What surgical care is indicated in the treatment of third cranial nerve palsy (oculomotor cranial nerve palsy)?

Updated: Oct 08, 2018
  • Author: James Goodwin, MD; Chief Editor: Andrew G Lee, MD  more...
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Answer

For practical purposes, surgical care of third cranial nerve palsy includes clipping, gluing, coiling, or wrapping of the berry aneurysm by a neurosurgeon in the acute stage. [35]

Patients who do not recover from third cranial nerve palsy after 6-12 months may become candidates for strabismus surgery (eye muscle resection or recession) to treat persistent and stable-angle deviation. [36] Some of these patients also may require some form of lid-lift surgery for persistent ptosis that restricts vision or is cosmetically unacceptable to the patient.

Comparison of third cranial nerve palsy recovery following surgical intervention shows that aneurysm clipping is more likely to result in resolution than coiling since the latter does not reliably remove the mass effect of the aneurysm on the nerve. [37] Also, total third cranial nerve palsy has less recovery potential than partial palsy. [38, 39]


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