开颅夹闭与介入治疗后交通动脉瘤性动眼神经麻痹的预后对比

Comparison of effects of surgical clipping and endovascular embolization for aneurysm of posterior communicating artery induced oculomotor nerve palsy

目的比较开颅夹闭与介入治疗后交通动脉瘤性动眼神经麻痹(ONP)的恢复情况及其影响因素。方法回顾性分析2010年7月至2013年7月收治的48例后交通动脉瘤同时伴有动眼神经麻痹患者的临床及随访资料,其中13例患者选择开颅动脉瘤夹闭术(夹闭组),35例患者选择动脉瘤栓塞术(栓塞组),比较两组患者的年龄、是否伴有SAH、动脉瘤大小、术前ONP程度及发病至治疗时间等可能影响动眼神经麻痹预后的相关因素。结果 48例后交通动脉瘤患者中,最终ONP完全恢复41例(85.4%),部分恢复7例(14.6%)。其中,栓塞组的35例患者中,31例完全恢复,4例部分恢复;夹闭组的13例患者中,10例完全恢复,3例部分恢复。术前伴有SAH、部分动眼神经麻痹及发病至治疗时间≤14 d的患者比未破动脉瘤、完全动眼神经麻痹及发病至治疗时间>14 d的患者动眼神经麻痹症状改善明显(P<0.05)。结论在治疗后交通动脉瘤伴有动眼神经麻痹的患者时,开颅夹闭术与血管内栓塞术在动眼神经麻痹恢复方面无明显差异。

Objective To explore the clinical efficacy and influencing factors of surgical clipping and endovascular embolization in the treatment of posterior communicating artery aneurysm induced oculomotor nerve palsy( ONP). Methods The clinical and follow-up data of communicating artery aneurysm induced oculomotor nerve palsy in 48 patients from July 2010 to July 2013 were analyzed retrospectively.Among the 48 patients,13 patients were treated with surgical clipping and 35 patients with endovascular embolization. The different treatment modalities that might affect ONP prognostic factors were compared,including the age,whether having preoperative subarachnoid hemorrhage( SAH),size of aneurysm,seriousness of oculomotor nerve palsy and therapeutic duration. Results Of the 48 patients with Pcom AA,41( 85. 4%) patients with ONP recovered completely and 7( 14. 6%) recovered partially. Of the 35 patients treated with endovascular embolization,31 patients with ONP recovered completely and 4 patients recovered partially. Of the 13 patients in the surgical clipping group,10 patients with ONP recovered completely and 3 patients recovered partially. Compared to the patients with unruptured intracranial aneurysm,with preoperative complete ONP or accepted treatment after 14 days since the onset of symptoms,the symptoms of oculomotor nerve palsy recovered significantly in the patients accompanying subarachnoid hemorrhage( SAH),with preoperative partial ONP or accepted treatment in 14 days since the onset of symptoms( P < 0. 05). Conclusion There is no significant difference in the clinical efficacy between surgical clipping and endovascular embolization as treatment for posterior communicating artery aneurysm patients with ONP.