Early Endovascular Management of Oculomotor Nerve Palsy Associated with Posterior Communicating Artery Aneurysms

摘要

Palsy of the third cranial nerve (oculomotor nerve, CNIII) is a well-known clinical presentation of posterior communicating artery (P-com) aneurysm. We report a series of 11 patients with partial or complete third nerve palsy secondary to P-com aneurysm. All were treated with endovascular embolization within seven days of symptom onset. Third nerve palsy symptoms resolved in 7/11. (64%), improved in 2/11 (18%) and did not change in 2/11 (18%) patients. The incidence of third nerve palsy (TNP) associated with ipsilateral P-com aneurysm has been reported as high as 56%. However, these data likely are inflated by selection bias at tertiary care centers. Our experience is more consistent with reports that describe the true incidence of TNP among patients with ruptured or unruptured P-com aneurysm at or below 30%. The presence of unilateral TNP in association with ipsilateral P-com aneurysm has been used as a rationale for surgical clipping rather than endovascular coiling based on the theory that surgical clipping provides better decompression of the aneurysm and decreased mass effect on the third cranial (occu-lomotor) nerve.