Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery

Clinical article

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Object

Resolution of oculomotor nerve palsy (ONP) after clipping of posterior communicating artery (PCoA) aneurysms has been well documented. However, whether additional decompression of the oculomotor nerve via aneurysm sac dissection or resection is superior to pure aneurysm clipping is the subject of much debate. Therefore, the objective in the present investigation was to analyze the influence of surgical strategy—specifically, clipping with or without aneurysm dissection—on ONP resolution.

Methods

Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured PCoA aneurysms causing ONP were treated at the authors' institution. Oculomotor nerve palsy was evaluated on admission and at follow-up. The electronic database MEDLINE was searched for additional data in published studies of PCoA aneurysms causing ONP. Two reviewers independently extracted data.

Results

Overall, 8 studies from the literature review and 6 patients in the current series (121 PCoA aneurysms) met the study inclusion criteria. Ninety-four aneurysms were treated with simple aneurysm neck clipping and 27 with clipping plus aneurysm sac decompression. The surgical strategy, simple aneurysm neck clipping versus clipping plus oculomotor nerve decompression, had no effect on full ONP resolution on univariate (p = 0.5) and multivariate analyses. On multivariate analysis, patients with incomplete ONP at admission were more likely to have full resolution of the palsy than were those with complete ONP at admission (p = 0.03, OR = 4.2, 95% CI 1.1–16).

Conclusions

Data in the present study indicated that ONP caused by PCoA aneurysms improves after clipping without and with oculomotor nerve decompression. The resolution of ONP is inversely associated with the initial severity of ONP.

Abbreviations used in this paper:ONP = oculomotor nerve palsy; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage.

Article Information

Address correspondence to: Erdem Güresir, M.D., Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany. email: Gueresir@em.uni-frankfurt.de.

Please include this information when citing this paper: published online August 31, 2012; DOI: 10.3171/2012.8.JNS111239.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Intraoperative images of a PCoA aneurysm (asterisks) compressing the left oculomotor nerve (arrow) before (A) and after clipping (C) without additional oculomotor nerve decompression. Three-dimensional digital subtraction angiograms of the left internal carotid artery before (B) and after clipping (D) of the PCoA aneurysm (B, asterisk).

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    Flow chart showing search strategy.

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