title: Oculomotor nerve palsy induced by internal carotid artery aneurysm: prognostic factors for recovery.
abstract: BACKGROUND
  Aneurysms at the posterior face of the internal carotid artery can lead to oculomotor nerve palsy (ONP) with an uncertain prognosis of recovery post-treatment. The aim of this study was to define the prognostic factors for ONP recovery, with particular interest in treatment modality (surgery or endovascular techniques).
  
  
  METHODS
  A literature review was performed to select the most pertinent prognostic factors. A retrospective study was then performed to determine whether these factors had significantly modified the prognosis of ONP recovery in our series of patients.
  
  
  RESULTS
  In the literature, factors linked to poorer outcome were age, vascular risk factors, initial ONP severity and delay before treatment; better recovery was associated with surgical treatment. Between 2000 and 2013, 23 consecutive patients were treated in our department for ONP-inducing aneurysms: 14 by endovascular embolization and 9 by surgical clipping and aneurysm puncture. Mean follow-up was 48.8 months. After treatment, overall recovery occurred in 87% of cases, always within 6 months. Apart from treatment modality, no selected prognostic factor significantly modified the quality or timing of ONP recovery. In the endovascular group, four patients recovered completely, seven partially and three did not recover. In the surgical group, seven patients recovered completely and two partially. Surgery was significantly associated with a more complete and earlier ONP recovery (p < 0.05).
  
  
  CONCLUSIONS
  Surgery was associated with a more complete and earlier ONP recovery as compared to endovascular treatment, confirming the results of previous studies. However, conclusions must be confirmed by a prospective randomized study.
authors.affiliation: CHU Pellegrin, Service de Neurochirurgie B, Hôpital Pellegrin-Tripode, Place Amélie Raba-Léon, 33 076, Bordeaux Cedex, France, julien.engelhardt@gmail.com.
authors.forename: Julien
authors.initials: J
authors.lastname: Engelhardt
authors.forename: Jérôme
authors.initials: J
authors.lastname: Berge
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cuny
authors.forename: Guillaume
authors.initials: G
authors.lastname: Penchet
mesh_terms: D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D011379:Prognosis; D020127:Recovery of Function