Hou Yuyang, Chen Rudong, Yang Hongkuan, Li Hua, Wang Junhong, Hu Shengqi, Xu Weidong, Yu Jiasheng
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan 430030, Hubei Province, PR China.
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan 430030, Hubei Province, PR China.
J Clin Neurosci. 2022 May;99:212-216. doi: 10.1016/j.jocn.2022.03.015. Epub 2022 Mar 12.
To explore prognostic factors of complete recovery of oculomotor nerve palsy (ONP) induced by posterior communicating artery aneurysm (PcomAA).
PcomAA patients aged 18-60 years combined with ONP who underwent surgical clipping or endovascular embolization at our institution between January 2014 and January 2020 were enrolled. Characteristics included maximum diameter of aneurysm, width of aneurysm, subarachnoid hemorrhage (SAH), duration of ONP, age, sex, ONP type, treatment method were compared. Based on the recovery of ONP, patients were separated into two groups: complete recovery group, partial and no recovery group. Analyzing by univariate and multivariate logistic regressions to identify the independent prognostics for complete ONP recovery. We established a score based on these prognostics. Receiver operating characteristics (ROC) were conducted to under the performance of the predictors and score.
Finally, ONP type (OR 6.457 95% CI 1.664-25.052, p = 0.007), treatment method (OR 5.051, 95% CI 1.332-19.158, p = 0.017), and interval to treatment ≤2 weeks (OR 25.601 95% CI 6.222-105.340, p < 0.001) were independent predictors of complete ONP recovery. The score had an area under the curve (AUC) value of 0.870. We defined that the score higher than 5 points as easier to achieve complete ONP recovery, and the AUC value of this definition was 0.821.
For ONP induced by PcomAA in patients aged 18-60 years, the best prognostic factor for complete ONP recovery was timely treatment. The ONP type and treatment methods were correlated with complete ONP recovery.
探讨后交通动脉瘤（PcomAA）所致动眼神经麻痹（ONP）完全恢复的预后因素。
纳入2014年1月至2020年1月在本机构接受手术夹闭或血管内栓塞治疗的18 - 60岁合并ONP的PcomAA患者。比较动脉瘤最大直径、动脉瘤宽度、蛛网膜下腔出血（SAH）、ONP持续时间、年龄、性别、ONP类型、治疗方法等特征。根据ONP恢复情况，将患者分为两组：完全恢复组、部分恢复和未恢复组。采用单因素和多因素逻辑回归分析确定ONP完全恢复的独立预后因素。基于这些预后因素建立一个评分系统。进行受试者操作特征（ROC）分析以评估预测指标和评分系统的性能。
最终，ONP类型（OR 6.457，95%CI 1.664 - 25.052，p = 0.007）、治疗方法（OR 5.051，95%CI 1.332 - 19.158，p = 0.017）以及治疗间隔≤2周（OR 25.601，95%CI 6.222 - 105.340，p < 0.001）是ONP完全恢复的独立预测因素。该评分系统的曲线下面积（AUC）值为0.870。我们定义评分高于5分为更易实现ONP完全恢复，此定义的AUC值为0.821。
对于18 - 60岁由PcomAA所致的ONP，ONP完全恢复的最佳预后因素是及时治疗。ONP类型和治疗方法与ONP完全恢复相关。
