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Recovery from oculomotor nerve palsy due to posterior communicating artery aneurysms: results after clipping versus coiling in a single-center series

  • Clinical Article - Vascular
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Abstract

Background

Oculomotor nerve palsy (ONP) is a common clinical manifestation of ruptured or unruptured posterior communicating artery (PcomA) aneurysms. Although microsurgical clip ligation has been proven a safe and durable treatment, endovascular management is emerging as an increasingly popular alternative. The aim of our study is to compare the recovery rate from ONP and assess the safety and long-term durability of both techniques.

Methods

We have reviewed the retrospective data concerning twenty-two patients treated at our institution between 2004 and 2012 for PcomA aneurysms with ONP. Seven patients were operated on via a standard pterional approach, and fourteen were treated by endovascular occlusion with coils. One patient was managed conservatively. Pre-treatment and post-treatment severity of ONP was recorded, as well as the duration of symptoms before admission and treatment-related complications.

Results

All seven patients who underwent surgery improved, with six total recoveries and one partial recovery. Among the fourteen patients treated by embolization, thirteen initially recovered, but long-term follow-up revealed three cases of exacerbation of ONP after refilling of the aneurysms. Two of them were clipped, and one embolized. Also, one partially resolved patient underwent a second embolization. No severe complications occurred in either group.

Conclusions

Despite the small number of patients, our study suggests that both surgical clipping and embolization are safe and effective methods in regards to functional recovery (complete ONP recovery in about 85 % of the cases). However, coiling may lead to delayed recurrence of third cranial nerve (CN) palsy at long-term follow-up, requiring additional treatment.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, La Pitié-Salpêtrière Hospital, 47 Boulevard de l’Hôpital, 75013, Paris, France

    Marina Brigui, Dorian Chauvet, Aurélien Nouet, Stéphane Clémenceau, Anne-Laure Boch, Anne-Laure Bernat & Philippe Cornu

  2. Department of Interventional Neuroradiology, La Pitié-Salpêtrière Hospital, Paris, France

    Frédéric Clarençon, Nader-Antoine Sourour & Federico Di Maria

  3. Department of Anesthesiology, La Pitié-Salpêtrière Hospital, Paris, France

    Vincent Degos

  4. Université Pierre et Marie Curie, Paris, France

    Dorian Chauvet, Vincent Degos & Philippe Cornu

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  1. Marina Brigui
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Correspondence to Dorian Chauvet.

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Brigui, M., Chauvet, D., Clarençon, F. et al. Recovery from oculomotor nerve palsy due to posterior communicating artery aneurysms: results after clipping versus coiling in a single-center series. Acta Neurochir 156, 879–884 (2014). https://doi.org/10.1007/s00701-014-2050-8

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  • DOI: https://doi.org/10.1007/s00701-014-2050-8

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