EARLY SURGERY IMPROVES THE CURE OF ANEURYSM-INDUCED OCULOMOTOR PALSY

BACKGROUND Aneurysm of the internal carotid-posterior communicating ar tery (ICA-PCoA) is the most frequent cause of sudden unilateral oculom otor palsy. Timely surgery for the aneurysm is the most important fact or for third nerve recovery. METHODS We scrutinized the world literatu re with nearly one thousand cases of isolated unilateral oculomotor pa lsy caused by intracranial aneurysms and treated with surgery. Only th ose reports (one-third of all) in which the time interval between the onset of oculomotor palsy and surgery could be determined were include d. We treated 1314 patients with cerebral aneurysms (183 = 14% with IC A-PCoA aneurysms) from our catchment area in Eastern Finland during ye ars 1977-1992. Twenty-eight patients having oculomotor palsy caused by ICA-PCoA aneurysm had surgery as soon as the diagnosis was made. RESU LTS Eight of 9 patients operated on within three days (0-3) and 4 of 6 patients operated on within 4 to 6 days the onset of oculomotor palsy had complete recovery of their third nerve function, in contrast to o nly 4 of 13 patients operated on later. Especially those operated on m ore than four weeks later had a dismal outcome: only 1 of 6 had comple te recovery. CONCLUSIONS We recommend immediate admission and acute or early surgery for aneurysm-induced third nerve palsy, preferably with in 3 days, to avoid functionally and cosmetically invalidizing disabil ity.