Dimopoulos Vassilios G, Fountas Kostas N, Feltes Carlos H, Robinson Joe Sam, Grigorian Arthur A
Department of Neurosurgery, Medical Center of Central Georgia, Mercer University School of Medicine, Macon, GA, USA.
Neurosurg Rev. 2005 Oct;28(4):256-60. doi: 10.1007/s10143-005-0393-6. Epub 2005 Jun 10.
The association of third cranial nerve palsy subsequent to an enlarging posterior communicating artery (P-Com A) aneurysm has been well described. In our current communication, we review the relevant literature and propose a classification system for the severity of the third cranial nerve palsy, correlating it to the postoperative recovery. Our four grade scale (I-IV) included the degree of the levator palpebrae muscle paresis, the presence of pupillary reaction and the impairment of the third nerve mediated extraocular muscle movement. We evaluated five patients with third nerve palsy secondary to non-ruptured, P-Com A aneurysm. Patients were re-evaluated at 2, 4, 8, 24 weeks postoperatively. Four of the five patients had complete recovery within 4-8 weeks after surgery. One patient had grade II third nerve paresis and complete resolution of the third nerve symptoms within 4 weeks, whereas three patients with grade III and IV had complete resolution 4-8 weeks after surgery. The fifth patient, with grade IV paresis, had minimal (grade III) improvement 6 weeks after surgery, and incomplete recovery (grade I) 6 months postoperatively. Our simple grading system of third nerve palsy associated with P-Com A aneurysms, can be a helpful tool for the initial evaluation and for the monitoring of recovery in these patients.
后交通动脉（P-Com A）动脉瘤增大继发动眼神经麻痹的关联已得到充分描述。在我们当前的交流中，我们回顾了相关文献，并提出了一种动眼神经麻痹严重程度的分类系统，将其与术后恢复情况相关联。我们的四级量表（I-IV）包括上睑提肌麻痹程度、瞳孔反应情况以及动眼神经介导的眼外肌运动障碍。我们评估了5例因未破裂的P-Com A动脉瘤继发动眼神经麻痹的患者。术后2周、4周、8周和24周对患者进行重新评估。5例患者中有4例在术后4-8周内完全恢复。1例患者为II级动眼神经麻痹，在4周内动眼神经症状完全消失，而3例III级和IV级患者在术后4-8周完全恢复。第5例患者为IV级麻痹，术后6周有轻微（III级）改善，术后6个月恢复不完全（I级）。我们简单的与P-Com A动脉瘤相关的动眼神经麻痹分级系统，可作为这些患者初始评估和恢复监测的有用工具。
