Introduction/Purpose Large internal carotid artery (ICA) aneurysms can cause compressive cranial neuropathies, resulting in double vision, vision loss, facial weakness, and/or facial pain. Open microsurgical decompression for such cases carries substantial risk and the treatment paradigm has shifted to endovascular embolization with use of flow-diverting stents and coils. Embolization relies on intrasaccular thrombosis, which may cause changes in shape and size of the aneurysm, which in turn affects the cranial nerve compression. The trajectory for cranial neuropathies after embolization with such devices is poorly understood.

Materials and Methods A retrospective review was completed at a single academic institution. Inclusion criteria included adult patients who presented with a cranial neuropathy attributable to compression from a cerebral aneurysm, and who underwent flow-diverting device placement from 2015–2023. Demographic, radiographic, and clinical data was collected from the electronic medical record. Patients with less than 6-month follow-up were excluded.

Results Ninety-two patients undergoing flow diverting device placement during the study timeframe were screened. A total of 8 patients met inclusion criteria. All patients were female and underwent placement of a single flow-diverting device with a range of 2–19 coils. Six patients (75%) had cavernous segment aneurysms, and the remainder had supraclinoid ICA aneurysms. Eleven cranial neuropathies were identified between the 8 patients. Average aneurysm size in greatest dimension was 21.8 mm [range 14.1–36 mm]. At last clinical follow-up, one cranial neuropathy had resolved (9%) and six had improved (55%). There were no new cranial neuropathies reported after embolization. No procedural complications were identified.

Conclusion Patients with compressive cranial neuropathies from large ICA aneurysms, who undergo embolization with flow-diverting stent and coils, often experience improvement in their cranial neuropathies over time.

Disclosures D. Defta: None. C. Labak: None. A. Kosanam: None. Y. Hu: None. A. Ray: None.