Recovery of Ophthalmoplegia after Endovascular Treatment of Intracranial Aneurysms

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Fig 1.
Graph shows that smaller aneurysms (≤10 mm) have a higher but not statistically significant tendency for better CNP recovery (complete recovery, 11/20; 55%) compared with larger aneurysms (>10 mm) (complete recovery, 4/10; 40%).
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Fig 2.
Graph shows that more patients achieve a complete recovery of CNP in cases of unruptured aneurysms (12/18, 67%) than in cases of ruptured aneurysms (3/12, 25%). The difference is not statistically significant.
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Fig 3.
Graph shows that the degree of preinterventional CNP (ie, complete or partial) is the only parameter that affects significantly (P = .009) the recovery of ophthalmoplegia. Patients with incomplete initial CNP have a statistically significant higher degree of CNP recovery.
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Fig 4.
Unruptured cavernous aneurysm of the left ICA causing partial sixth cranial nerve paresis for 2 months. Anteroposterior (A and B, early and middle arterial phase) and lateral arteriograms (C and D, early and middle arterial phase) before intervention. Anteroposterior (E) and lateral arteriograms (F) after stent-supported coiling. The white arrows in the insert of the anteroposterior arteriogram (E) show the stent struts.

Table 1:

Patient demographics and aneurysm characteristics

Characteristic/Demographics	Data
Patients (No.)	30
Age (mean) (yr)	53 (range, 14–75)
Sex
Male	8
Female	22
ONP (at presentation)
Incomplete	19
Complete	11
Aneurysm location
ICA-cavernous	11
ICA-PcomA	10
ICA-supraophthalmic	4
Posterior circulation	5
Aneurysm size (mean) (mm)	10 (range, 2–27).
Rupture
Yes	10
No	20
Time to treatment (mean) (days)	48 (range, 1–240)
Time to recovery (mean) (days)	69 (range, 1–300)

Table 2:

Evolution of ONP after endovascular treatment according to aneurysm location

	Complete ONP Recovery (Postintervention)	Incomplete ONP Recovery (Postintervention)	No Improvement (Postintervention)	Total No. of Patients
ICA-PcomA	3/10 (30%)	6/10 (60%)	1/10 (10%)	10
ICA-cavernous	6/11 (54.5%)	4/11 (36.4%)	1/11 (9.1%)	11
ICA-supraophthalmic	2/4 (50%)	1/4 (25%)	1/4 (25%)	4
Posterior circulation	4/5 (80%)	1/5 (20%)	0/5 (0%)	5

Table 3:

Statistical tests and P values of each variable that was correlated with the final recovery degree of CNP^a

Parameter	Statistical Test	P Value
Patient age	Spearman correlation	.157
Aneurysm neck size	Fisher exact test	.458
Duration of CNP before intervention (time interval)	Spearman correlation	.835
Aneurysm size	Spearman correlation	.547
Rupture of aneurysm	Fisher exact test	.082
Grade of preinterventional CNP	Fisher exact test	.009
Degree of aneurysm embolization	Fisher exact test	.391
Aneurysm location	Fisher exact test	.588

a The degree of initial CNP was the only statistically significant prognostic factor concerning the final outcome, resulting in better recovery in case of incomplete initial CNP.

Table 4:

Postembolization clinical morbidity related to periprocedural complications and final outcome

Postembolization Clinical Morbidity	Identified Cause	Procedure-Related Clinical Morbidity at Follow-Up (mean, 19 mo; range, 0.2–73 mo)
Speech disturbance	Not identified	Partial improvement
Trigeminal neuralgia	Compression of the gasserian ganglion	Complete resolution
Worsening of CNP of III and VI	Mild pressure on the cavernous part of nerves III and VI	Complete resolution
Global aphasia	Not identified	Complete resolution
Hemiparesis (4/5) + speech disturbance	MCA temporary occlusion	No improvement
Hemiparesis (4/5) + paresis of nerve VII	Not identified	Complete resolution

Table 5:

Literature review of series reporting recovery rates after endovascular treatment of aneurysms causing ophthalmoplegia

Study	Patients	Location	Time to Treatment (mean)	Complete Recovery	Incomplete Recovery	No Improvement
Birchall et al (1999)⁷	3	PcomA	2.3 days	3 (100%)	0	0
Mavilio et al (2000)¹⁴	6	PcomA	2 days to 6 mo (range)	6 (100%)	0	0
Kazekawa et al (2003)¹³	12	PcomA-2/Cav-6/Car.ophth-2	13.7 mo	5 (42%)	4 (33%)	3 (25%)
Kim et al (2003)⁹	7	PcomA-2/Cav-3/Basilar-2	11 mo	2 (29%)	3 (42%)	2 (29%)^a
Stiebel-Kalish et al (2003)¹⁷	11	PcomA	9 days	0	11 (100%)	0
Chen et al (2006)¹⁸	6	PcomA	5.5 days	4 (33%)	2 (67%)	0
Ahn et al (2006)²¹	10	PcomA	Unknown	6 (60%)	3 (30%)	1 (10%)
Mansour et al (2007)¹⁵	11	PcomA-6/Cav-5	10 weeks	7 (64%)	4 (36%)^b
Hanse et al (2008)¹⁶	21	PcomA	1 to >14 days (range)	8 (38.1%)	11 (52.4%)	2 (9.5%)
Kassis et al (2010)²⁰	20	PcomA	71 days	7 (35%)	12 (60%)	1 (5%)
Santillan et al (2010)¹⁹	11	PcomA	≤7 days	7 (64%)	2 (18%)	2 (18%)
Current study	30	PcomA-10/Cav-11/Post.circ-5/paraophth-4	48 days	15 (50%)	12 (40%)	3 (10%)

Table 6:

Literature review of series reporting recovery rates after surgical treatment of aneurysms causing ophthalmoplegia

Study	Patients	Location	Time to Treatment (mean)	Complete Recovery	Incomplete Recovery	No Improvement
Literature review by Leivo et al (before 1996)	283	PcomA	Unknown	117 (41%)	147 (52%)	19 (7%)
Leivo et al (1996)¹	28	PcomA	0 to >30 days	16 (57%)	Unknown	Unknown
Yanaka et al (2003)²²	14^a	PcomA-11/AchoA-2/basilar-1	17.3 days	7 (50%)	6 (43%)	1 (7%)
Chen et al (2006)¹⁸	7	PcomA	1–90 days	6 (85.7%)	1 (14.7%)	0
Ahn et al (2006)²¹	7	PcomA	Unknown	3 (42.9%)	4 (57.1%)	0