血管内介入治疗后交通动脉瘤性动眼神经麻痹的疗效及其影响因素研究

Investigation of efficacy and its influence factors of intravascular interventional treatment on treating oculomotor nerve palsy induced by posterior communicating artery aneurysms

目的探讨血管内介入治疗后交通动脉瘤性动眼神经麻痹的疗效及其影响因素。方法对31例后交通动脉瘤性动眼神经麻痹患者进行血管内介入治疗。于术后3个月时行脑血管的CT血管成像(CTA)检查,明确栓塞效果及有无再通发生。评价术后1.5年时动眼神经麻痹的恢复情况。采用多因素Lo-gistic回归法分析影响血管内介入治疗疗效的危险因素。结果本组31例患者于血管内介入治疗后3个月时行经脑血管CTA检查发现栓塞效果较好,均为完全闭塞,无栓塞后血管再通现象。随访1.5年发现,31例患者中16例患者完全恢复,12例患者部分恢复,3例患者无改变;有效率达90.3%,治愈率为51.6%。多因素Logistic回归分析显示,动眼神经完全麻痹是血管内介入治疗效果差的影响因素(OR=32.53,95%CI:2.89～365.92,P=0.005),而有蛛网膜下腔出血是其治疗效果好的影响因素(OR=11.63,95%CI:1.12～121.37,P=0.040)。结论血管内介入治疗可以有效地治疗后交通动脉瘤所致的动眼神经麻痹。动眼神经完全麻痹是血管内介入治疗后交通动脉瘤性动眼神经麻痹效果差的危险因素,而有蛛网膜下腔出血是其治疗效果好的预测因素。

Objective To explore the efficacy and its influence factors of intravascular interventional treatment on treating oculomotor nerve palsy（ONP） induced by posterior communicating artery aneurysms.Methods Thirty-one patients with ONP induced by posterior communicating artery aneurysms were treated by intravascular interventional treatment.The cerebrovascular was detected by CT angiography（CTA） in 3 months after operation to definite the embolization effect and whether there occurred recanalization.The recovery condition of ONP was evaluated 1.5 years after operation.The risk factors of the efficacy of intravascular interventional treatment were analyzed by multiple Logistic regression analysis.Results The CTA examination in 3 months after endovascular treatment showed that all the 31 patients in this group had great effects of embolization,which was totally occlusion,and recanalization after embolization was not found.The 1.5 years follow-up showed that among the 31 patients,recovery of ONP was complete in 16 patients and partial in 12 patients,3 patients remained unchanged;the effective rate was 90.3%,and the cure rate was 51.6%.The multiple Logistic regression analysis showed that the complete ONP was the influence factor of poor outcome of endovascular treatment（OR=32.53,95%CI： 2.89-365.92,P=0.005）,while the subarachnoid hemorrhage was the influence factor of good outcome（OR=11.63,95%CI： 1.12-121.37,P=0.040）.Conclusions The intravascular interventional treatment is effective on treating ONP induced by posterior communicating artery aneurysms.Complete ONP is a risk factor,while subarachnoid hemorrhage is a protective factor for the intravascular interventional treatment efficacy of ONP patients induced by posterior communicating artery aneurysms.