Oculomotor nerve palsy due to posterior communicating artery aneurysm: Clipping vs coiling - 06/05/21

Doi : 10.1016/j.neuchi.2021.03.012

A.S. Nikova ^a,^b,⁎ , G.S. Sioutas ^b, K. Sfyrlida ^c, G. Tripsianis ^d, M. Karanikas ^e, T. Birbilis ^b
^a Department of neurosurgery, Evangelismos General hospital, Ipsilantou 45-47, 10676 Athens, Greece
^b Department of neurosurgery, Democritus University of thrace, Alexandroupolis, Greece
^c Department of medicine, Medical University of Thessaly, Larissa, Greece
^d Department of statistics, Democritus University of Thrace, Alexandroupolis, Greece
^e Department of surgery, Democritus University of Thrace, Alexandroupolis, Greece

^⁎Corresponding author at: Department of neurosurgery, Evangelismos General hospital, Ipsilantou 45-47, 10676 Athens, Greece.Department of neurosurgery, Evangelismos General hospitalIpsilantou 45-47Athens10676Greece

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Abstract

Objective

Posterior communicating artery aneurysms (PCoAA) usually present with brain hemorrhage, but they might present with oculomotor nerve palsy (ONP) in about one out of five patients. Treatment options include endovascular coiling and surgical clipping. The present analysis aims to compare the two treatment options for ONP due to PCoAA in terms of complete recovery and related parameters.

Methods

A comprehensive literature search was performed for studies published between 2000 and 2019 on ONP due to PCoAA. The included studies were divided into two categories—surgical clipping (group A) and endovascular coiling (group B). The collected data were statistically processed with SPSS version 25.

Results

There was a significant difference between the two treatment groups regarding complete recovery of ONP (P<0.001), suggesting superiority of the surgical clipping. The correlation analysis showed no correlations for group A. Group B had negative and positive correlations, showing that endovascular coiling results in higher rates of complete ONP recovery for elderly patients.

Conclusion

Surgical clipping is superior to endovascular coiling in terms of complete recovery among patients with ONP due to PCoAAs. Endovascular coiling seems to benefit older patients. While no recommendations exist for the treatment of ONP due to intracranial aneurysms, an increasing number of studies imply the superiority of operative clipping.

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Keywords : Posterior communicating artery aneurysm, Oculomotor nerve palsy, Recovery, Subarachnoid hemorrhage, Endovascular, Surgical

Abbreviations : NOS, ONP, PCoAA, SAH