AneurysmResolution of cranial nerve paresis after endovascular management of cerebral aneurysms
Introduction
Endovascular treatment is becoming an acceptable alternative to microsurgical clipping for selected intracerebral aneurysms [11]. The effect of endovascular treatment on the recovery of neural function in patients with CNP caused by aneurysmal pressure effect is poorly documented. It has been argued that coiling is less effective in resolving aneurysmal mass effect than clipping as the aneurysm is packed and does not collapse.
We report the outcome of endovascular treatment in 11 patients with third and/or fourth, and/or sixth CN dysfunctions caused by PcomA aneurysms and/or intracavernous aneurysms.
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Clinical data and methods
Between January 1999 and December 2004, 820 patients presented with aneurysmal SAH and/or mass effect to Beaumont Hospital. Eleven of these patients presented with third, and/or fourth, and/or sixth nerve dysfunctions and underwent endovascular treatment (1%).
The inclusion criteria were (1) cerebral aneurysm; (2) the presence of third, fourth, or sixth CN dysfunctions, which is explained by the location of the aneurysm; (3) the aneurysm was treated by endovascular Guglielmi detachable coils or
Results
The study population consists of 1 man and 10 women, whose ages ranged from 42 to 75 years (average age, 59 years) (Table 1).
The background medical history was reported (diabetes mellitus, hypertension, and smoking). None of the patients were diabetic, 5 (45%) were hypertensive, and 7 (64%) were smokers. Four (36%) patients were older than 60 years.
We recorded the duration of the ophthalmoplegia before treatment, which ranged from 1 day to 20 weeks (average, 10 weeks). The patients with SAH
Discussion
Endovascular techniques (thrombus occlusion of aneurysm using detachable balloons or coils) have led to improved CNs mass effect symptoms according to few reports [3], [4], [5], [8], [9], [13]. The resolution of oculomotor nerve paresis after endovascular treatment of PcomA was described by Mavilio et al [10], Birchall et al [1], and Stiebel-Kalish et al [12], who reported 6, 3, and 11 patients, respectively. The resolution was described as complete in the first 2 studies and incomplete in the
Conclusion
Endovascular treatment is a viable alternative to clipping for treatment of CNP owing to the aneurysmal mass effect. The results are similar to or may even be better than surgical treatment. It seems that a pattern of aneurysm and patient factors predicting poor recovery can be recognized. More than 1-month duration of CNP, intracavernous carotid aneurysms, absence of SAH, and complete CNP all correlated with poor outcome. The number of cases in this study is small and further studies including
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