Third nerve decompression by anterior petroclinoid ligament opening after clipping of posterior communicating artery aneurysm-How I do it.

Abstract

Posterior communicating artery aneurysms sometimes present with partial or complete oculomotor nerve palsy, due to direct oculomotor nerve compression, irritation by subarachnoid blood, or both. Superiority of surgical clipping over endovascular coiling in terms of postoperative outcome is still controversial. Direct oculomotor nerve decompression by opening of the anterior petroclinoid ligament during aneurysm clipping is performed as a simple and feasible surgical maneuver which allows to improve the decompression effect obtained by aneurysm exclusion. Anterior petroclinoid ligament opening permits to achieve a better oculomotor nerve decompression. Its efficiency on the recovery of the deficit needs to be proved by larger series.