Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA.
World Neurosurg. 2010 Apr;73(4):353-6. doi: 10.1016/j.wneu.2010.01.002.
The objective of the study was to identify the predictors of improved third cranial nerve (CN III) function in patients who underwent surgical clipping for posterior communicating artery (PComA) aneurysms with varying degrees of CN III palsy at presentation.
We retrospectively evaluated the outcome of the CN III function in a series of 26 patients with CN III dysfunction due to PComA aneurysms that were treated by surgical clipping.
CN III palsy was complete in 18 patients (69%) and partial in 8 patients (31%) at the time of admission. In 15 patients (58%), there was total improvement of CN III function. Partial improvement was noted in 5 patients (19%). Overall improvement (partial and total) of CN III function was observed in 20 (77%) of the 26 patients. The improvement in CN III function following early surgery (0-3 days) was 81.3% when compared to 75% when surgery was performed after 3 days. In univariate analysis, the only variable showing significant association with total improvement of CN III function was type of third nerve palsy at admission (complete vs partial) (P=.004). There was no statistical significant association between early surgery and improvement of CN III function (P=.722). In multivariate analysis, among all the factors, the type of third nerve palsy at presentation (complete and partial) was the significant predictor of the improved CN III function (P=.0038).
Surgical clipping of the PComA aneurysm in patients with CN III palsy results in improvement of the CN III function in the majority of patients. The type of the CN III palsy at admission (complete/partial) is a significant predictor of complete improvement in CN III function.
本研究旨在确定伴有不同程度动眼神经（CN III）麻痹的后交通动脉瘤患者，行手术夹闭后 CN III 功能改善的预测因素。
我们回顾性评估了 26 例因后交通动脉瘤导致 CN III 功能障碍的患者的 CN III 功能结局，这些患者均接受了手术夹闭治疗。
入院时，18 例（69%）患者 CN III 麻痹完全，8 例（31%）患者 CN III 麻痹不完全。15 例（58%）患者 CN III 功能完全恢复，5 例（19%）患者部分恢复。26 例患者中，20 例（77%）的 CN III 功能总体改善（部分和完全）。与术后 3 天以上手术相比，早期手术（0-3 天）时 CN III 功能的改善率为 81.3%，差异有统计学意义（P=.004）。单因素分析显示，与 CN III 功能完全改善相关的唯一变量是入院时的第三神经麻痹类型（完全性与不完全性）（P=.004）。早期手术与 CN III 功能改善之间无统计学显著相关性（P=.722）。多因素分析中，所有因素中，就诊时的第三神经麻痹类型（完全性和不完全性）是 CN III 功能改善的显著预测因素（P=.0038）。
对于伴有 CN III 麻痹的后交通动脉瘤患者，行手术夹闭可使大多数患者的 CN III 功能得到改善。入院时的 CN III 麻痹类型（完全性/不完全性）是 CN III 功能完全改善的显著预测因素。
