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Posterior communicating artery aneurysm related oculomotor nerve palsy: the influence of surgical and endovascular treatment on recovery. Single center series and systematic review.
MedLine Citation:
PMID:  21311376     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Compression of the third nerve resulting in oculomotor nerve palsy (ONP) is a common initial symptom and in some cases the only neurological deficit in patients harbouring posterior communicating artery (PcomA) aneurysms. OBJECTIVE:: To analyse the recovery of ONP after surgical or endovascular treatment in comparison with its spontaneous course. METHODS:: Between June 1999 and April 2008, 5 of 914 consecutive patients with ruptured and 10 of 344 with unruptured intracranial aneurysms causing ONP were treated in our institution. ONP was recorded at admission and at follow-up. The electronic database MEDLINE was searched for published studies of PcomA aneurysm caused ONP. Two reviewers independently extracted data. RESULTS:: Overall, 26 studies and 15 patients of the current series totalling 201 PcomA aneurysms met inclusion criteria. 132 patients underwent surgical clipping, 54 patients were treated endovascularly and 15 patients remained untreated. Surgical treatment was associated with a significantly higher rate of complete ONP resolution (55% vs. 32%; p=0.006; OR=2.6; 95% CI 1.3 - 5.1) and ONP recovery of any degree (92% vs. 74%; p=0.001; OR 4.3; 95% CI 1.8 - 10.4) compared to endovascularly treated patients. In the multivariate analyses, surgical clipping was significantly associated with ONP recovery of any degree (p<0.0001; OR=12.2; 95% CI 3 - 49) and of complete resolution (p=0.006; OR=7.1; 95% CI 1.8 - 28). CONCLUSION:: The present data indicates that ONP caused by PcomA aneurysms recovers in a significantly higher portion of patients after surgical treatment compared to endovascular coiling and the spontaneous course.
Erdem Güresir; Patrick Schuss; Matthias Setzer; Johannes Platz; Volker Seifert; Hartmut Vatter
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-09
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
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