We present three patients who suffered aneurysmal sub-arachnoid hemorrhage with mean age of 48 years. Two patients had middle cerebral artery aneurysms and the third had an anterior communicating artery aneurysm. All three patients underwent a standard frontotemporal craniotomy for clipping of ruptured aneurysm. All three aneurysms were clipped without the need for temporary occlusion and, in no case, was dissection or direct visualization of the oculomotor nerve necessary to obtain proximal control. Local vasospasm was visually apparent in the exposed carotid circulation in all three cases; thus topical 3-5 cc of a 3% solution of papaverine was administered after surgical clipping was completed. Immediate postoperative exam in all three cases revealed isolated ipsilateral oculomotor nerve palsy. The patients had no other neurological deficits suggestive of a space-occupying lesion or raised intracranial pressure.
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