Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2025
Oculomotor nerve palsy from unruptured cavernous internal carotid artery aneurysms: a case series and report of an anatomical variant.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Hung Alice, Hughes Liam P, Yang Wuyang, Yedavalli Vivek, Jackson Christopher, Gonzalez Fernando, Caplan Justin, Huang Judy, Tamargo Rafael, Xu Risheng
Аннотация
BACKGROUND AND OBJECTIVES: Oculomotor nerve palsies (ONP) resulting from cavernous internal carotid artery (ICA) aneurysms are rare and usually reported in case reports. We present a case series of patients presenting with ONP from cavernous ICA aneurysms.
METHODS: Patients treated for cerebral aneurysms at our institution between 1992 and 2024 were reviewed from a prospectively-accrued database, and those who presented with ONP resulting from cavernous ICA aneurysm compression were selected.
RESULTS: Eight patients presented with partial ONP from unruptured cavernous ICA aneurysms. The average duration of symptoms was 61.3 ± 70.5 days. Most patients had ONP due to compression of the oculomotor nerve in the cavernous sinus, most often in the setting of large cavernous ICA aneurysms causing mass effect. In contrast, we also present an unusual case of a small aneurysm arising from a high-riding posterior genu of the cavernous ICA causing compression of the cisternal segment of the oculomotor nerve. In our cohort, only one patient had complete ONP recovery at last follow up, and 4 (50.0 %) had some improvement of their partial ONP. Patients who had partial or complete ONP improvement had significantly shorter mean duration of symptoms (p < 0.01, 14 ± 14.7 vs 140 ± 45.8 days).
CONCLUSION: Small cavernous ICA aneurysms can cause oculomotor nerve compression in the setting of a high-riding cavernous ICA posterior genu that places the aneurysm in close proximity to the cisternal segment of the nerve. Early treatment should be considered for better chance of ONP recovery.
METHODS: Patients treated for cerebral aneurysms at our institution between 1992 and 2024 were reviewed from a prospectively-accrued database, and those who presented with ONP resulting from cavernous ICA aneurysm compression were selected.
RESULTS: Eight patients presented with partial ONP from unruptured cavernous ICA aneurysms. The average duration of symptoms was 61.3 ± 70.5 days. Most patients had ONP due to compression of the oculomotor nerve in the cavernous sinus, most often in the setting of large cavernous ICA aneurysms causing mass effect. In contrast, we also present an unusual case of a small aneurysm arising from a high-riding posterior genu of the cavernous ICA causing compression of the cisternal segment of the oculomotor nerve. In our cohort, only one patient had complete ONP recovery at last follow up, and 4 (50.0 %) had some improvement of their partial ONP. Patients who had partial or complete ONP improvement had significantly shorter mean duration of symptoms (p < 0.01, 14 ± 14.7 vs 140 ± 45.8 days).
CONCLUSION: Small cavernous ICA aneurysms can cause oculomotor nerve compression in the setting of a high-riding cavernous ICA posterior genu that places the aneurysm in close proximity to the cisternal segment of the nerve. Early treatment should be considered for better chance of ONP recovery.