栓塞术对后交通动脉动脉瘤致动眼神经麻痹的疗效及影响因素的探讨

Efficacy and influential factors of embolization on posterior communicating artery aneurysm caused oculomotor nerve palsy

目的探讨血管内栓塞术治疗后交通动脉动脉瘤(PcomAA)所致的动眼神经麻痹患者的恢复情况及其影响因素。方法从2006年6月2009年11月对连续收住院的19例伴有动眼神经麻痹的PcomAA患者采用动脉瘤栓塞术。其中男1例,女18例;平均年龄53岁。动脉瘤直径平均为7.9 mm。发病到治疗的时间平均为16.7 d。利用确切概率法分析下列因素与动眼神经麻痹恢复程度之间的关系。具体包括:最初动眼神经麻痹的程度、动脉瘤的大小、是否伴有蛛网膜下腔出血(SAH)、发病至开始治疗的时间。结果①19例患者治疗时均为完全栓塞。②术后随访时间平均为3.1个月。12例患者动眼神经麻痹完全恢复正常,7例患者的症状部分恢复。其中1例患者因1年后动脉瘤复发行二次栓塞术,2年后再次造影随访证实动脉瘤栓塞致密。该患者在二次治疗后2个月余动眼神经麻痹症状恢复,且未出现症状反复的情况。③动眼神经麻痹程度、发病到开始治疗时间及是否伴有SAH,对恢复情况均有影响(P<0.05);动脉瘤的大小对恢复情况无影响(P>0.05)。结论动脉瘤栓塞术是PcomAA所致的动眼神经麻痹的有效治疗方式。在患者群中,尽早治疗的、伴有SAH或动眼神经麻痹程度较轻者,其预后良好。

Objective To investigate the efficacy and influential factors of embolization on patients with posterior communicating aneurysms caused oculomotor nerve palsy. Methods Nineteen consecutive patient with posterior communicating aneurysms caused oculomotor nerve palsy were treated with aneurysm embolization from June 2006 to November 2009. There was 1 man and 18 women （mean age, 53 years）. The average diameter of the aneurysms was 7.9 mm. The mean time interval from onset to treatment was 16.7 days. Fisher＇s exact test was used to analyze the relation between the following factors and the degree of recovery oeulomotor nerve palsy, such as the severity of initial oculomotor nerve palsy, aneurysm size, whether or not accompanying subarachnoid hemorrhage （SAH） , and the time interval from onset to treat- ment. Results ~The aneurysms in 19 patients were embolized completely. （2）The mean follow-up period was 3.1 months after the procedure. Oculomotor nerve palsy of 12 patients were recovered completely, and of 7 patients recovered partially. One of them underwent second embolization because of recurrence of the aneurysm one year later after the first embolization. The follow-up angiography performed 2 years later confirmed that the aneurysm sac was densely packed, The oeulomotor nerve palsy of the patient did not recover until more than 2 months after the second treatment, and no relapse of symptoms occurred. （3）The severity of oculomotor nerve palsy, the time interval from onset to treatment, and whether or not accompanying SAH had impact on the recovery （P 〈0.05） ,while the size of aneurysm did not have any impact on the recovery （P 〉 0. 05）. Conclusion Aneurysm embolization is an effective means in the treatment of posteri- or communicating aneurysms caused oculomotor nerve palsy. It should be treated as early as possible, and the patients accompanying milder SAH and milder oculomotor nerve palsy may have better outcome.