Okauchi Masanobu, Matsumura Hikari, Fujimori Takeshi, Toyota Yasunori, Shishido Hajime, Kawakita Kenya, Kawanishi Masahiko, Miyake Keisuke, Tamiya Takashi
Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan.
Emergency Medical Center, Kagawa University Hospital, Kita-gun, Kagawa, Japan.
J Neuroendovasc Ther. 2022;16(5):243-249. doi: 10.5797/jnet.oa.2021-0078. Epub 2021 Sep 16.
Coil embolization for the treatment of internal carotid artery-posterior communicating artery aneurysms (PComAAn) associated with oculomotor nerve palsy (ONP) remains controversial in terms of the therapeutic effect to improve ONP. Patients with PComAAn treated in our hospital were retrospectively analyzed to evaluate the effectiveness of coil embolization on ONP.
Twenty-three patients who had coil embolization for PComAAn with ONP were included in the analysis. In the evaluation of postoperative outcome of ONP, complete resolution of all symptoms was considered as a total recovery. ONP with a few residual symptoms that are stable and not disabling was considered as a subtotal recovery and that with only a slight improvement as a partial recovery.
Preoperative ONP was complete palsy in 14 and partial palsy in nine cases. The mean maximum diameter of the aneurysms was 9.1 ± 3.5 mm (3-17 mm), and the mean time from the onset to treatment was 46.3 ± 98.4 days (0-300 days). The embolization state immediately after the procedure was complete occlusion in seven, neck remnant in eight, and body filling (BF) in eight cases. Total recovery was observed in nine, subtotal recovery in 11, and partial recovery in three cases. The mean time to any improvement in ONP was 6.0 ± 6.0 months (0.5-25 months). Comparing 20 cases with total plus subtotal recovery and three cases with partial recovery, five (25.0%) and three (100%) cases showed BF immediately after the procedure, respectively, which was statistically significant ( = 0.015).
The analysis indicated that coil embolization for the treatment of PComAAn with ONP resulted in satisfactory recovery of ONP in 87% of the cases and the outcome of aneurysm embolization was related to improvement in ONP.
对于伴有动眼神经麻痹（ONP）的颈内动脉-后交通动脉瘤（PComAAn），采用弹簧圈栓塞治疗在改善ONP的疗效方面仍存在争议。对我院收治的PComAAn患者进行回顾性分析，以评估弹簧圈栓塞治疗ONP的有效性。
纳入23例行PComAAn伴ONP弹簧圈栓塞治疗的患者进行分析。在评估ONP术后结局时，所有症状完全消失视为完全恢复。ONP有一些残留症状但稳定且不致残视为部分恢复，仅有轻微改善视为部分恢复。
术前ONP完全麻痹14例，部分麻痹9例。动脉瘤平均最大直径为9.1±3.5mm（3 - 17mm），发病至治疗的平均时间为46.3±98.4天（0 - 300天）。术后即刻栓塞状态为完全闭塞7例，颈部残留8例，瘤体填充（BF）8例。完全恢复9例，部分恢复11例，部分恢复3例。ONP出现任何改善的平均时间为6.0±6.0个月（0.5 - 25个月）。比较20例完全恢复加部分恢复和3例部分恢复的患者，术后即刻分别有5例（25.0%）和3例（100%）出现BF，差异有统计学意义（=0.015）。
分析表明，采用弹簧圈栓塞治疗PComAAn伴ONP，87%的病例ONP恢复满意，动脉瘤栓塞结局与ONP改善相关。
