Skip to main content
Top
Published in: BMC Neurology 1/2020

Open Access 01-12-2020 | Oculomotor Nerve Palsy | Research article

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

Authors: Li-qiang Tian, Qing-xi Fu

Published in: BMC Neurology | Issue 1/2020

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Golshani K, Ferrell A, Zomorodi A, Smith TP, Britz GW. A review of the management of posterior communicating artery aneurysms in the modern era. Surg Neurol Int. 2010;1:88.CrossRef Golshani K, Ferrell A, Zomorodi A, Smith TP, Britz GW. A review of the management of posterior communicating artery aneurysms in the modern era. Surg Neurol Int. 2010;1:88.CrossRef
2.
go back to reference Kassis SZ, Jouanneau E, Tahon FB, Salkine F, Perrin G, Turjman F. Recovery of third nerve palsy after endovascular treatment of posterior communicating artery aneurysms. World Neurosurg. 2010;73(1):11–6 discussion e2.CrossRef Kassis SZ, Jouanneau E, Tahon FB, Salkine F, Perrin G, Turjman F. Recovery of third nerve palsy after endovascular treatment of posterior communicating artery aneurysms. World Neurosurg. 2010;73(1):11–6 discussion e2.CrossRef
3.
go back to reference Giombini S, Ferraresi S, Pluchino F. Reversal of oculomotor disorders after intracranial aneurysm surgery. Acta Neurochir. 1991;112(1–2):19–24.CrossRef Giombini S, Ferraresi S, Pluchino F. Reversal of oculomotor disorders after intracranial aneurysm surgery. Acta Neurochir. 1991;112(1–2):19–24.CrossRef
4.
go back to reference Nam KH, Choi CH, Lee JI, Ko JG, Lee TH, Lee SW. Unruptured intracranial aneurysms with Oculomotor nerve palsy : clinical outcome between surgical clipping and coil embolization. J Korean Neurosurg Soc. 2010;48(2):109–14.CrossRef Nam KH, Choi CH, Lee JI, Ko JG, Lee TH, Lee SW. Unruptured intracranial aneurysms with Oculomotor nerve palsy : clinical outcome between surgical clipping and coil embolization. J Korean Neurosurg Soc. 2010;48(2):109–14.CrossRef
5.
go back to reference Molyneux AJKR, Birks J, Ramzi N, Yarnold J, Sneade M, Rischmiller J. ISAT Collaborators. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol. 2009;8:427–33.CrossRef Molyneux AJKR, Birks J, Ramzi N, Yarnold J, Sneade M, Rischmiller J. ISAT Collaborators. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol. 2009;8:427–33.CrossRef
6.
go back to reference Ahn JY, Han IB, Yoon PH, Kim SH, Kim NK, Kim S, et al. Clipping vs coiling of posterior communicating artery aneurysms with third nerve palsy. Neurology. 2006;66(1):121–3.CrossRef Ahn JY, Han IB, Yoon PH, Kim SH, Kim NK, Kim S, et al. Clipping vs coiling of posterior communicating artery aneurysms with third nerve palsy. Neurology. 2006;66(1):121–3.CrossRef
7.
go back to reference Brigui M, Chauvet D, Clarencon F, Degos V, Sourour NA, Nouet A, et al. Recovery from oculomotor nerve palsy due to posterior communicating artery aneurysms: results after clipping versus coiling in a single-center series. Acta Neurochir. 2014;156(5):879–84.PubMed Brigui M, Chauvet D, Clarencon F, Degos V, Sourour NA, Nouet A, et al. Recovery from oculomotor nerve palsy due to posterior communicating artery aneurysms: results after clipping versus coiling in a single-center series. Acta Neurochir. 2014;156(5):879–84.PubMed
8.
go back to reference Chen PR, Amin-Hanjani S, Albuquerque FC, McDougall C, Zabramski JM, Spetzler RF. Outcome of oculomotor nerve palsy from posterior communicating artery aneurysms: comparison of clipping and coiling. Neurosurgery. 2006;58(6):1040–6 discussion −6.CrossRef Chen PR, Amin-Hanjani S, Albuquerque FC, McDougall C, Zabramski JM, Spetzler RF. Outcome of oculomotor nerve palsy from posterior communicating artery aneurysms: comparison of clipping and coiling. Neurosurgery. 2006;58(6):1040–6 discussion −6.CrossRef
9.
go back to reference Guresir E, Schuss P, Setzer M, Platz J, Seifert V, Vatter H. Posterior communicating artery aneurysm-related oculomotor nerve palsy: influence of surgical and endovascular treatment on recovery: single-center series and systematic review. Neurosurgery. 2011;68(6):1527–33 discussion 33-4..CrossRef Guresir E, Schuss P, Setzer M, Platz J, Seifert V, Vatter H. Posterior communicating artery aneurysm-related oculomotor nerve palsy: influence of surgical and endovascular treatment on recovery: single-center series and systematic review. Neurosurgery. 2011;68(6):1527–33 discussion 33-4..CrossRef
10.
go back to reference Khan SA, Agrawal A, Hailey CE, Smith TP, Gokhale S, Alexander MJ, et al. Effect of surgical clipping versus endovascular coiling on recovery from oculomotor nerve palsy in patients with posterior communicating artery aneurysms: a retrospective comparative study and meta-analysis. Asian J Neurosurg. 2013;8(3):117–24.CrossRef Khan SA, Agrawal A, Hailey CE, Smith TP, Gokhale S, Alexander MJ, et al. Effect of surgical clipping versus endovascular coiling on recovery from oculomotor nerve palsy in patients with posterior communicating artery aneurysms: a retrospective comparative study and meta-analysis. Asian J Neurosurg. 2013;8(3):117–24.CrossRef
