Department of Neurosurgery, SRH Wald-Klinikum Gera, academic hospital of Jena University, Gera, Germany.
Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Dr, Australia.
Neurosurg Rev. 2024 Jul 26;47(1):358. doi: 10.1007/s10143-024-02613-8.
This study aimed to investigate the association between intracerebral aneurysms and cranial nerve (CN) palsies, focusing on nerves other than the oculomotor nerve. It sought to determine the prevalence, risk factors, and clinical outcomes of these nerve palsies and compare the effectiveness of microsurgical clipping versus endovascular coiling in restoring nerve function.
Following PRISMA guidelines, a comprehensive literature search was conducted using databases like PubMed, Scopus, and Google Scholar, covering studies from 1975 to April 2024. The inclusion criteria targeted patients with non-oculomotor nerve palsies diagnosed with cerebral aneurysms. Studies published before 1975 and non-English studies were excluded. Data extraction included study design, patient characteristics, and intervention outcomes. The Joanna Briggs Institute and Newcastle-Ottawa scales were used to assess study quality. Data were synthesized narratively and statistically analysed using SPSS v27.
The analysis included 47 patients (53.2% female, mean age 44.8 years). The internal carotid artery (ICA) was the most common aneurysm site (44.7%), and the abducent nerve (CN VI) was most frequently affected. Ruptured aneurysms had better recovery outcomes (88.9%) than unruptured ones (66.7%). Hypertension was present in 9.2%. Unilateral aneurysms were seen in 80.9%, with 76.6% having a single nerve palsy. Non-ruptured aneurysms accounted for 58.1%, and ruptured for 41.9% of associated cranial nerve palsies. Treatment included microsurgical approaches (42.6%), endovascular approaches (34%), combined approaches (6.4%), and conservative management (17%). Recovery of the palsy was observed in 75.6%, with endovascular procedures showing higher recovery (93.3%) compared to conservative treatment (28.6%).
Intracerebral aneurysms are significantly associated with non-oculomotor CN palsies. Endovascular procedures yield higher recovery rates than conservative management, particularly in ruptured aneurysms. Timely and appropriate treatment is crucial for improving nerve function recovery in these patients.
本研究旨在探讨颅内动脉瘤与颅神经（CN）麻痹之间的关系，重点关注动眼神经以外的其他神经。旨在确定这些神经麻痹的患病率、风险因素和临床结果，并比较显微手术夹闭与血管内栓塞在恢复神经功能方面的效果。
根据 PRISMA 指南，使用 PubMed、Scopus 和 Google Scholar 等数据库进行全面的文献检索，涵盖了 1975 年至 2024 年 4 月的研究。纳入标准为诊断为颅内动脉瘤且伴有非动眼神经麻痹的患者。排除 1975 年以前发表的研究和非英文研究。数据提取包括研究设计、患者特征和干预结果。采用 Joanna Briggs 研究所和纽卡斯尔-渥太华量表评估研究质量。使用 SPSS v27 对数据进行描述性和统计学分析。
分析纳入了 47 名患者（53.2%为女性，平均年龄 44.8 岁）。颈内动脉（ICA）是最常见的动脉瘤部位（44.7%），最常受影响的是展神经（CN VI）。破裂的动脉瘤的恢复结果（88.9%）优于未破裂的动脉瘤（66.7%）。高血压的患病率为 9.2%。单侧动脉瘤占 80.9%，单侧动脉瘤中有 76.6%伴有单一神经麻痹。未破裂的动脉瘤占 58.1%，破裂的动脉瘤占相关颅神经麻痹的 41.9%。治疗方法包括显微手术（42.6%）、血管内治疗（34%）、联合治疗（6.4%）和保守治疗（17%）。观察到麻痹恢复的占 75.6%，血管内治疗的恢复率（93.3%）高于保守治疗（28.6%）。
颅内动脉瘤与非动眼 CN 麻痹显著相关。血管内治疗的恢复率高于保守治疗，尤其是在破裂的动脉瘤中。及时、适当的治疗对于改善这些患者的神经功能恢复至关重要。
