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

  • Clinical Article - Vascular
  • Published:
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Abstract

Background

Aneurysms at the posterior face of the internal carotid artery can lead to oculomotor nerve palsy (ONP) with an uncertain prognosis of recovery post-treatment. The aim of this study was to define the prognostic factors for ONP recovery, with particular interest in treatment modality (surgery or endovascular techniques).

Method

A literature review was performed to select the most pertinent prognostic factors. A retrospective study was then performed to determine whether these factors had significantly modified the prognosis of ONP recovery in our series of patients.

Results

In the literature, factors linked to poorer outcome were age, vascular risk factors, initial ONP severity and delay before treatment; better recovery was associated with surgical treatment. Between 2000 and 2013, 23 consecutive patients were treated in our department for ONP-inducing aneurysms: 14 by endovascular embolization and 9 by surgical clipping and aneurysm puncture. Mean follow-up was 48.8 months. After treatment, overall recovery occurred in 87 % of cases, always within 6 months. Apart from treatment modality, no selected prognostic factor significantly modified the quality or timing of ONP recovery. In the endovascular group, four patients recovered completely, seven partially and three did not recover. In the surgical group, seven patients recovered completely and two partially. Surgery was significantly associated with a more complete and earlier ONP recovery (p < 0.05).

Conclusions

Surgery was associated with a more complete and earlier ONP recovery as compared to endovascular treatment, confirming the results of previous studies. However, conclusions must be confirmed by a prospective randomized study.

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Acknowledgments

The authors thank Dominic Ballard for help in manuscript preparation.

Portions of this work were presented in abstract form at the National Congress of The French Neurosurgical Society, Dijon, France, 6 April 2011.

Conflicts of interest

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. CHU Pellegrin, Service de Neurochirurgie B, Hôpital Pellegrin-Tripode, Place Amélie Raba-Léon, 33 076, Bordeaux Cedex, France

    Julien Engelhardt, Emmanuel Cuny & Guillaume Penchet

  2. CHU Pellegrin, Service de Neuroimagerie Diagnostique et Thérapeutique, Bordeaux, France

    Jérôme Berge

  3. Université de Bordeaux, Bordeaux, France

    Emmanuel Cuny

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  1. Julien Engelhardt
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  2. Jérôme Berge
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  4. Guillaume Penchet
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Correspondence to Julien Engelhardt.

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Engelhardt, J., Berge, J., Cuny, E. et al. Oculomotor nerve palsy induced by internal carotid artery aneurysm: prognostic factors for recovery. Acta Neurochir 157, 1103–1111 (2015). https://doi.org/10.1007/s00701-015-2440-6

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  • DOI: https://doi.org/10.1007/s00701-015-2440-6

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