Resolution of cranial nerve paresis after endovascular management of cerebral aneurysms.
BACKGROUND
This work aimed to study the outcome of endovascular (coiling and balloon occlusion) treatment in patients with aneurysmal mass effect (ophthalmoplegia due to third, fourth, or sixth CN paresis) and to compare it with the outcome of clipping (from the international literature). We looked at the outcome of endovascular treatment of CNP (third, fourth, and sixth) due to aneurysmal mass effect (PcomA aneurysms and intracavernous carotid aneurysms).


METHODS
Between January 1999 and December 2004, 820 patients presented with aneurysmal SAH and/or mass effect. Eleven of these patients (1%) presented with third, and/or fourth, and/or sixth nerve dysfunctions and underwent endovascular treatment. The degree of the ophthalmoplegia was recorded at presentation, 2 months, 6 months, and yearly intervals thereafter. We correlated recovery of CNP to SAH, duration of the symptoms, degree of CNP, type of CNP, microvascular risks (age, diabetes mellitus, hypertension, and smoking), aneurysm size, and degree of coiling or balloon occlusion.


RESULTS
The study showed a favorable outcome of endovascular treatment in the majority of patients. Resolution of CN dysfunctions occurred in 7 (64%) of 11 patients. The late follow-up showed that all the 7 patients are resuming normal life activities. This compares favorably to the results after clipping in [Leivo, Hemesniemi, Luukkonen, & Vapalahti, 1996] (41%). Presentation with SAH and isolated third CNP correlated with a better resolution of CNP (P < .05).


CONCLUSIONS
Although mass effect remains after endovascular packing, CNP improves comparably to the recovery observed after surgical clipping. It seems likely that the decrease in aneurysmal pulsatility is responsible for the improvement of the CNP. The relatively atraumatic approach associated with endovascular management explains the favorable results. All previous reports assessed the outcome of only the third CNP after endovascular treatment in a very limited number of cases. To the best of our knowledge, this is the first study to assess the outcome of various CNP after endovascular treatment.
Mansour
Nassir
N
Department of Neurology and Neurosurgery Beaumont Hospital, Dublin, Ireland. nmanso1@hotmail.com
Kamel
Mahmoud Hamdy
MH
Kelleher
Michael
M
Aquilina
Kristian
K
Thornton
John
J
Brennan
Paul
P
Bolger
Ciaran
C
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome