| Objective Through the Comparison of the effects of surgical clipping and endovascular embolization for aneurysm of posterior communicating artery caused oculomotor nerve palsy(ONP), we can choose the appropriate surgery more quickly and effectively according to patients’ condition, and to explore related factors that influence on the recovery of oculomotor nerve palsy patients,we can predict the patients’ prognosis.Methods The clinical and follow‐up data of communicating artery aneurysm induced oculomotor nerve palsy in 48 patients from July 2010 to July 2013 were analyzed retrospectively. There was 16 male and 32 women with a mean age of 58.6 years. Among the 48 patients, 13 patients were treated with surgical clipping and 35 patients were treated with endovascular embolization. Statistical analysis was performed using SPSS 16.0 software, with P< 0.05 as the difference has statistical significance. The different treatment modalities that might affect ONP prognostic factors were compared used the chi square test that reflect the correlation,including the age, whether having preoperative subarachnoid hemorrhage(SAH), size of aneurysm, seriousness of oculomotor nerve palsy and therapeutic duration.Results Through the analysis on the clinical data and regular follow up of patients, we found that in the 48 patients of posterior communicating arteryaneurysm oculomotor nerve palsy in patients with oculomotor nerve palsy, 41(41/48, 85.4%) patients with ONP recovered completely and 7(7/48,14.6%) recovered partially. Of the 35 patients treated with endovascular embolization, 31(31/35, 88.6%) patients with ONP recovered completely and 4(4/35, 11.4%) patients recovered partially. Of the 13 patients in the surgical clipping group, 10(10/13, 76.9%) patients with ONP recovered completely and 3(3/13,23.1%) patients recovered partially. There was no statistically significant difference between the two groups of patients with oculomotor paralysis prognosis(χ2=0.309,P=0.578).Of all influencing factors, 17 cases of less than 55 year old, 14(14/17, 82.4%) patients with ONP recovered completely, 3(3/17, 17.6%) patients recovered partially. 31 cases of more than 55 year old, 27(27/31, 87.1%) patients with ONP recovered completely, 4(4/ 31,12.9%) patients recovered partially. 34 cases of with subarachnoid hemorrhage, 32(32/34, 94.1%) patients with ONP recovered completely, 2(2/34, 5.9%) patients recovered partially. 14 patients with unruptured intracranial aneurysm, 9(9/14, 64.3%) patients with ONP recovered completely, 5(5/14, 35.7%) patients recovered partially. 26 cases with the aneurysm diameter less than 10 mm, 22(22/26, 84.6%) patients with ONP recovered completely, 4(4/26, 15.4%) patients recovered partially. 22 cases with the aneurysm diameter more than 10 mm, 19(19/22, 86.4%) patients with ONP recovered completely, 3(3/22, 13.6%) patients recovered partially. 32 cases with preoperative partial ONP, 30(30/32, 93.8%) patients with ONP recovered completely, 2(2/32, 6.2%) patients recovered partially.16 cases with preoperative complete ONP, 11(11/16, 68.8%) patients with ONP recovered completely, 5(5/16, 31.2%) patients recovered partially.37 cases accepted treatment in 14 days since the onset of symptoms, 34(34/37, 91.9%) patients with ONP recovered completely, 3(3/37, 8.1%) patients recovered partially. 11 cases accepted treatment after 14 days since the onset of symptoms, 7(7/11, 63.6%) patients with ONP recovered completely, 4(4/11, 36.4%)patients recovered partially. Compared to the patients with preoperative complete ONP, accepted treatment after 14 days since the onset of symptoms or with unruptured intracranial aneurysm the symptoms of oculomotor nerve palsy recovered significantly in the patients with preoperative partial ONP, accepted treatment in 14 days since the onset of symptoms or accompanying subarachnoid hemorrhage(SAH)(P< 0.05). Compared to the patients of less than 55 year old or with the aneurysm diameter less than 10 mm the symptoms of oculomotor nerve palsy recovered significantly in the patients of more than 55 year old or with the aneurysm diameter more than 10 mm(P> 0.05).Conclusion There is no significant difference in recovery from 0NP between surgical clipping and endovascular embolization as treatment for posterior communicating artery aneurysm patients with ONP. But both microsurgery and interventional method call achieve satisfactory clinical effect. Early diagnosis and treatment help the recover of oculomotor nerve function. |
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