• Neurosurgery · Jun 2011

    Review

    Posterior communicating artery aneurysm-related oculomotor nerve palsy: influence of surgical and endovascular treatment on recovery: single-center series and systematic review.

    • Erdem Güresir, Patrick Schuss, Matthias Setzer, Johannes Platz, Volker Seifert, and Hartmut Vatter.
    • Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. Gueresir@em.uni-frankfurt.de
    • Neurosurgery. 2011 Jun 1;68(6):1527-33; discussion 1533-4.

    BackgroundCompression 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.ObjectiveTo analyze the resolution of ONP after surgical or endovascular treatment in comparison with its spontaneous course.MethodsBetween 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.ResultsOverall, 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<.0001; OR, 12.2; 95% CI, 3-49) and of complete resolution (P=.006; OR, 7.1; 95% CI, 1.8-28).ConclusionThe 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.Copyright © 2011 by the Congress of Neurological Surgeons

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