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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
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Trochlear nerve palsy associated with intracranial aneurysms: Scoping review
Ahmed Muthana1, Zahraa A Alsubaihawi1, Bandar M Alhadeethi1
1Department of Neurosurgery, University of Baghdad, Karbala, Iraq.
Surgical Neurology International
|October 2, 2025
Summary
Trochlear nerve palsy (TNP) is linked to intracranial aneurysms (IA), particularly large ones in the internal carotid artery. Most TNP cases occur at presentation, with a high recovery rate within six months.
Area of Science:
- Neurology
- Neurosurgery
- Ophthalmology
Background:
- Trochlear nerve palsy (TNP) can be associated with intracranial aneurysms (IA), either due to the aneurysm itself or its treatment.
- Understanding this association is crucial for diagnosis and management of patients presenting with cranial nerve deficits.
Purpose of the Study:
- To systematically review the existing literature on trochlear nerve palsy in patients with intracranial aneurysms.
- To analyze the characteristics, presentation, and outcomes of TNP associated with IA.
Main Methods:
- A systematic literature search was conducted across PubMed, ScienceDirect, and Web of Science.
- Data extraction and quality assessment followed PRISMA guidelines, including 29 studies with 134 patients.
Main Results:
- The majority of patients (78%) were female, with a mean age of 55.35 years.
- Most TNP cases (91%) were associated with large to giant aneurysms in the internal carotid artery or posterior communicating artery.
- TNP occurred at initial presentation in 96.2% of cases, with a recovery rate of 85.2% within <6 months.
Conclusions:
- Trochlear nerve palsy is significantly correlated with intracranial aneurysms.
- The location and size of the aneurysm are key factors influencing the occurrence of TNP.
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