Unruptured Internal Carotid-Posterior Communicating Artery Aneurysm Splitting the Oculomotor Nerve: A Case Report and Literature Review

Abstract

Objective To report a rare case of unruptured internal carotid-posterior communicating artery (IC-PC) aneurysm splitting the oculomotor nerve treated by clipping and to review the previously published cases.

Case Presentation A 42-year-old man suddenly presented with left oculomotor paresis. Three-dimensional digital subtraction angiography (3D DSA) demonstrated a left IC-PC aneurysm with a bulging part. During surgery, it was confirmed that the bulging part split the oculomotor nerve. After the fenestrated oculomotor nerve was dissected from the bulging part with a careful microsurgical technique, neck clipping was performed. After the operation, the symptoms of oculomotor nerve paresis disappeared within 2 weeks.

Conclusions We must keep in mind the possibility of an anomaly of the oculomotor nerve, including fenestration, and careful observation and manipulation should be performed to preserve the nerve function during surgery, even though it is very rare.

Keywords

fenestration - oculomotor nerve - internal carotid-posterior communicating artery aneurysm - three-dimensional digital subtraction angiography

• References

• 1 Binning MJ, Couldwell WT. Fenestration of the oculomotor nerve by a duplicated posterior cerebral artery and aneurysm. Case report. J Neurosurg 2009; 111 (1) 84-86
• 2 Horiuchi T, Kyoshima K, Oya F, Kobayashi S. Fenestrated oculomotor nerve caused by internal carotid-posterior communicating artery aneurysm: case report. Neurosurgery 1997; 40 (2) 397-398 ; discussion 398–399
• 3 Maekawa H, Hadeishi H, Tanaka M. Unruptured internal carotid-posterior communicating artery aneurysm splitting the oculomotor nerve: case report. J Stroke 2010; 32 (2) 163-166
• 4 Yasargil MG. Internal carotid artery aneurysms. In Yasargil MG, , ed. Microneurosurgery. Vol 2. Stuttgart, Germany: Thieme; 1984: 76-77
• 5 Bulsara KR, Jackson D, Galvan GM. Rate of third nerve palsy recovery following endovascular management of cerebral aneurysms. Neurosurg Rev 2007; 30 (4) 307-310 ; discussion 310–311
• 6 Chen PR, Amin-Hanjani S, Albuquerque FC, McDougall C, Zabramski JM, Spetzler RF. Outcome of oculomotor nerve palsy from posterior communicating artery aneurysms: comparison of clipping and coiling. Neurosurgery 2006; 58 (6) 1040-1046 ; discussion 1040–1046