title: Resolution of third nerve palsy despite persistent aneurysmal mass effect after flow diversion embolization of posterior communicating artery aneurysms.
abstract: Posterior communicating artery (PCOM) aneurysms may cause third nerve palsies. The optimal treatment with clipping versus coiling remains controversial. Here we report on two cases of resolution of third nerve palsy after flow diversion embolization of large and giant PCOM aneurysms without adjuvant coil placement. The resolution of third nerve palsy was not preceded by significant shrinkage of the aneurysmal sac on MRI. However, one patient showed resolution of T2-weighted signal abnormalities in the midbrain and mesial temporal lobe despite a similar size of the aneurysm. Therefore, flow diversion embolization of a PCOM aneurysm may resolve oculomotor nerve palsies through decreasing arterial pulsations against the nerve or midbrain.
authors.affiliation: Department of Neurosurgery, UC Davis Medical Center, 2315 Stockton Blvd., Sacramento, CA 95817, USA.
authors.forename: Tamar R
authors.initials: TR
authors.lastname: Binyamin
authors.affiliation: Department of Radiology, UC Davis Medical Center, Sacramento, CA 95817, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Dahlin
authors.affiliation: Department of Neurosurgery, UC Davis Medical Center, 2315 Stockton Blvd., Sacramento, CA 95817, USA. Electronic address: bwaldau@ucdavis.edu.
authors.forename: Ben
authors.initials: B
authors.lastname: Waldau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D015840:Oculomotor Nerve Diseases / Q000628:therapy*
keywords: Flow diversion embolization; Mass effect; PCOM aneurysm; Pipeline device; Pulsations; Third nerve palsy