11.
go back to reference Mino M, Yoshida M, Morita T, Tominaga T. Outcomes of Oculomotor nerve palsy caused by internal carotid artery aneurysm: comparison between microsurgical clipping and endovascular coiling. Neurol Med Chir (Tokyo). 2015;55(12):885–90.CrossRef Mino M, Yoshida M, Morita T, Tominaga T. Outcomes of Oculomotor nerve palsy caused by internal carotid artery aneurysm: comparison between microsurgical clipping and endovascular coiling. Neurol Med Chir (Tokyo). 2015;55(12):885–90.CrossRef
12.
go back to reference Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103–10.CrossRef Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103–10.CrossRef
13.
go back to reference McCracken DJ, Lovasik BP, McCracken CE, Caplan JM, Turan N, Nogueira RG, et al. Resolution of Oculomotor nerve palsy secondary to posterior communicating artery aneurysms: comparison of clipping and coiling. Neurosurgery. 2015;77(6):931–9 discussion 9.CrossRef McCracken DJ, Lovasik BP, McCracken CE, Caplan JM, Turan N, Nogueira RG, et al. Resolution of Oculomotor nerve palsy secondary to posterior communicating artery aneurysms: comparison of clipping and coiling. Neurosurgery. 2015;77(6):931–9 discussion 9.CrossRef
14.
go back to reference Signorelli F, Pop R, Ganau M, Cebula H, Scibilia A, Gallinaro P, et al. Endovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms. J Neurointerv Surg. 2020;12(10):964–7.CrossRef Signorelli F, Pop R, Ganau M, Cebula H, Scibilia A, Gallinaro P, et al. Endovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms. J Neurointerv Surg. 2020;12(10):964–7.CrossRef
15.
go back to reference Tan H, Huang G, Zhang T, Liu J, Li Z, Wang Z. 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;76(6):687–94 discussion 94.CrossRef Tan H, Huang G, Zhang T, Liu J, Li Z, Wang Z. 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;76(6):687–94 discussion 94.CrossRef
16.
go back to reference Zheng F, Dong Y, Xia P, Mpotsaris A, Stavrinou P, Brinker G, et al. Is clipping better than coiling in the treatment of patients with oculomotor nerve palsies induced by posterior communicating artery aneurysms? A systematic review and meta-analysis. Clin Neurol Neurosurg. 2017;153:20–6.CrossRef Zheng F, Dong Y, Xia P, Mpotsaris A, Stavrinou P, Brinker G, et al. Is clipping better than coiling in the treatment of patients with oculomotor nerve palsies induced by posterior communicating artery aneurysms? A systematic review and meta-analysis. Clin Neurol Neurosurg. 2017;153:20–6.CrossRef
17.
go back to reference Yasargil MGAJ, Laciga R, Jain KK, Hodosh RM, Smith RD. Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol. 1976;6(2):83–91.PubMed Yasargil MGAJ, Laciga R, Jain KK, Hodosh RM, Smith RD. Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol. 1976;6(2):83–91.PubMed
18.
go back to reference Byrne JV, Molyneux AJ, Brennan RP, Renowden SA. Embolisation of recently ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry. 1995;59(6):616–20.CrossRef Byrne JV, Molyneux AJ, Brennan RP, Renowden SA. Embolisation of recently ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry. 1995;59(6):616–20.CrossRef
19.
go back to reference Yanovitch T, Buckley E. Diagnosis and management of third nerve palsy. Curr Opin Ophthalmol. 2007;18(5):373–8.CrossRef Yanovitch T, Buckley E. Diagnosis and management of third nerve palsy. Curr Opin Ophthalmol. 2007;18(5):373–8.CrossRef
20.
go back to reference Birchall D, Khangure MS, McAuliffe W. Resolution of third nerve paresis after endovascular management of aneurysms of the posterior communicating artery. AJNR Am J Neuroradiol. 1999;20(3):411–3.PubMedPubMedCentral Birchall D, Khangure MS, McAuliffe W. Resolution of third nerve paresis after endovascular management of aneurysms of the posterior communicating artery. AJNR Am J Neuroradiol. 1999;20(3):411–3.PubMedPubMedCentral
21.
go back to reference Stiebel-Kalish H, Maimon S, Amsalem J, Erlich R, Kalish Y, Rappaport HZ. Evolution of oculomotor nerve paresis after endovascular coiling of posterior communicating artery aneurysms: a neuro-ophthalmological perspective. Neurosurgery. 2003;53(6):1268–73 discussion 73-4.CrossRef Stiebel-Kalish H, Maimon S, Amsalem J, Erlich R, Kalish Y, Rappaport HZ. Evolution of oculomotor nerve paresis after endovascular coiling of posterior communicating artery aneurysms: a neuro-ophthalmological perspective. Neurosurgery. 2003;53(6):1268–73 discussion 73-4.CrossRef
Metadata
Title
Recovery of posterior communicating artery aneurysm induced oculomotor nerve palsy: a comparison between surgical clipping and endovascular embolization
Authors
Li-qiang Tian
Qing-xi Fu
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2020
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-020-01847-5

Other articles of this Issue 1/2020

BMC Neurology 1/2020 Go to the issue