All India Institute of Medical Sciences, Department of Neurosurgery, Patna, India.
Turk Neurosurg. 2024;34(1):6-13. doi: 10.5137/1019-5149.JTN.32677-20.1.
To assess the risk factors and simultaneously compared the benefits of procedures (clipping vs. coiling) in the recovery of function from oculomotor nerve palsy (OMNP) between cases with unruptured and ruptured posterior communicating artery (PCOM) aneurysms.
Among the 225 cases of aneurysm treated in our department between July 2018 and February 2020, 25 patients with PCOM aneurysm with OMNP (unruptured: n=13; ruptured: n=12) were retrospectively analysed.
The average duration from onset of symptoms to treatment in unruptured PCOM aneurysm cases was 13.33 ± 3.76 days compared with 7.41 ± 2.42 days in ruptured aneurysm cases. Moreover, an 80% improvement was observed when OMNP was treated within 17 days with the earliest improvement noticed in 33.05 ± 18.75 days in unruptured aneurysm cases compared with 39.66 ± 31.75 days in ruptured PCOM aneurysm cases. Stepwise logistic regression analysis revealed that the type of aneurysm (better recovery in unruptured aneurysm cases) was a significant risk factor (p=0.0126), but not the procedure (clipping vs. coiling) performed, for function recovery from OMNP.
Patients with unruptured PCOM aneurysms with OMNP have a better recovery rate than those with ruptured PCOM aneurysms. No procedural (clipping vs. coiling) advantages were observed on the recovery of function from OMNP. Transmitted pulsation reduction significantly affects the recovery of function from OMNP.
评估危险因素，并同时比较未破裂和破裂后交通动脉（PCOM）动脉瘤病例眼运动神经麻痹（OMNP）恢复功能的手术（夹闭与血管内介入治疗）的获益。
在 2018 年 7 月至 2020 年 2 月期间，我们科室治疗的 225 例动脉瘤患者中，回顾性分析了 25 例伴有 PCOM 动脉瘤的 OMNP 患者（未破裂：n=13；破裂：n=12）。
未破裂 PCOM 动脉瘤病例从症状发作到治疗的平均时间为 13.33±3.76 天，而破裂动脉瘤病例为 7.41±2.42 天。此外，OMNP 在 17 天内得到治疗时，有 80%的患者得到改善，最早在未破裂动脉瘤病例中观察到改善，为 33.05±18.75 天，而在破裂 PCOM 动脉瘤病例中为 39.66±31.75 天。逐步逻辑回归分析显示，动脉瘤类型（未破裂动脉瘤病例的恢复更好）是一个显著的风险因素（p=0.0126），而不是手术方式（夹闭与血管内介入治疗），对 OMNP 功能的恢复有影响。
伴有 OMNP 的未破裂 PCOM 动脉瘤患者的恢复率优于伴有破裂 PCOM 动脉瘤的患者。在 OMNP 的功能恢复方面，未观察到手术（夹闭与血管内介入治疗）的优势。传入搏动减少对 OMNP 的功能恢复有显著影响。
