Abstract WP80: Efficacy of Coiling Versus Clipping for Posterior Communicating Artery Aneurysms Causing Oculomotor Nerve Palsy: A Systematic Review and Meta-analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ou Siqi ◽  
Liang Feng ◽  
Li Fanying ◽  
Yang Yibing ◽  
Qi Tiewei
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Cochrane Library ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Nerve Paralysis ◽  
Ruptured Aneurysms

Objective: To compare the advantages in respect of recovery from oculomotor nerve paralysis(ONP) between endovascular coiling and surgical clipping in the treatment of cases with posterior communicating artery (PComA) aneurysms in China. Methods: By retrieving PubMed, Cochrane Library, Embase, Chinese Biomedicine Database(CMB), Chinese National Knowledge Infrastructure(CNKI) and other domestic literature database, we collect relevant studies of cases in China from 2004 to 2015. Using Review Manager (RevMan) version 5.0 software, we perform a systematic review of literature and conduct meta-analysis. Result: The meta-analysis included 12 related studies involving 712 Chinese patients with ONP secondary to PComA aneurysms, of whom 302(42.4%) were treated by endovascular coiling while 410(57.6%) received surgical clipping. Surgical clipping (298 of 410 patients, or 72.7%) resulted in greater complete recovery from ONP compared with endovascular coiling (151 of 302 patients, or 50.0%), in correspond to overall pooled odds ratio (OR) of 0.39 [confidence interval (CI) =0.19-0.83, P = 0.01]. The subgroup analysis reveal a significant benefit of surgical clipping over endovascular coiling in cases with preoperative ruptured aneurysms(P=0.01)or complete initial ONP(P=0.002). Conclusion: Better resolution of ONP with PComA aneurysms is more commonly associated with clipping than coiling, which could be especially true in the patients with preoperative ruptured aneurysms or complete initial ONP. A randomized trial including more cases is expected to elaborate this effect.

Endovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms

2020 ◽  
Vol 12 (10) ◽  
pp. 964-967
Author(s):  
Francesco Signorelli ◽  
Raoul Pop ◽  
Mario Ganau ◽  
Helene Cebula ◽  
Antonino Scibilia ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Univariate Analysis ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Surgical Clipping ◽  
Unruptured Aneurysms ◽  
Significant Difference ◽  
Complete Treatment

BackgroundThere 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 methodsA 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.ResultsWe 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 <4 weeks, aneurysm recurrence during follow-up, and retreatment during follow-up were significantly correlated with ONP outcome in the univariate analysis. In the multivariate analysis, independent predictors of ONP improvement were interval to complete treatment <4 weeks (OR 5.15, 95% CI 1.37 to 23.71, p=0.015) and aneurysm recurrence during follow-up (OR 0.1, 95% CI 0.02 to 0.47, p=0.003).ConclusionThere 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.

Recovery of oculomotor nerve palsy following surgical clipping of posterior communicating artery aneurysms

2010 ◽  
Vol 58 (1) ◽  
pp. 103 ◽  
Author(s):  
SaratP Chandra ◽  
ManishK Kasliwal ◽  
Sumit Sinha ◽  
Ashish Suri ◽  
Aditya Gupta ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Surgical Clipping

Outcome of Oculomotor Nerve Palsy from Posterior Communicating Artery Aneurysms: Comparison of Clipping and Coiling

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1040-1046 ◽  
Author(s):  
Peng R. Chen ◽  
Sepideh Amin-Hanjani ◽  
Felipe C. Albuquerque ◽  
Cameron McDougall ◽  
Joseph M. Zabramski ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Artery Aneurysm ◽  
Complete Recovery ◽  
Treatment Method ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Surgical Patients ◽  
Oculomotor Nerve Palsy ◽  
Endovascular Coiling ◽  
Posterior Communicating Artery Aneurysm

Abstract 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.

scholarly journals Evaluation of Surgical Clipping and Endovascular Coiling on Oculomotor Nerve Palsy Caused by Internal Carotid Artery Aneurysm

2020 ◽  
Vol 11 ◽  
Author(s):  
Zhenqing Sun ◽  
Xueqiang Yan ◽  
Xiaolong Li ◽  
Jie Wu
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Recovery Rate ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Microsurgical Clipping

Objectives: Internal carotid artery (ICA) aneurysm often leads to oculomotor nerve palsy (ONP) that impairs eye movement. Currently, microsurgical clipping and endovascular coiling are the two major options to treat ONP. The purpose of the current study is to compare the clinical outcomes of the two methods in patients with ONP caused by ICA aneurysm.Patients and Methods: In the present study, we assessed the prognostic factors and recovery outcomes of a total of 90 ICA aneurysm-induced ONP patients, where 50 of them were treated with microsurgical clipping and 40 of them were treated with endovascular coiling. Within the endovascular coiling group, 20 of the patients were treated with balloon-assisted coiling and the other 20 were treated with stent-assisted coiling.Results: Overall, we achieved a 59% (53 out of 90) full recovery rate. Both surgical clipping and endovascular coiling treatment methods achieved similar recovery outcomes in the tested patients. However, within the endovascular coiling group, balloon-assisted coiling treatment demonstrated a significantly higher full recovery rate (17 out of 20) compared to stent-assisted coiling treatment (eight out of 20).Conclusion: In general, no significant difference was identified between the surgical and coiling treatments, and both procedures were considered as beneficial for ICA aneurysm-induced ONP.

