Turkish Neurosurgery 2014 , Vol 24 , Num 2
Posterior Communicating Aneurysm with Oculomotor Nerve Palsy: Clinical Outcome After Aneurysm Clipping
Sio-Iong CHANG1,4, Ming-Dar TSAI2, Chih-Peng WEI2,3
1Yonghe Cardinal Tien Hospital, Department of Neurosurgery, New Taipei City, Taiwan
2Shin Kong Wu-Ho-Su Memorial Hospital, Department of Neurosurgery, Taipei, Taiwan
3Cardinal Tien Hospital, Department of Neurosurgery, New Taipei City, Taiwan
4Institute of Emergency and Critical Care Medicine, National Yang Ming University, Taiwan
DOI : 10.5137/1019-5149.JTN.6446-12.1 AIM: One of the clinical presentations of intracranial aneurysm is unilateral oculomotor nerve palsy (ONP). The most common location is the posterior communicating artery. Surgical clipping and/or endovascular coiling of the aneurysm are the treatments. The aim of this study was to identify the factors that influence the postoperative recovery of patients who have posterior communicating aneurysm with ONP.

MATERIAL and METHODS: We included 13 patients diagnosed at our hospital from 1993 to 2008 with posterior communicating aneurysm with ONP. Ten patients underwent craniotomy to clip the aneurysm; 3 patients refused surgery.

RESULTS: Five (50%) patients presented with periorbital pain. Seven (70%) patients had complete ONP recovery with a median recovery time of 58 days. We found that the first recovered component of ONP after clipping was the parasympathetic fibers with a mean recovery time of 4.4 days. Nine patients had a good recovery outcome; one patient died from postoperative vasospasm. There was no significant linear trend in complete recovery rate across palsy symptom periods. However, the palsy symptom period was significant correlated with recovery time.

CONCLUSION: Early decompression of the posterior communicating aneurysm yielded satisfactory recovery and ONP can be reversible. In our patients, the first component of oculomotor function to recover was the parasympathetic fibers. Keywords : Intracranial aneurysm, Posterior communicating aneurysm, Oculomotor nerve palsy, Aneurysm clipping

Corresponding author : Ming-dar Tsař, brain23.tw@yahoo.com.tw