Original Research

Recovery of oculomotor nerve palsy after endovascular management of posterior communicating artery aneurysms

Elkharbash Abdurahman, Khatija Amod, Duncan Royston, Rohen Harrichandparsad
South African Journal of Radiology | Vol 24, No 1 | a1887 | DOI: https://doi.org/10.4102/sajr.v24i1.1887 | © 2020 Elkharbash Abdurahman, Khatija Amod, Duncan Royston, Rohen Harrichandparsad | This work is licensed under CC Attribution 4.0
Submitted: 08 April 2020 | Published: 31 August 2020

About the author(s)

Elkharbash Abdurahman, Department of Radiology, University of KwaZulu-Natal, Durban, South Africa
Khatija Amod, Department of Radiology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
Duncan Royston, Lake, Smit & Partners, Durban, South Africa
Rohen Harrichandparsad, Department of Neurosurgery, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa


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Abstract

Background: Oculomotor nerve palsy (ONP) is a common clinical presentation of posterior communicating artery (PcomA) aneurysms. It remains unclear if patients have a better rate of recovery after surgical clipping or endovascular coiling.

Objectives: The main objectives of this study were to assess the overall rate of ONP recovery after endovascular coiling of PcomA aneurysms, as well as to determine the associated predictive factors of oculomotor nerve recovery.

Method: We retrospectively evaluated the demographic, clinical, and radiological characteristics and the outcome of consecutive patients presenting with PcomA aneurysms treated by endovascular coiling from January 2012 to November 2016 with at least 1 year clinical and radiological follow-up. Statistical analysis was applied to determine the association between ONP recovery and the demographic, clinical and radiological variables.

Results: A total of 91 patients with PcomA aneurysms were treated endovascularly. Thirty-four patients (22 women and 12 men) with ONP related to PcomA aneurysms were included. The mean age of the patients was 49.8 years. Subarachnoid haemorrhage was present in 27 patients. The mean aneurysm size was 6.7 mm. The overall rate of recovery was 88.2%. Complete nerve recovery was seen in 16 (47%) patients and partial recovery was observed in 14 (41.2%) patients, whilst 4 (11.8%) patients remained unchanged after treatment. The non-posterolateral direction of the aneurysm showed a tendency towards better recovery compared to the posterolateral projection (p = 0.06).

Conclusion: Endovascular coiling of PcomA aneurysms in patients with ONP resulted in a cure or improvement of oculomotor nerve dysfunction in the majority of patients.


Keywords

ONP; PcomA; clipping versus coiling; diagnostic radiology; Endovascular coiling; Oculomotor nerve recovery.

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