Relation of Cranial Nerve Involvement to the Location of Intracranial Aneurysms

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Abstract
Nine-hundred-thirty intracranial aneurysms in 774 cases were analyzed to investigate the relation of cranial nerve involvement to the location of intracranial aneurysms. The commonest aneurysm site was the region of the anterior communicating artery (Aco) (28.3%), followed by the region of the main branchings (M1-M2) of the middle cerebral artery (22.0%) and the region of the internal carotid-posterior communicating junction (IC-PC) (20.6%). There were 411 males (53%) and 363 females (47%). Females cases were predominant in IC-PC (142 females, 50 males), while males were predominant in Aco (173 males, 90 females), and the sex incidence was approximately equal in M1-M2 aneurysms (106 males, 99 females). Oculomotor nerve involvement had its highest incidence in IC-PC aneurysms (34.4%), followed by oculomotor palsies due to IC aneurysms (30.2%) and basilar top aneurysms (18.2%). Second, fourth, fifth, and sixth cranial nerve involvement caused by IC aneurysms, IC-ophthalmic aneurysms, or Aco aneurysms were observed less frequently. Other cranial nerve involvement was very rare. Isolated abducens nerve palsy due to an intracranial aneurysm is uncommon. Only two cases were observed in which the abducens nerve had been initially affected. In the 14 most recent patients complaining of isolated abducens palsy, no aneurysm was verified by angiography. In this series, however, a vascular tumor, a dural AVM, and a carotid-cavernous fistula were encountered in 3 cases (20%). Angiography seems to be useful in investigating the pathogenesis of isolated abducens nerve palsy.

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