Postoperative Course of Involved Cranial Nerves due to Intracranial Aneurysms

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Abstract
The postoperative course of cranial nerve involvement caused by 62 cerebral aneurysms (oculomotor nerve palsy: 52, visual disturbance: 4 and multiple cranial nerve involvement: 6) was analyzed. Statistical analysis was respectively applied to 27 unruptured and 20 ruptured internal carotid artery aneurysms on the correlation between the outcome of oculomotor nerve palsy one year after clipping surgery, and the interval between the onset of the palsy and clipping (less than 2 weeks or not), the degree of the preoperative palsy (incomplete or complete palsy) and the beginning of the recovery after clipping (within 2 weeks or not). In the unruptured group, the outcome was more influenced by the duration of the palsy (P=0.09) than the degree of the preoperative palsy (P=0.25). In the ruptured group, however, the outcome was more influenced by the degree of the preoperative palsy (P=0.004) than the duration of the palsy (P=0.20). The prognosis was better in cases where recovery had started within 2 weeks than in cases, where recovery had started 2 weeks or more after clipping surgery, independent of subarachnoid hemorrhage (unruptured group: P=0.002, ruptured group: P=0.02). There was no statistically significant difference between the unruptured group and the ruptured group on the outcome, so that the subarachnoid hemorrhage itself was not the factor causing a poor outcome. The size and direction of the aneurysm in carotid angiograms did not seem to affect the degree of recovery in the ruptured group, but in the unruptured group the posterolateral inferior direction of aneurysms was more common in the incomplete recovery cases (74%) than in the complete recovery cases (26%). Visual disturbance due to ruptured anterior communicating artery aneurysms in 3 cases and unruptured internal carotid-ophthalmic artery aneurysm in 1 case was immediately improved by clipping surgery, even though the duration of the visual disturbance was long, i.e., between 24 days and 3 years. Multiple cranial nerve involvement (I-VI) due to ruptured (2 cases) and unruptured (4 cases) internal carotid artery aneurysms was also improved by carotid ligation.

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