Recovery of oculomotor nerve palsy following surgical clipping of posterior communicating artery aneurysms

Oculomotor nerve palsy (ONP) can be the presenting feature of ruptured or an unruptured posterior communicating artery (PComA) aneurysm. Etiopathogenesis and recovery of ONP following treatment of PComA aneurysm has been a subject of controversy. Case records of thirteen patients (mean age 42 years (range 19-65 years), M:F: 3:10) with PComA aneurysm and ONP who underwent surgery over a period of eight years were analyzed. Twelve patients presented with subarchnoid hemorrhage and one had unruptured aneurysm. The interval between the onset of symptoms and surgery ranged between 4 and 70 days (mean 16.7 days). All the four patients with partial ONP had complete recovery and of the nine patients with complete ONP, six had complete recovery and three had partial recovery. The recovery of the ONP is influenced by the degree of preoperative deficit. Although clipping of the aneurysm probably expedites the recovery of the third nerve palsy, age, sex and timing of surgery may not have any influence on the recovery patterns.