title: Recovery from oculomotor nerve palsy due to posterior communicating artery aneurysms: results after clipping versus coiling in a single-center series.
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.
authors.affiliation: Department of Neurosurgery, La Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Marina
authors.initials: M
authors.lastname: Brigui
authors.forename: Dorian
authors.initials: D
authors.lastname: Chauvet
authors.forename: Frédéric
authors.initials: F
authors.lastname: Clarençon
authors.forename: Vincent
authors.initials: V
authors.lastname: Degos
authors.forename: Nader-Antoine
authors.initials: NA
authors.lastname: Sourour
authors.forename: Aurélien
authors.initials: A
authors.lastname: Nouet
authors.forename: Stéphane
authors.initials: S
authors.lastname: Clémenceau
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Boch
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Bernat
authors.forename: Federico
authors.initials: F
authors.lastname: Di Maria
authors.forename: Philippe
authors.initials: P
authors.lastname: Cornu
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000209:etiology / Q000601:surgery*; D020127:Recovery of Function / Q000502:physiology; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*