In Reply: Risks for Oculomotor Nerve Palsy and Time to Recovery After Surgical Clipping of Posterior Communicating Artery Aneurysms: A Multicenter Retrospective Cohort Study

To the Editor: We have read with interest the letter from Danhoff et al commenting on our manuscript entitled “Risks for Oculomotor Nerve Palsy and Time to Recovery After Surgical Clipping of Pcom Aneurysms: A Multicenter Retrospective Cohort Study.”1,2 The authors pointed out one of our limitations, which is the lack of comparison of our results with an endovascular group. For this reason, we thank them for bringing the issue to discussion. In fact, we have not compared our results with endovascular treatment. Still, this methodological aspect of the study is related to our objective of demonstrating the outcome of oculomotor nerve palsy with surgical treatment. The invited centers have a strong tradition of surgical treatment of brain vascular diseases, and the fact of not including the endovascular treatment does not mean that this treatment is not viable as an option to treat Pcom aneurysm with oculomotor palsy. Our results, by not including the endovascular comparison, can state only the outcomes in the clipping group. We also recognize that for many years, the discussion on clipping vs coiling was a huge debate in cases of Pcom aneurysm with oculomotor palsy, with some advocating that the surgery with clipping would be the only way to decompress the nerve and then promoting the resolution of the oculomotor palsy; however, as stated by Danhoff et al, many authors brought their results, in different manuscripts, showing no difference between these 2 modalities of treatment. Finally, we consider that the issue clipping vs coiling should not be extended because we agree that the ideal would be to put the centers together to compare their results and come up with a consensual nomogram as suggested by Danhoff et al.