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Updated: Aug 10, 2026

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
First a third, then a fourth nerve palsy in multiple intracranial aneurysms
Bénédicte Dupas1, Dan Milea, Nader Sourour
1Service d'Ophtalmologie, Hôpital de la Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France. dupasbene@hotmail.com
Background:
Intracranial aneurysms may be a cause of ocular motor dysfunction, the third nerve being more often involved than the two other cranial ocular motor nerves.
Methods:
We report the unusual occurrence of an isolated fourth nerve palsy related to a cavernous carotid aneurysm, angiographically confirmed. The patient already underwent clipping of a ruptured posterior communicating artery aneurysm 17 years earlier, revealed at that time by a third nerve palsy.
Results:
Endovascular treatment of the cavernous carotid aneurysm was performed, resulting in complete recovery of the palsy.
Conclusion:
Occurrence of an acquired fourth nerve palsy in a patient with a past history of aneurysm should prompt neurovascular imaging as multiple aneurysms may cause sequential ocular motor palsies.
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