| ObjectiveTo explore in the post communicating artery aneurysms craniotomy clipping operation, of communicating artery aneurysm aneurysm sac treatment strategies for recovery of oculomotor nerve palsy. MethodCollected in our hospital in January 2012- 2014 years 10 months, by CTA or DSA diagnosis parallel and closure of 99 cases of posterior communicating artery aneurysm, including only 13 cases with oculomotor nerve palsy, 10 underwent craniotomy clipping. Analysis the image characteristics and intraoperative aneurysm sac treatment strategy effect on the recovery of oculomotor nerve palsy. Clinical follow-up records, the records of the clinical data of 13 cases, and postoperative patients with oculomotor paralysis recovery rate, according to the postoperative recovery and analysis of its clinical features. The data of 13 patients were statistically analyzed, and the results of measurement were compared with that of the standard deviation of X(S), and the results of T were compared with the two groups, and P<0.05 was statistically significant. Gender, age, smoking and alcohol history, hypertension, hunt Hess grade, operation time, preoperative symptoms occur, the operative time in the aneurysm sac treatment is chosen as factors that may influence after communicating artery aneurysm with oculomotor nerve palsy patients after recovery was used to analyze the risk factors. Continued variable with the average value of the standard deviation or the median and four points from(twenty-fifth and seventy-fifth percentile), to meet the normal distribution. Categorical variables are expressed as counts and percentages.. The complete recovery rate difference between total ONP and incomplete ONP is compared with the exact probability method of Fisher.. The linear trend of complete recovery of different symptom time was satisfied normal distribution. Categorical variables are expressed as counts and percentages.. The linear trend of the total recovery rate of different symptoms was analyzed by Cochran-Armitage trend test.. The linear relationship between the time of paralysis symptoms and ONP recovery time was analyzed by Spearman rank correlation coefficient.. SPSS software was used for statistical analysis, version 17(Product and Service Solutions Statistical), and P<0.05 was used to express the difference.ResultBetween January 2012 and October 2014, 13 patients with ONP caused by post traffic aneurysms received treatment in our hospital.. The indications for the treatment of the ruptured aneurysms are determined by ISUIA, and the consent of the patients is obtained by the treatment program.. SAH was confirmed by CT or lumbar puncture in ruptured aneurysms.. The decision to treat(embolization or clipping) is based on the interdisciplinary consultation of each case. There is no clear data in the literature, and ONP has no criteria for determining the treatment options.. Us within 24 hours after admission to all clinical levels(in addition to patients with unstable hemodynamics or dying) comply with early treatment strategy. At the same time, the treatment including from the time of admission from the use of nimodipine and all the aneurysms in all SAH patients were through the standard pterional approach for surgical treatment. In the operation, the aneurysm neck was highly satisfied and the tumor capsule was treated for a greater degree of functional decompression.. The patients with 6(46.15%) patients showed orbital pain, and 7(53.85%) patients were completely disappeared(the median recovery time was 58 days).. We found that in aneurysm clip after clipping of ONP first to recover part of the parasympathetic nerve fibers(mean recovery time was 4.4 days), which in 9 cases(69.23%) patients in the postoperative recovery was good, 3 cases(23.08%) patients with incomplete recovery in 1 case(7.69%) due to poor prognosis leads to no recovery. The recovery rate had no correlation with the duration of the symptoms of paralysis, but the duration of the symptoms of paralysis was significantly correlated with the recovery time of the patients. Conclusion1. In 13 cases of posterior communicating artery aneurysm with patients with oculomotor nerve palsy, implement clipping of 10 patients with effective recovery rate of 9 cases.2. From 13 cases of patients with postoperative recovery analysis and oculomotor nerve palsy after surgery recovery and preoperative degree of oculomotor nerve paralysis, and oculomotor nerve palsy and to carry out the operation of interval; and with other factors such as the patient’s gender, age, smoking and alcohol history, hypertension, hunt Hess grade, operation time, preoperative symptoms occur, the operative time in the aneurysm sac processing has nothing to do with the factors.3. The treatment effect was observed that: patients in the preoperative belongs to the oculomotor nerve palsy is not full, the postoperative recovery time is short, the prognosis is good. Patients in the preoperative belongs to oculomotor nerve palsy completely, and oculomotor nerve paralysis for more than a week, postoperative recovery for a long time and prognosis of difference.4 simple aneurysm clipping and clipping treatment and tumor capsule compared, the latter is more conducive to the complete recovery of oculomotor function. If the conditions permit, the tumor capsule should be removed, and full decompression should be reduced... |
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