Rate of third nerve palsy recovery following endovascular management of cerebral aneurysms

Endovascular management of cerebral aneurysms resulting in third nerve palsies has been proposed as an alternative to microsurgical clip ligation. Third nerve function recovery following endovascular treatment in a large patient population has not been evaluated. A literature search of MEDLINE, PubMed, and Cochrane databases for third nerve palsies and endovascular management of cerebral aneurysms was performed. All reported patients in these studies were systematically compiled. Fifty-two patients with third nerve palsies secondary to cerebral aneurysms underwent endovascular treatment. Endovascular management resulted in some degree of third nerve recovery in 65% of patients. The extent of recovery was reported in 21 patients. Of these, 71% had complete recovery. At least two procedure-related third nerve palsies are reported in the literature. One was permanent. One case of recurrent painful palsy is also reported. Microsurgical clip ligation of cerebral aneurysms has a 93% rate of third nerve palsy recovery and a 43% rate of complete third nerve recovery. Endovascular management of cerebral aneurysms can alleviate third nerve palsies in some patients. In reviewing the world literature, however, microsurgical clip ligation is associated with a higher rate of third nerve recovery. Endovascular management, in the subset of patients in whom extent of recovery was documented, demonstrated a higher rate of complete recovery.