Cranial nerve palsies associated with intracranial aneurysms: Systematic Review

Introduction: Cranial nerve palsy (CNP) in patients with intracranial aneurysms can result from the disease process or its treatment. We systematically reviewed the literature on CNP at presentation in patients with intracranial aneurysms.

Methods: PubMed, Web-of-Science, and Scopus were searched according to the PRISMA guidelines. Data extraction and quality assessment were performed according to pre-established guidelines.

Results: Our review yielded 52 studies out of 620. A total of 513 patients with intracranial aneurysms and 630 instances of CNP at presentation were included. The most frequently reported CNPs were the third cranial nerve (58%; n=367) and the sixth cranial nerve (16%; n=100). Other CNPs include 2nd, 4th, 5th, and 7-8th in decreasing frequency. Cavernous internal carotid artery (ICA) aneurysms (36%) and ophthalmic aneurysms (18%) were seen only in the unruptured group, while posterior inferior cerebellar artery aneurysm was more in the ruptured group (ruptured 20%, unruptured 0.8%). The posterior communicating artery was the most common site causing CNP (46%; n=236), followed by cavernous ICA (29%; n=150) and ophthalmic artery (13%; n=69). Medium-sized aneurysms were the most common size associated with CNP, while small-sized aneurysms were the least reported size. Fifty-five percent of patients have complete resolution of cranial nerve function, with most (89%; n=134) resolved within the first 6 months. The sixth cranial nerve palsy had the highest complete resolution rate (60%; n=40). While the lowest one is second cranial nerve dysfunction (43%; n=18).

Conclusion : Cranial nerve palsies are correlated with intracranial aneurysms, and this correlation depends on the rupture status, aneurysmal location, and the dome size.