An Analysis of Prognostic Factors forRecovery from Oculomotor Nerve Palsy in Patients withPosterior CommunicatingArtery Aneurysms

Cho, Jong Ho; Joo, Sung Pil; Kim, Tae Sun; Lee, Jung Kil; Kim, Jae Hyoo; Kim, Soo Han

Abstract

OBJECTIVE
The aim of this study was to identify the prognostic factors for recovery from oculomotor nerve palsy in patients with a posterior communicating artery aneurysm after surgical intervention.
METHODS
We retrospectively reviewed 16 patients with a ruptured or unruptured posterior communicating artery aneurysm that was associated with oculomotor nerve palsy and these patients were treated in our hospital between 2002 and 2006. Fifteen of the 16 patients were women, and the patients' ages ranged between 38 and 75 years (mean age: 52.6 years), and the follow up period was from 0.5 to 36 months (mean: 8.75 months).
RESULTS
The total number of aneurysmal cases treated over the 5-year study period was 1135, and there were 223 patients (19.6%) with posterior communicating artery aneurysms. Among these 223 patients, 16 (7.2%) presented with third cranial nerve palsy (4 ruptured, 12 unruptured). Ptosis was presented in all cases (100.0%). Extraocular muscle palsy was presented to some degree by 10 cases (62.5%). The affected pupils were dilated and fixed in all patients (100.0%). The ptosis improved completely in 13 patients (81.3%), and incompletely in 3 patients (18.7%) within 6 months. The dilated and fixed pupils were improved in 10 of the 16 patients (62.5%). The extraocular muscle palsies recovered completely in 15 cases within 6 months. The mean interval between palsy onset and the time of surgery was 6.2 days for the complete recovery cases, and 22 days for the incomplete recovery cases. However, recovery of papillary function was unpredictable.
CONCLUSIONS
The duration of symptoms and the degree of preoperative deficits are considered as prognostic factors for the postoperative recovery from third nerve palsy in patients with a posterior communicating artery aneurysm.