Kassis Sebouh Z, Jouanneau Emmanuel, Tahon Florence B, Salkine Fadi, Perrin Gilles, Turjman Francis
Department of Neurosurgery, P. Wertheimer Neurological Hospital, Pinel, Lyon, France.
World Neurosurg. 2010 Jan;73(1):11-6; discussion e2. doi: 10.1016/j.surneu.2009.03.042. Epub 2009 Jul 15.
High recovery rates after endovascular treatment of TNP-inducing PcomA aneurysms have been reported. However, only few and often small series were reported. The results of the 2 available comparative studies are controversial. Choosing clipping or coiling as treatment modality nowadays is still a matter of debate. We report the ophthalmologic outcome of 20 consecutive patients treated by coiling of TNP-inducing PcomA aneurysms.
The third nerve function before and after endovascular treatment was assessed and studied retrospectively. Predictive recovery factors known from literature including treatment timing, the degree of preoperative nerve deficit, the association with SAH, coil type, cardiovascular risk factors, and age were analyzed. A review of the literature was performed.
Eight patients presented initially with complete nerve palsy (40%) and 12 with partial palsy (60%). Eleven patients had SAH. The mean aneurysm size was 7.14 mm; there were no partially thrombosed aneurysms. Of the 20 patients, 19 (95%) recovered. Recovery was complete in 7 patients (35%), partial in 12 patients (60%), and 1 patient remained unchanged (5%). The mean duration of follow-up was 24.7 months. One patient with complete TNP recovered completely after 5 months of coiling. One case of late complete nerve recovery was observed at 20 months. No cases of reoccurrences or worsening of the partial TNP were observed, including patients who developed recanalization of the aneurysmal sac. Clinical presentation with SAH and early management were statistically significant factors that positively influenced nerve recovery (P = .006549 and P = .015718, respectively). Initial partial TNP seems to influence recovery but did not reach significance (P = .079899).
Coiling of PcomA aneurysms is associated with high rates of third nerve function recovery. Complete recovery can be expected even after long periods and in cases of initial complete nerve palsy. The early treatment and the association with SAH seem to promote the nerve recovery.
有报道称，对导致动眼神经麻痹（TNP）的后交通动脉瘤（PcomA）进行血管内治疗后恢复率较高。然而，所报道的往往只是少数且规模较小的系列研究。两项现有比较研究的结果存在争议。如今，选择夹闭术还是栓塞术作为治疗方式仍是一个有争议的问题。我们报告了连续20例通过栓塞治疗导致TNP的PcomA动脉瘤患者的眼科治疗结果。
对血管内治疗前后的动眼神经功能进行回顾性评估和研究。分析了文献中已知的预测恢复因素，包括治疗时机、术前神经功能缺损程度、与蛛网膜下腔出血（SAH）的关联、栓塞类型、心血管危险因素和年龄。并进行了文献综述。
8例患者最初表现为完全性神经麻痹（40%），12例为部分性麻痹（60%）。11例患者发生SAH。动脉瘤平均大小为7.14mm；无部分血栓形成的动脉瘤。20例患者中，19例（95%）恢复。7例（35%）完全恢复，12例（60%）部分恢复，1例（5%）无变化。平均随访时间为24.7个月。1例完全性TNP患者在栓塞术后5个月完全恢复。在20个月时观察到1例迟发性完全性神经恢复。未观察到部分性TNP复发或加重的病例，包括动脉瘤囊再通的患者。伴有SAH的临床表现和早期治疗是对神经恢复有积极影响的统计学显著因素（分别为P = 0.006549和P = 0.015718）。最初的部分性TNP似乎影响恢复，但未达到显著水平（P = 0.079899）。
PcomA动脉瘤栓塞与动眼神经功能高恢复率相关。即使在长时间后以及最初为完全性神经麻痹的情况下，也有望实现完全恢复。早期治疗以及与SAH的关联似乎促进了神经恢复。
