Outcome of oculomotor nerve palsy from posterior communicating artery aneurysms: comparison of clipping and coiling.
OBJECTIVE
Recovery of posterior communicating artery aneurysm-induced oculomotor nerve palsy (ONP) after aneurysm coiling has been reported. However, the coil mass may compromise recovery of the nerve. Therefore, we compared the outcome of coiling and clipping for this indication.


METHODS
We retrospectively compared the outcomes of ONP in 13 patients, six of whom underwent endovascular coiling and seven of whom underwent surgical clipping.


RESULTS
Six of the seven surgical patients with ONP recovered completely, compared with two of the six patients in the endovascular group. Of the patients with more than 1 year of follow-up, all six surgical patients recovered completely, compared with two of four endovascular patients (P = 0.05). In addition, preoperative complete or partial ONP also was associated with degree of resolution by survival analysis (P = 0.03). All patients with partial ONP in the surgical group and two of three patients in the endovascular group recovered without residual deficits, whereas three of the four patients with complete ONP in the clipping group and none in the coiling group recovered completely. Regardless of the treatment method, time to complete resolution of ONP was 6 months in both groups.


CONCLUSIONS
Clipping posterior communicating artery aneurysms was associated with a higher probability of complete recovery from ONP than coiling. Degree of preoperative ONP also affected recovery. If patients can tolerate surgery, it should be considered the treatment of choice.
Chen
Peng R
PR
Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Amin-Hanjani
Sepideh
S
Albuquerque
Felipe C
FC
McDougall
Cameron
C
Zabramski
Joseph M
JM
Spetzler
Robert F
RF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000592:standards; D015840:Oculomotor Nerve Diseases / Q000209:etiology* / Q000503:physiopathology; D020127:Recovery of Function; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome