title: Posterior communicating artery aneurysm-related oculomotor nerve palsy: influence of surgical and endovascular treatment on recovery: single-center series and systematic review.
abstract: BACKGROUND
  Compression of the third nerve resulting in oculomotor nerve palsy (ONP) is a common initial symptom and in some cases the only neurological deficit in patients with posterior communicating artery (PcomA) aneurysms.
  
  
  OBJECTIVE
  To analyze the resolution of ONP after surgical or endovascular treatment in comparison with its spontaneous course.
  
  
  METHODS
  Between June 1999 and April 2008, 5 of 914 consecutive patients with ruptured and 10 of 344 with unruptured intracranial aneurysms causing ONP were treated at our institution. ONP was recorded at admission and at follow-up. The electronic database MEDLINE was searched for published studies of PcomA aneurysm-caused ONP. Two reviewers independently extracted data.
  
  
  RESULTS
  Overall, 26 studies and 15 patients of the current series totaling 201 PComA aneurysms met the inclusion criteria. A total of 132 patients underwent surgical clipping, 54 patients were treated endovascularly, and 15 patients remained untreated. Surgical treatment was associated with a significantly higher rate of complete ONP resolution (55% vs 32%; P=.006; odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3-5.1) and ONP resolution of any degree (92% vs 74%; P=.001; OR, 4.3; 95% CI, 1.8-10.4) compared with endovascularly treated patients. In the multivariate analyses, surgical clipping was significantly associated with ONP resolution of any degree (P<.0001; OR, 12.2; 95% CI, 3-49) and of complete resolution (P=.006; OR, 7.1; 95% CI, 1.8-28).
  
  
  CONCLUSIONS
  The present data indicate that ONP caused by PComA aneurysms resolves in a significantly higher portion of patients after surgical treatment compared with endovascular coiling and the spontaneous course.
authors.affiliation: Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. Gueresir@em.uni-frankfurt.de
authors.forename: Erdem
authors.initials: E
authors.lastname: Güresir
authors.forename: Patrick
authors.initials: P
authors.lastname: Schuss
authors.forename: Matthias
authors.initials: M
authors.lastname: Setzer
authors.forename: Johannes
authors.initials: J
authors.lastname: Platz
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
mesh_terms: D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000209:etiology* / Q000601:surgery*; D013525:Surgical Instruments; D014656:Vascular Surgical Procedures / Q000295:instrumentation*