8,15,17,24]. 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.…”

Neuroophthalmological outcomes associated with use of the Pipeline Embolization Device: analysis of the PUFS trial results

“…Moreover, although we did not collect data on symptom duration, there is ample evidence that earlier intervention following symptom onset results in the highest likelihood of recovery from cranial or optic neuropathy. 11 This observation may be important because the composition of the aneurysm cohort targeted by PUFS (large, complex neck lesions for which acceptable alternative therapies were lacking) may have contained a bias toward patients with longstanding symptoms.…”

“…The relatively brief follow-up period in this analysis may limit our estimation of the ultimate therapeutic benefit of PED. In a retrospective study of patients with CN palsies related to intracranial aneurysms of any location, 11 the mean length of time between treatment and recovery was 69 days; however, some patients' recoveries took up to 300 days. Moreover, although we did not collect data on symptom duration, there is ample evidence that earlier intervention following symptom onset results in the highest likelihood of recovery from cranial or optic neuropathy.…”

“…In addition, optic neuropathy may develop from direct compression of the optic nerve, resulting in visual field (VF) deficits, visual acuity (VA) problems, and/or afferent pupillary defects (APDs). Although the effects of both endovascular and surgical aneurysm treatments on neuroophthalmological morbidity rates have been studied, 1,[3][4][5]8,9,11,13,15,16 the literature on this matter as a whole is diminished by the lack of prospective studies, the variable length of reported follow-up, and the lack of consensus on fundamental neuroophthalmological endpoints; for example, there is a lack of agreement whether objective findings such as "ophthalmoparesis" should be grouped with subjective findings such as "diplopia. "…”

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

“…4 Several small observational studies have reported improvement in cranial nerve function after aneurysm treatment in those patients presenting with cranial nerve palsy, but no randomized trials have evaluated this practice. [123][124][125][126][127] For patients presenting with oculomotor palsy secondary to posterior communicating aneurysms, several retrospective studies have indicated better resolution with surgery than endovascular therapy [128][129][130] or conservative management. 128 Sudden onset of third nerve palsy in this setting is generally considered an indication of expansion and concern for imminent rupture, necessitating rapid workup and intervention.…”