gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Oculomotor nerve palsy by posterior communicating artery aneurysms. Influence of the surgical strategy – nerve decompression versus simple clipping – on recovery. Single center series and systematic review

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  • E. Güresir - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • P. Schuss - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • H. Vatter - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.15.03

doi: 10.3205/12dgnc135, urn:nbn:de:0183-12dgnc1352

Published: June 4, 2012

© 2012 Güresir et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Recovery of oculomotor nerve palsy (ONP) after surgical treatment of posterior communicating artery (PcomA) aneurysms has been well documented. However, if additional decompression of the oculomotor nerve by aneurysmal sac dissection or resection is superior to pure aneurysm clipping is controversially discussed. Objective of the present investigation was, therefore, to analyse the influence of the surgical strategy –clipping with and without aneurysm dissection-on ONP recovery.

Methods: Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured intracranial aneurysms causing ONP were treated in our institution. ONP was recorded at admission and at follow-up. The electronic database MEDLINE was searched for published studies of PcomA aneurysm caused ONP. Two reviewers independently extracted data.

Results: Overall 8 studies and 6 patients of the current series totalling 121 PcomA aneurysms met the inclusion criteria. 94 aneurysms were treated by simple aneurysm neck clipping, 27 aneurysms were treated with clipping and additional aneurysmal sac decompression. The surgical strategy, simple aneurysmal neck clipping versus additional oculomotor nerve decompression, had no effect on complete ONP recovery in the univariate (p = 0.5) and the multivariate analysis. In the multivariate analysis, patients with incomplete ONP at admission were more likely to achieve complete resolution of ONP compared to those with complete ONP at admission (p = 0.03; OR = 4.2; 95% CI 1.1 - 16).

Conclusions: The present data indicate that ONP caused by PcomA aneurysms improves after clipping without and with additional oculomotor nerve decompression. The recovery of ONP is inversely associated with the initial severity of initial ONP.