Recovery of Oculomotor Nerve Palsy After Treatment of Posterior Communicating Artery Aneurysms: Have the Outcomes Changed?

Introduction It is unclear whether microsurgical clipping or endovascular coiling is the best treatment for recovery from oculomotor nerve palsy (ONP) secondary to posterior communicating artery (PComm) aneurysm. This is a five-year study of aneurysms presenting with ONP and their outcomes after treatment. Method The study included all patients from 2017-2022 who presented to a tertiary care centre in the United Kingdom with complete or partial ONP from ruptured or unruptured PComm aneurysms. Electronic medical records of these patients were compared with data from the same unit of an earlier cohort of patients. Results A total of 165 patients with PComm aneurysms were identified in the five-year period. Of these, 30 presented with ONP, of which 17 were complete. A total of 20 patients presented with a subarachnoid haemorrhage; 10 patients underwent microsurgical clipping, and 40% of them had improved ONPs at six months, whereas only 20% of the coiling group improved. The odds ratio of full recovery of ONP with coiling was 0.20 (0.03-1.07) when compared to clipping. Overall, these results were largely similar to those of the earlier cohort; however, this study noted a difference in the rate of recovery depending on treatment modality, albeit not statistically significant. Conclusion No significant difference in rates of recovery of ONPs was found between surgical clipping or endovascular coiling, although this conclusion is limited by the small sample size. Both modalities continue to appear equally effective for aneurysm management.