Abstract
Internal carotid artery (ICA) aneurysms may present with cranial nerve dysfunction. Therapeutic ICA occlusion, when tolerated, is an effective treatment resulting in improvement or cure of symptoms in most patients. When ICA occlusion is not tolerated, selective endovascular aneurysm occlusion can be considered. We compare recovery of cranial nerve dysfunction in patients treated with selective coil occlusion and with therapeutic ICA occlusion. In 16 patients with 17 large or giant (11-45 mm) unruptured ICA aneurysms presenting with dysfunction of cranial nerves (CN) II, III, IV, or VI, selective coil occlusion was performed. From a cohort of 39 patients with ICA aneurysms treated with ICA occlusion and long-term follow-up, we selected 31 patients with aneurysms presenting with cranial nerve dysfunction. Clinical recovery at follow-up from oculomotor dysfunction and visual symptoms was compared for both treatment modalities. Of 17 aneurysms treated with selective coiling, symptoms of cranial nerve dysfunction resolved in 3, improved in 10, and remained unchanged in 4. In 9 of 17 patients, additional coiling during follow-up was required. Of 31 aneurysms treated with carotid artery occlusion, cranial nerve dysfunction resolved in 19, improved in 9, and remained unchanged in 3. These differences were not significant. There were no complications of treatment. Recovery of ICA aneurysm-induced cranial nerve dysfunction occurs in most patients, both after ICA occlusion and after selective coiling. In patients who cannot tolerate ICA occlusion, selective aneurysmal occlusion with coils is a valuable alternative.
Highlights
AND PURPOSE: Internal carotid artery (ICA) aneurysms may present with cranial nerve dysfunction
Of 31 aneurysms treated with carotid artery occlusion, cranial nerve dysfunction resolved in 19, improved in 9, and remained unchanged in 3
Recovery of ICA aneurysm-induced cranial nerve dysfunction occurs in most patients, both after ICA occlusion and after selective coiling
Summary
In patients with large or giant (11– 45 mm) unruptured ICA aneurysms presenting with dysfunction of cranial nerves (CN) II, III, IV, or VI, selective coil occlusion was performed. From a cohort of 39 patients with ICA aneurysms treated with ICA occlusion and long-term follow-up, we selected 31 patients with aneurysms presenting with cranial nerve dysfunction. General At our institution, patients with unruptured large or giant ICA aneurysms presenting with cranial nerve dysfunction are preferably treated with endovascular ICA balloon occlusion. Assessment of Cranial Nerve Dysfunction Oculomotor dysfunction was defined as paresis of CN III, IV, or VI or a combination with diplopia in single or multiple gazes with or without ptosis and pupillary dysfunction. The criteria for complete recovery of oculomotor dysfunction were no diplopia in all direction of gazes, complete resolution of ptosis, and partial or complete recovery of pupillary reaction. Partial recovery of oculomotor dysfunction was defined as residual diplopia in upward, downward, lateral, or medial gaze with or without normal primary gaze, residual ptosis, and pupillary dysfunction
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