Endovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms
- 5 March 2020
- journal article
- research article
- Published by BMJ in Journal of NeuroInterventional Surgery
- Vol. 12 (10), 964-967
- https://doi.org/10.1136/neurintsurg-2020-015802
Abstract
Background There is no consensus regarding the best treatment option for unruptured aneurysms of the posterior communicating artery (PCom) presenting with oculomotor nerve palsy (ONP). We aimed to assess predictors of ONP recovery in a multicenter series of consecutive patients. Materials and methods A retrospective review of prospective databases in three tertiary neurosurgical centers was carried out, selecting patients with ONP caused by unruptured PCom aneurysms, treated by surgical clipping or embolization, between January 2006 and December 2013. Patient files and imaging studies were used to extract ophthalmological assessments, treatment outcomes, and follow-up data. Predictors of ONP recovery during follow-up were explored using univariate and multivariate analyses. Results We identified 55 patients with a median ONP duration before treatment of 11 days (IQR 4.5–18); the deficit was complete in 27 (49.1%) and incomplete in 28 (50.9%) cases. Median aneurysm size was 7 mm (IQR 5–9). Twenty-four (43.6%) patients underwent surgical clipping and 31 (56.4%) embolization as the primary treatment. Overall, ONP improved in 40 (72.7%) patients and persisted/recurred in 15 (27.3 %). Surgery, interval to complete treatment Conclusion There was no significant difference in ONP recovery between surgical clipping and embolization. The best predictor for ONP recovery was timely, complete, and durable aneurysm exclusion.Keywords
This publication has 40 references indexed in Scilit:
- Intraoperative oculomotor nerve monitoring predicts outcome following clipping of posterior communicating artery aneurysmsJournal of Clinical Neuroscience, 2012
- Recovery of Ophthalmoplegia after Endovascular Treatment of Intracranial AneurysmsAmerican Journal of Neuroradiology, 2010
- Endovascular Management and Recovery from Oculomotor Nerve Palsy Associated with Aneurysms of the Posterior Communicating ArteryWorld Neurosurgery, 2010
- Recovery of Third Nerve Palsy Following Surgical Clipping of Posterior Communicating Artery AneurysmsWorld Neurosurgery, 2010
- Recovery of third nerve palsy after endovascular treatment of posterior communicating artery aneurysmsWorld Neurosurgery, 2010
- Endovascular coil transfixing a cranial nerve five years after embolisationActa Neurochirurgica, 2008
- Upper basilar artery aneurysms: oculomotor outcomes in 163 casesJournal of Neurosurgery, 2005
- Early surgery improves the cure of aneurysm-induced oculomotor palsySurgical Neurology, 1996
- Non-invasive radiological investigation for oculomotor palsy.Journal of Neurology, Neurosurgery & Psychiatry, 1990
- Prognosis of oculomotor palsy in patients with aneurysms of the posterior communicating arteryActa Neurochirurgica, 1982