Superciliary keyhole surgery for unruptured posterior communicating artery aneurysms with oculomotor nerve palsy: maximizing symptomatic resolution and minimizing surgical invasiveness

2011 ◽  
Vol 115 (4) ◽  
pp. 700-706 ◽  
Author(s):  
Jaechan Park ◽  
Dong-Hun Kang ◽  
Bo-Young Chun
Keyword(s):  
Treatment Modality ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
3D Ct ◽  
Surgical Clipping ◽  
Technical Feasibility ◽  
Cosmetic Results ◽  
Keyhole Approach

Object For oculomotor nerve palsy (ONP) induced by unruptured posterior communicating artery (PCoA) aneurysms, the authors performed surgical clipping via a superciliary keyhole approach as an optimal treatment modality with high efficiency and low invasiveness. In this study, they then evaluated the technical feasibility, safety, clinical outcomes, including recovery from ONP as well as cosmetic results, and durability of the procedure. Methods Thirteen patients presenting with complete (7 patients) or incomplete (6 patients) ONP underwent surgery via a superciliary approach. The operative video record was used to evaluate the technical feasibility, neurological examinations and CT were performed to analyze the safety of the treatment, and neuroophthalmological examinations and 3D CT angiography were undertaken to determine the effectiveness and durability of the treatment. Results In all cases, the aneurysms were successfully clipped using a 3.5-cm eyebrow incision and supraorbital minicraniotomy. The mean operative time was 108 ± 24 minutes. Twelve (92.3%) of the 13 patients showed complete resolution of the ONP. All 6 patients (100%) with incomplete ONP recovered completely within 1–2 months after surgery, whereas 6 (85.7%) of the 7 patients with complete ONP recovered completely within 1–6 months after surgery. Cosmetic results for the operative wounds were excellent without frontalis palsy. The durability of the treatment was ascertained based on 3D CT angiograms obtained 1 year after surgery. Conclusions Surgical clipping via a superciliary keyhole approach can be an optimal treatment modality for PCoA aneurysms inducing ONP because it is effective, safe, and durable.

Posterior Communicating Artery Aneurysm–Related Oculomotor Nerve Palsy: Influence of Surgical and Endovascular Treatment on Recovery: Single-Center Series and Systematic Review

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1527-1534 ◽  
Author(s):  
Erdem Güresir ◽  
Patrick Schuss ◽  
Matthias Setzer ◽  
Johannes Platz ◽  
Volker Seifert ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Initial Symptom ◽  
Surgical Clipping ◽  
Unruptured Intracranial Aneurysms ◽  
Spontaneous Course

Abstract BACKGROUND: Compression of the third nerve resulting in oculomotor nerve palsy (ONP) is a common initial symptom and in some cases the only neurological deficit in patients with posterior communicating artery (PcomA) aneurysms. OBJECTIVE: To analyze the resolution of ONP after surgical or endovascular treatment in comparison with its spontaneous course. METHODS: Between June 1999 and April 2008, 5 of 914 consecutive patients with ruptured and 10 of 344 with unruptured intracranial aneurysms causing ONP were treated at our institution. ONP was recorded at admission and at follow-up. The electronic database MEDLINE was searched for published studies of PcomA aneurysm-caused ONP. Two reviewers independently extracted data. RESULTS: Overall, 26 studies and 15 patients of the current series totaling 201 PComA aneurysms met the inclusion criteria. A total of 132 patients underwent surgical clipping, 54 patients were treated endovascularly, and 15 patients remained untreated. Surgical treatment was associated with a significantly higher rate of complete ONP resolution (55% vs 32%; P = .006; odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3-5.1) and ONP resolution of any degree (92% vs 74%; P = .001; OR, 4.3; 95% CI, 1.8-10.4) compared with endovascularly treated patients. In the multivariate analyses, surgical clipping was significantly associated with ONP resolution of any degree (P &lt; .0001; OR, 12.2; 95% CI, 3–49) and of complete resolution (P = .006; OR, 7.1; 95% CI, 1.8–28). CONCLUSION: The present data indicate that ONP caused by PComA aneurysms resolves in a significantly higher portion of patients after surgical treatment compared with endovascular coiling and the spontaneous course.

Sign in / Sign up

Export Citation Format

Share Document