Improvement of Unilateral Oculomotor Nerve Palsy after Clipping of Internal Carotid-posterior Communicating Artery Aneurysm

ABSTRACT

OBJECTIVE: The most common cause of sudden unilateral oculomotor nerve palsy is aneurysms of the internal carotid-posterior communicating artery. But their post-operative clinical courses are not well known. The aim of this study is to evaluate clinical courses of oculomotor palsy after aneurysmal neck clipping and importance of early treatment. METHODS: Ten patients who had unilateral oculomotor palsy and angiographically demonstrated internal carotid-posterior communicating artery aneurysm are reviewed. All patients were women and their median age was 55 years. Five patients showed complete oculomotor palsy. All aneurysms were unruptured state and had narrow, long neck and their mean size was 7.8mm(5-10mm). Craniotomy and aneurysm clipping was performed emergently in all patients. Seven patients(group A) were operated within 8 days after the onset of oculomotor palsy and three patients(group B) were operated at 15, 25 and 35 days, respectively. RESULTS: First noticeable change was improvement of ptosis(mean duration >13.6 weeks) and followed by improvement of horizontal gaze(>19.4 weeks) and vertical gaze(>23.9 weeks). Recovery time for pupillary light reflex varied greatly(>14.2 weeks). Complete palsy usually took more time to recover when compared with incomplete palsy. Among group A patients 4 patients recovered completely(57%). In case of group B, 2 of 3(67%) patients recovered completely but their mean recovery time was longer than group A patients. CONCLUSION: Oculomotor palsy associated with internal carotid-posterior communicating artery aneurysms usually takes a long time to recover completely. Only the early surgical intervention would solve this problem.