Subscribe to RSS
DOI: 10.1055/s-0033-1349330
Perforated Oculomotor Nerve After Endovascular Coiling: Complete Regeneration After Microsurgical Repair. Case Report
Publication History
15 December 2012
22 March 2013
Publication Date:
29 July 2013 (online)
![](https://www.thieme-connect.de/media/jnlsa/2013S01/lookinside/thumbnails/10.1055-s-0033-1349330-1.jpg)
Abstract
Background and Importance We describe a patient who developed complete right oculomotor nerve palsy after endovascular coiling for a ruptured posterior communicating artery aneurysm caused by migration of the coils outside the aneurysm.
Clinical presentation A 50-year-old woman was admitted with an acute subarachnoid hemorrhage. She underwent, on the day of admission, endovascular coiling of a ruptured posterior communicating artery aneurysm. Four hours postcoiling, complete right oculomotor nerve palsy developed because of extrusion of the coils outside the aneurysm. The patient recovered completely after surgical exploration with removal of the migrated coils and microsurgical repair of the oculomotor nerve.
Conclusion This report illustrates that oculomotor nerve palsy is a rare complication after coiling of a posterior communicating artery aneurysm, and it should serve as a reminder to encourage neurovascular teams to consider surgical exploration in cases of third nerve palsy after endovascular coiling.
-
References
- 1 Soni SR. Aneurysms of the posterior communicating artery and oculomotor paresis. J Neurol Neurosurg Psychiatry 1974; 37 (4) 475-484
- 2 Fujiwara S, Fujii K, Nishio S, Matsushima T, Fukui M. Oculomotor nerve palsy in patients with cerebral aneurysms. Neurosurg Rev 1989; 12 (2) 123-132
- 3 Hanse MC, Gerrits MC, van Rooij WJ, Houben MP, Nijssen PC, Sluzewski M. Recovery of posterior communicating artery aneurysm-induced oculomotor palsy after coiling. AJNR Am J Neuroradiol 2008; 29 (5) 988-990
- 4 Chen PR, Amin-Hanjani S, Albuquerque FC, McDougall C, Zabramski JM, Spetzler RF. Outcome of oculomotor nerve palsy from posterior communicating artery aneurysms: comparison of clipping and coiling. Neurosurgery 2006; 58 (6) 1040-1046 , discussion 1040–1046
- 5 Güresir E, Schuss P, Setzer M, Platz J, Seifert V, Vatter H. Posterior communicating artery aneurysm-related oculomotor nerve palsy: influence of surgical and endovascular treatment on recovery: single-center series and systematic review. Neurosurgery 2011; 68 (6) 1527-1533 , discussion 1533–1534
- 6 Güresir E, Schuss P, Seifert V, Vatter H. Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery. J Neurosurg 2012; 117 (5) 904-910 [Epub ahead of print]
- 7 Leivo S, Hernesniemi J, Luukkonen M, Vapalahti M. Early surgery improves the cure of aneurysm-induced oculomotor palsy. Surg Neurol 1996; 45 (5) 430-434
- 8 Mansour N, Kamel MH, Kelleher M , et al. Resolution of cranial nerve paresis after endovascular management of cerebral aneurysms. Surg Neurol 2007; 68 (5) 500-504 , discussion 504
- 9 Bulsara KR, Jackson D, Galvan GM. Rate of third nerve palsy recovery following endovascular management of cerebral aneurysms. Neurosurg Rev 2007; 30 (4) 307-310 , discussion 310–311
- 10 Bhatti MT, Peters KR, Firment C, Mericle RA. Delayed exacerbation of third nerve palsy due to aneurysmal regrowth after endovascular coil embolization. J Neuroophthalmol 2004; 24 (1) 3-10
- 11 Thorell WE, Chow MM, Woo HH, Masaryk TJ, Rasmussen PA. Y-configured dual intracranial stent-assisted coil embolization for the treatment of wide-necked basilar tip aneurysms. Neurosurgery 2005; 56 (5) 1035-1040 , discussion 1035–1040
- 12 Dorfer C, Gruber A, Standhardt H, Bavinzski G, Knosp E. Management of residual and recurrent aneurysms after initial endovascular treatment. Neurosurgery 2012; 70 (3) 537-553 , discussion 553–554
- 13 Sameem M, Wood TJ, Bain JR. A systematic review on the use of fibrin glue for peripheral nerve repair. Plast Reconstr Surg 2011; 127 (6) 2381-2390
- 14 Menovsky T, van der Bergh Weerman M, Kubista OL, Bartels RH, van Overbeeke JJ. End-to-end versus peripheral nerve graft repair of the oculomotor nerve in rats: A comparative histological and morphometric study. Microsurgery 1999; 19 (8) 392-400
- 15 Turner SJ, Dexter MA, Smith JE, Ouvrier R. Primary nerve repair following resection of a neurenteric cyst of the oculomotor nerve. J Neurosurg Pediatr 2012; 9 (1) 45-48
- 16 Li S, Pan Q, Liu N, Liu Z, Shen F. Neurotization of oculomotor, trochlear and abducent nerves in skull base surgery. Chin Med J (Engl) 2003; 116 (3) 410-413
- 17 Sekhar LN, Lanzino G, Sen CN, Pomonis S. Reconstruction of the third through sixth cranial nerves during cavernous sinus surgery. J Neurosurg 1992; 76 (6) 935-943
- 18 Krajewski R. Oculomotor nerve repair using interposed nerve graft. Neurosurgery 1992; 30 (4) 591-594