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

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.

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.

A Retrospective Comparison of the Influence of Surgical Clipping and Endovascular Embolization on Recovery of Oculomotor Nerve Palsy in Patients With Posterior Communicating Artery Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 76 (6) ◽  
pp. 687-694 ◽  
Author(s):  
Haibin Tan ◽  
Guangfu Huang ◽  
Tian Zhang ◽  
Jinping Liu ◽  
Zhili Li ◽  
...  
Keyword(s):  
Recovery Time ◽  
Nerve Palsy ◽  
Postoperative Recovery ◽  
Endovascular Embolization ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Common Symptom ◽  
Surgical Clipping ◽  
The Impact

Abstract BACKGROUND: Oculomotor nerve palsy (ONP) is a common symptom of posterior communicating artery aneurysms (PcomAAs). Surgical clipping and endovascular embolization are used to treat PcomAAs with ONP. OBJECTIVE: To analyze the impact of these 2 techniques on recovery of ONP caused by PcomAAs. METHODS: The clinical data for 176 patients with intracranial PcomAAs with ONP admitted to the Department of Neurosurgery, Sichuan Provincial People's Hospital, between June 2008 and May 2013 who undergone surgical clipping or endovascular embolization were studied retrospectively. The 2 treatment groups were compared with respect to age, sex, aneurysm size, levels of hypertension and hyperlipidemia, preadmission ONP duration, subarachnoid hemorrhage (SAH), complete ONP, postoperative recovery time from ONP symptoms, and degree of recovery. The follow-up duration was a minimum of 12 months. Multivariate Cox regression was used for analysis. RESULTS: A total of 132 patients were treated by surgical clipping, and 44 were treated by endovascular embolization. Significant differences were found in postoperative recovery time (83.87 ± 34.70 days for clipping and 137.45 ± 44.94 days for embolization, P &lt; .001) and recovery rates (130 [98.5%] for clipping and 30 [68.2%] for embolization, P &lt; .001). The period between ONP onset and admission was associated with recovery. Postoperative complications included significant cerebral vasospasms (6 in the clipping group and 2 in the embolization group) and hydrocephalus (16 in the clipping group and 9 in the embolization group). CONCLUSION: Simultaneous elimination of 2 injury mechanisms, compression and pulsation, when treating the oculomotor nerve by surgical clipping may be more advantageous than endovascular embolization to treat ONP caused by PcomAA.

scholarly journals Recovery of posterior communicating artery aneurysm induced oculomotor nerve palsy: a comparison between surgical clipping and endovascular embolization

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Li-qiang Tian ◽  
Qing-xi Fu
Keyword(s):  
Nerve Palsy ◽  
Artery Aneurysm ◽  
Endovascular Embolization ◽  
Aneurysm Rupture ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Common Symptom ◽  
Surgical Clipping ◽  
Posterior Communicating Artery Aneurysm

Abstract Background Oculomotor nerve palsy (ONP) is a common symptom of posterior communicating artery aneurysm (PcomAA) that can lead to impaired eye movement and pupil dilation. Currently, surgical clipping and endovascular embolization are the two most popular treatment methods for PcomAA-induced ONP; however, the recovery outcome between the two methods remains to be elucidated. Methods In the present study, we thoroughly compared the pretreatment factors and recovery outcome of the two treatments on 70 patients with PcomAA-induced ONP. The patients were separated into two groups based on the treatment that was received. Pretreatment factors, including age, sex, time period between ONP onset and treatment, ONP type, aneurysm diameter, status of subarachnoid hemorrhage and aneurysm rupture were recorded for each individual patient. Recovery outcome of the patients was assessed over a 12-month period. Results No significant differences were observed in any of the analyzed factors. Importantly, we revealed a significantly higher full recovery rate for the patients receiving the surgical clipping treatment than the ones that received the endovascular embolization treatment. In addition, we showed that patients’ age was negatively correlated with the recovery extent in both treatment groups. Conclusions The outcome of our study suggests that surgical clipping might be a better option to treat PcomAA-induced ONP.

Oculomotor Nerve Palsy Due To Posterior Communicating Artery Aneurysm: Clipping vs Coiling

2021 ◽  
Author(s):  
Alexandrina S. Nikova ◽  
Georgios S Sioutas ◽  
Katerina Sfyrlida ◽  
Grigorios Tripsianis ◽  
Michael Karanikas ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Artery Aneurysm ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Aneurysm Clipping ◽  
Posterior Communicating Artery Aneurysm

Resolution of Oculomotor Nerve Palsy Secondary to Posterior Communicating Artery Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 931-939 ◽  
Author(s):  
D. Jay McCracken ◽  
Brendan P. Lovasik ◽  
Courtney E. McCracken ◽  
Justin M. Caplan ◽  
Nefize Turan ◽  
...  
Keyword(s):  
Median Time ◽  
Coil Embolization ◽  
Nerve Palsy ◽  
Aneurysm Rupture ◽  
Small Sample ◽  
Oculomotor Nerve ◽  
Full Recovery ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Time To Treatment

BACKGROUND: Previous studies have attempted to determine the best treatment for oculomotor nerve palsy (ONP) secondary to posterior communicating artery (PCoA) aneurysms, but have been limited by small sample sizes and limited treatment. OBJECTIVE: To analyze the treatment of ONP secondary to PCoA with both coiling and clipping in ruptured and unruptured aneurysms. METHODS: Data from 2 large academic centers was retrospectively collected over 22 years, yielding a total of 93 patients with ONP secondary to PCoA aneurysms. These patients were combined with 321 patients from the literature review for large data analyses. Onset symptoms, recovery, and time to resolution were evaluated with respect to treatment and aneurysm rupture status. RESULTS: For all patients presenting with ONP (n = 414) 56.6% of those treated with microsurgical clipping made a full recovery vs 41.5% of those treated with endovascular coil embolization (P = .02). Of patients with a complete ONP (n = 229), full recovery occurred in 47.3% of those treated with clipping but in only 20% of those undergoing coiling (P = .01). For patients presenting with ruptured aneurysms (n = 130), full recovery occurred in 70.9% compared with 49.3% coiled patients (P = .01). Additionally, although patients with full ONP recovery had a median time to treatment of 4 days, those without full ONP recovery had a median time to treatment of 7 days (P = .01). CONCLUSION: Patients with ONP secondary to PCoA aneurysms treated with clipping showed higher rates of full ONP resolution than patients treated with coil embolization. Larger prospective studies are needed to determine the true potential of recovery associated with each treatment.

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