• Samuel Hall, Ahmed-Ramadan Sadek, Alexander Dando, Adam Grose, Borislav D Dimitrov, John Millar, Jason H M Macdonald, Adam Ditchfield, Owen Sparrow, and Diederik Bulters.
• Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, United Kingdom. Electronic address: Samuel.hall@doctors.org.uk.
• World Neurosurg. 2017 Nov 1; 107: 581-587.

ObjectiveRecovery of oculomotor nerve palsy after microsurgical and endovascular treatment has been studied in numerous small series of predominantly ruptured aneurysms. Little consideration has been given to the distinction between ruptured and unruptured aneurysms. This study examines the influence of treatment modality on oculomotor palsy recovery as a result of unruptured posterior communicating artery aneurysms.MethodsPatients who presented between 2003 and 2015 with an oculomotor palsy secondary to an unruptured posterior communicating artery aneurysm were identified from the hospital database. A keyword search for "posterior communicating artery aneurysm" and "oculomotor nerve palsy OR third nerve palsy" using the PubMed database was performed for the narrative review.ResultsThe cohort study and narrative review identified 15 and 179 eligible patients, respectively. Surgically treated patients in the cohort study did not have a significantly better rate of complete palsy resolution than those who had been coiled (P = 0.08). In the review, clipping of the aneurysm resulted in a higher rate of complete palsy resolution (70.0%; 95% confidence interval [CI], 60.7%-79.3%) than did coiling (46.5%; 95% CI, 36.0%-57.0%). Patients who presented with an aneurysm <7 mm had a higher rate of complete palsy resolution compared with aneurysms >7 mm (68.6%; 95% CI, 57.7%-79.5% vs. 44.3%; 95% CI, 32.7%-55.9%). Patients presenting with a complete palsy (49.4%; 95% CI, 38.6%-60.2%) had a lower rate of recovery than did those with a partial palsy (71.4%; 95% CI, 60.2%-82.6%).ConclusionsIn this narrative review, surgical clipping of unruptured posterior communicating artery aneurysms was associated with a higher rate of associated oculomotor palsy recovery than was endovascular treatment.Copyright © 2017 Elsevier Inc. All rights reserved.

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