Recovery of Posterior Communicating Artery Aneurysm-Induced Oculomotor Palsy after Coiling

Abstract

BACKGROUND AND PURPOSE:Recovery of oculomotor (cranial nerve [CN] III) palsy after surgery of posterior communicating artery (PcomA) aneurysms has been well documented, but recovery after coiling is poorly understood. In this study, we report the recovery after coiling of PcomA aneurysminduced CN III palsy in 21 patients at follow-up of 1 to 7 years.

Endovascular Treatment of Posterior Communicating Artery Aneurysms with Oculomotor Nerve Palsy: Clinical Outcomes and Predictors of Nerve Recovery

“…Therefore, overall improvement (partial or complete) occurs in up to 90% of patients undergoing endovascular therapy. These important findings are in agreement with the findings of Hanse et al, 11 who assessed the recovery of ONP with endovascular therapy in 21 patients. The authors found that ONP recovered completely in 38.1% (8/21) of patients and partially in 52.4% (11/21) after endovascular therapy.…”

“…On the basis of these findings, it is possible that a significant number of patients with partial ONP recovery at their latest follow-up would eventually progress to complete recovery. Our findings contradict those of Chen et al 4 and Hanse et al, 11 who respectively reported that ONP recovery occurs invariably within 6 and 12 months following treatment. This question, however, requires further investigation ideally through large prospective studies with long periods of clinical follow-up.…”

“…Patient anatomy could account for an occasional ONP occurring with small unruptured PcomA aneurysms. A variety of factors have been found to influence ONP recovery in the literature, including the degree of initial palsy, 4,5,7,8,11,18 treatment timing, 8,11,19 subarachnoid hemorrhage, 6,8,10 patient age, 14 and cardiovascular risk factors. 14 In the present study, a partial ONP at presentation was the only statistically significant predictor of complete ONP recovery with endovascular therapy.…”

“…4,5 Endovascular therapy has also shown high efficacy in promoting nerve recovery. 9,11,12 Experience with endovascular therapy, however, has been limited to a few case series of small sample size. We assessed the resolution of ONP in a series of 37 patients undergoing endovascular treatment in our institution.…”

Partially Thrombosed Intracranial Aneurysms Presenting with Mass Effect: Long-Term Clinical and Imaging Follow-Up after Endovascular Treatment

“…20,21 In comparing ours to previous studies regarding clinical follow-up and neurologic outcome of patients presenting with neurologic symptoms from all types of endovascularly treated aneurysms, we found no apparent worse outcome of the endovascularly treated partially thrombosed aneurysms in our study. 2,6,8,10,15,[22][23][24] Partially thrombosed aneurysms might have a different pathogenesis and, therefore, may form a different disease than aneurysms without intraluminal thrombus. Some propose that the vasa vasorum of the aneurysmal wall play a crucial role in the development and growth of aneurysms with intraluminal thrombus by proliferation, inflammation, and rupture.…”