Recovery of Third Nerve Palsy Following Surgical Clipping of Posterior Communicating Artery Aneurysms

BackgroundThe objective of the study was to identify the predictors of improved third cranial nerve (CN III) function in patients who underwent surgical clipping for posterior communicating artery (PComA) aneurysms with varying degrees of CN III palsy at presentation.MethodsWe retrospectively evaluated the outcome of the CN III function in a series of 26 patients with CN III dysfunction due to PComA aneurysms that were treated by surgical clipping.ResultsCN III palsy was complete in 18 patients (69%) and partial in 8 patients (31%) at the time of admission. In 15 patients (58%), there was total improvement of CN III function. Partial improvement was noted in 5 patients (19%). Overall improvement (partial and total) of CN III function was observed in 20 (77%) of the 26 patients. The improvement in CN III function following early surgery (0-3 days) was 81.3% when compared to 75% when surgery was performed after 3 days. In univariate analysis, the only variable showing significant association with total improvement of CN III function was type of third nerve palsy at admission (complete vs partial) (P=.004). There was no statistical significant association between early surgery and improvement of CN III function (P=.722). In multivariate analysis, among all the factors, the type of third nerve palsy at presentation (complete and partial) was the significant predictor of the improved CN III function (P=.0038).ConclusionSurgical clipping of the PComA aneurysm in patients with CN III palsy results in improvement of the CN III function in the majority of patients. The type of the CN III palsy at admission (complete/partial) is a significant predictor of complete improvement in CN III function.