Resolution of Oculomotor Nerve Palsy Secondary to Posterior Communicating Artery Aneurysms: Comparison of Clipping and Coiling.
BACKGROUND
Previous studies have attempted to determine the best treatment for oculomotor nerve palsy (ONP) secondary to posterior communicating artery (PCoA) aneurysms, but have been limited by small sample sizes and limited treatment.


OBJECTIVE
To analyze the treatment of ONP secondary to PCoA with both coiling and clipping in ruptured and unruptured aneurysms.


METHODS
Data from 2 large academic centers was retrospectively collected over 22 years, yielding a total of 93 patients with ONP secondary to PCoA aneurysms. These patients were combined with 321 patients from the literature review for large data analyses. Onset symptoms, recovery, and time to resolution were evaluated with respect to treatment and aneurysm rupture status.


RESULTS
For all patients presenting with ONP (n = 414) 56.6% of those treated with microsurgical clipping made a full recovery vs 41.5% of those treated with endovascular coil embolization (P = .02). Of patients with a complete ONP (n = 229), full recovery occurred in 47.3% of those treated with clipping but in only 20% of those undergoing coiling (P = .01). For patients presenting with ruptured aneurysms (n = 130), full recovery occurred in 70.9% compared with 49.3% coiled patients (P = .01). Additionally, although patients with full ONP recovery had a median time to treatment of 4 days, those without full ONP recovery had a median time to treatment of 7 days (P = .01).


CONCLUSIONS
Patients with ONP secondary to PCoA aneurysms treated with clipping showed higher rates of full ONP resolution than patients treated with coil embolization. Larger prospective studies are needed to determine the true potential of recovery associated with each treatment.


BACKGROUND
EUH, Emory University HospitalIQR, interquartile rangeJHU, Johns Hopkins UniversitymRS, modified Rankin ScaleONP, oculomotor nerve palsyPCoA, posterior communicating arterySAH, subarachnoid hemorrhage.
*Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia; ‡Emory University School of Medicine, Atlanta, Georgia; §Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
D Jay
DJ
McCracken
Brendan P
BP
Lovasik
Courtney E
CE
McCracken
Justin M
JM
Caplan
Nefize
N
Turan
Raul G
RG
Nogueira
C Michael
CM
Cawley
Jacques E
JE
Dion
Rafael J
RJ
Tamargo
Daniel L
DL
Barrow
Gustavo
G
Pradilla
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome