Unruptured Aneurysms with Cranial Nerve Symptoms: Efficacy of Endosaccular Guglielmi Detachable Coil Treatment

Abstract

ObjectiveTo evaluate the efficacy of endosaccular Guglielmi detachable coil (GDC) treatment of unruptured aneurysms causing cranial nerve (CN) symptoms.Materials and MethodsAmong a database of 218 patients whose aneurysms were treated using GDC, seven patients met the criteria for unruptured aneurysms presenting with symptoms and signs of CN palsy. Changes in CN symptoms before and after GDC treatment were reviewed.ResultsAneurysms were located in the internal carotid-posterior communicating artery (n=3), the basilar bifurcation (n=1) and the cavernous internal carotid artery (n=3). CN symptoms included ptosis (n=6), mydriasis (n=2), and extraocular muscle (EOM) disorder (CN III: n=4; CN VI: n=3). Overall, improvement or resolution of CN symptoms after treatment was noted in five patients. CN symptoms in cases involving small (≤ 10 mm) and intradural aneurysms tended to respond better to GDC treatment. Ptosis was the initial symptom to show improvement, while EOM dysfunction responded least favourably.ConclusionGDC coil packing appears to be an appropriate treatment method for the relief of CN symptoms associated with intracranial aneurysms.

Recovery of Ophthalmoplegia after Endovascular Treatment of Intracranial Aneurysms

“…11 Evolution of ocular motor nerve (third, fourth, and sixth) paresis after endovascular therapy has been reported in the literature: Beyond sporadic reports with ONP resolution after coiling of PcomA aneurysms, 12 a literature review concerning series including Ն3 aneurysms revealed a mean rate of 46.6% complete recovery after endovascular treatment of 118 (55/118) aneurysms that caused ophthalmoplegia (Table 5). 7,9,[13][14][15][16][17][18][19][20][21] Our results concerning endovascular treatment are very encouraging: In a mean follow-up of 19 a The degree of initial CNP was the only statistically significant prognostic factor concerning the final outcome, resulting in better recovery in case of incomplete initial CNP.…”

“…8 Mydriasis can be caused by an ICAPcomA aneurysm compressing the oculomotor nerve superomedially and, more specifically, the dorsomedially located iridoconstrictor fibers. 9 Compression of the pain sensory afferent fibers, which are recruited from the ophthalmic division of the trigeminal nerve and which lie within the periphery of the oculomotor nerve, causes ipsilateral orbitofacial pain. 10 Compressive lesions of the cavernous sinus may lead to localized oculomotor or abducens CN dysfunction and Horner syndrome.…”

Intentional Sparing of Daughter Sac from Coil Packing in the Embolization of Aneurysms Causing the Third Cranial Nerve Palsy : Initial Clinical and Radiological Results

“…Coil packing is known to decompress CN III by reducing the pulsatile expansion of the aneurysm dome 6,8,15) . However, it is generally accepted that clipping is superior to coiling because there is the possibility of intraoperative decompression such as resection or shrinkage of the dome 3,15,16) .…”

“…There are also reports that embolized aneurysms usually become larger than initial ones 17) and can cause surrounding edema, especially when the aneurysm is located close to the brain parenchyme 7) . However, there has been no other report on improvement of the recovery rate after embolization except for early intervention of the partially affected patients 6,8) .…”

“…Complete or partial recovery of CN III palsy after clipping has been widely reported while the recovery rate after coiling has been documented only in a small number of reports and is not as good as that of clipping [1][2][3]6,8,16) . In contrast to clipping, which can shrink or puncture the aneurysm dome at the end of the operation for more effective decompression 3,15,16) , coiling by its nature tends to maintain the original size of the dome by filling in detachable coils after successful embolization.…”