Abstract
Twenty-six patients with oculomotor nerve palsy due to cerebral aneurysms were examined. There were six males and twenty females with a mean age of 55 years. 25 of the 26 aneurysms were located at the junction of the internal carotid and the posterior communicating artery and one was at the junction of the basilar artery and the superior cerebellar artery. Twelve patients had associated subarachnoid hemorrhage (SAH); the other 14 did not. The initial symptoms in many patients were ptosis and double vision. Twenty-one of the patients had total oculomotor nerve palsy, one had a sparing of medial rectus muscle; three patients had only ptosis and anisocoria, and one had oculomotor nerve palsy with pupillary sparing. All aneurysms, including giant aneurysms, were clipped under a microscope, and six oculomotor nerves were found to be decompressed at surgery. The follow-up periods were from six months to three years. Nine patients had a complete recovery of oculomotor function; thirteen had an incomplete recovery; and four remained unchanged. The mean interval between the onset of palsy and the time of surgery was 24 days in complete recovery cases, 42 days in incomplete recovery cases, and 119 days in unchanged cases. The recovery of oculomotor function started with the levator palpebrae muscle and followed by the medial rectus muscle. The recovery of pupillary function was, however, not consistent. Of the factors influencing recovery from oculomotor nerve palsy, the interval between the onset of palsy and the time of surgery was most important. Therefore, aneurysms with oculomotor nerve palsy should be operated on as early as possible, regardless of the presence or absence of SAH.
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References
Fox JL: Intracranial aneurysms. Vol. 1, Springer-Verlag, New York 1983
Fujiwara S, S Hachisuga, M Matsubara: Results of microsurgical management of ruptured intracranial aneurysms. Acta Neurochir 68 (1983) 227–237
Hamer J: Prognosis of oculomotor palsy in patients with aneurysms of the posterior communicating artery. Acta Neurochir 66 (1982) 173–185
Hamilton JG, MA Falconer: Immediate and late results of surgery in cases of saccular intracranial aneurysms. J Neurosurg 16 (1959) 514–541
Kissel JT, RM Burde, TG Klingele, HE Zeiger: Pupil-sparing oculomotor palsies with internal carotid-posterior communicating artery aneurysms. Ann Neurol 13 (1983) 149–154
Oono S, Y Shinohara, K Fujii: Pupillary sparing in oculomotor palsy from internal carotid aneurysm. Case report. In: Highlights in Neuro-ophthalmology, Proceedings of the sixth meeting of the international neuro-ophthalmology society (INOS) Hakone, Japan 1986
Paterson A: Direct surgery in the treatment of posterior communicating aneurysms. Lancet 2 (1968) 808–811
Sano K: Internal carotid-posterior communicating anterior choroidal region aneurysms. Microsurgical treatment. In:Pia, HW, C Langmaid, J Zierski (eds): Cerebral aneurysms. Advances in diagnosis and therapy. Springer, Berlin—Heidelberg—New York 1979
Soni SR: Aneurysms of the posterior communicating artery and oculomotor paresis. J Neurol Neurosurg Psychiatry 37 (1974) 475–484
Sunderland S, ESR Hughes: The pupillo-constrictor pathway and nerves to the ocular muscles in man. Brain 69 (1946) 301–309
Walsh FB, WF Hoyt: Clinical Neuro-Ophthalmology, 3rd edn., Williams and Wilkins, Baltimore 1969
Watanabe A, R Ishii, R Tanaka: Postoperative course of involved cranial nerves due to intracranial aneurysms. Neurol Med Chir (Tokyo) 25 (1985) 633–639
Weir B: Intracranial aneurysm and subarachnoid hemorrhage: an overview. In:RH Wilkins, SS Rengachary (eds) Neurosurgery, McGraw-Hill, New York 1985, 1308–1329
Yasargil MG, JL Fox: The microsurgical approach to intracranial aneurysms. Surg Neurol 3 (1975) 7–14
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Fujiwara, S., Fujii, K., Nishio, S. et al. Oculomotor nerve palsy in patients with cerebral aneurysms. Neurosurg. Rev. 12, 125–132 (1989). https://doi.org/10.1007/BF01741485
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DOI: https://doi.org/10.1007/BF01741485