Outcome of oculomotor nerve palsy from posterior communicating artery aneurysms: Comparison of clipping and coiling
Outcome of oculomotor nerve palsy from posterior communicating artery aneurysms: Comparison of clipping and coiling
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DOI：
10.1227/01.neu.0000215853.95187.5e
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发表时间：
2006-06-01
期刊：
影响因子：
4.8
通讯作者：
Spetzler, Robert F.
中科院分区：
文献类型：
--
作者：
Chen, Peng R.;Amin-Hanjani, Sepideh;Spetzler, Robert F.
目的：动脉瘤弹簧圈栓塞术后后交通动脉痉挛引起的眼神经麻痹（ONP）恢复已有报道。然而，线圈质量可能会损害神经的恢复。因此，我们比较了弹簧圈栓塞术和夹闭术的结果，为这个indication.METHODS：我们回顾性比较了13例患者的ONP的结果，其中6例接受血管内弹簧圈栓塞术，7例接受外科手术clipping.Results：6的7例ONP手术患者完全恢复，相比之下，2的6例患者在血管内组。在随访超过1年的患者中，所有6例手术患者完全恢复，而4例血管内患者中有2例完全恢复（P = 0.05）。此外，通过生存分析，术前完全或部分ONP也与缓解程度相关（P = 0.03）。手术组中所有部分ONP患者和血管内组中3例患者中的2例患者均恢复，无残留缺损，而夹闭组中4例完全ONP患者中的3例患者和弹簧圈栓塞组中无患者完全恢复。无论治疗方法，时间到ONP完全解决是6个月，在这两个group.CONCLUSION：夹闭后交通动脉瘤与更高的概率完全恢复ONP比弹簧圈。术前ONP的程度也影响恢复。如果患者能够耐受手术，则应考虑作为治疗的首选。
OBJECTIVE: Recovery of posterior communicating artery aneurysm-induced oculomotor nerve palsy (ONP) after aneurysm coiling has been reported. However, the coil mass may compromise recovery of the nerve. Therefore, we compared the outcome of coiling and clipping for this indication.METHODS: We retrospectively compared the outcomes of ONP in 13 patients, six of whom underwent endovascular coiling and seven of whom underwent surgical clipping.RESULTS: Six of the seven surgical patients with ONP recovered completely, compared with two of the six patients in the endovascular group. Of the patients with more than 1 year of follow-up, all six surgical patients recovered completely, compared with two of four endovascular patients (P = 0.05). In addition, preoperative complete or partial ONP also was associated with degree of resolution by survival analysis (P = 0.03). All patients with partial ONP in the surgical group and two of three patients in the endovascular group recovered without residual deficits, whereas three of the four patients with complete ONP in the clipping group and none in the coiling group recovered completely. Regardless of the treatment method, time to complete resolution of ONP was 6 months in both groups.CONCLUSION: Clipping posterior communicating artery aneurysms was associated with a higher probability of complete recovery from ONP than coiling. Degree of preoperative ONP also affected recovery. If patients can tolerate surgery, it should be considered the treatment of choice.