title: Unruptured internal carotid-posterior communicating artery aneurysm splitting the oculomotor nerve: a case report and literature review.
abstract: Objective To report a rare case of unruptured internal carotid-posterior communicating artery (IC-PC) aneurysm splitting the oculomotor nerve treated by clipping and to review the previously published cases. Case Presentation A 42-year-old man suddenly presented with left oculomotor paresis. Three-dimensional digital subtraction angiography (3D DSA) demonstrated a left IC-PC aneurysm with a bulging part. During surgery, it was confirmed that the bulging part split the oculomotor nerve. After the fenestrated oculomotor nerve was dissected from the bulging part with a careful microsurgical technique, neck clipping was performed. After the operation, the symptoms of oculomotor nerve paresis disappeared within 2 weeks. Conclusions We must keep in mind the possibility of an anomaly of the oculomotor nerve, including fenestration, and careful observation and manipulation should be performed to preserve the nerve function during surgery, even though it is very rare.
authors.affiliation: Department of Neurosurgery, Kansai Rosai Hospital, Hyogo, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Toyota
authors.affiliation: Department of Neurosurgery, Kansai Rosai Hospital, Hyogo, Japan.
authors.forename: Takuyu
authors.initials: T
authors.lastname: Taki
authors.affiliation: Department of Neurosurgery, Osaka Neurological Institute, Osaka, Japan.
authors.forename: Akatsuki
authors.initials: A
authors.lastname: Wakayama
authors.affiliation: Department of Neurosurgery, Osaka University Medical School, Osaka, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
keywords: fenestration; internal carotid-posterior communicating artery aneurysm; oculomotor nerve; three-dimensional digital subtraction angiography
references.citation: Neurosurgery. 2006 Jun;58(6):1040-6; discussion 1040-6
references.pmid: 16723882
references.citation: Neurosurg Rev. 2007 Oct;30(4):307-10; discussion 310-1
references.pmid: 17593410
references.citation: J Neurosurg. 2009 Jul;111(1):84-6
references.pmid: 19284238
references.citation: Neurosurgery. 1997 Feb;40(2):397-8; discussion 398-9
references.pmid: 9007877