显微夹闭与介入栓塞治疗对术前伴动眼神经麻痹的颈内-后交通动脉瘤术后恢复情况对比

Postoperative recovery from oculomotor nerve palsy secondary to internal carotid-posterior communicating artery aneurysm after microsurgical clipping and endovascular coiling:a comparative study

目的:分析显微夹闭与介入栓塞治疗伴动眼神经麻痹(oculomotor never palsy,ONP)的颈内-后交通动脉瘤(internal carotid-posterior communication artery aneurysm,IC-PcomA)患者术后ONP恢复情况,并对影响ONP恢复因素进行分析。方法:回顾性分析重庆医科大学附属第一医院神经外科50例伴ONP的IC-PcomA患者,其中行显微夹闭手术37例,介入栓塞治疗13例,对不同手术后3个月、6个月后ONP恢复程度进行对比。并对患者年龄、性别、高血压、糖尿病、动脉瘤有无破裂、治疗间隔、麻痹程度、动脉瘤直径、Hunt-Hess分级、手术方式与术后ONP恢复程度进行多因素logistic回归分析。结果:单因素分析术前各因素,治疗间隔对ONP术后恢复有统计学意义(P<0.05);再进行logistic回归分析,治疗间隔是术后恢复的独立影响因素(P<0.05),OR为0.134(0.034,0.528),回归系数为-2.009,治疗间隔与治疗效果呈负相关,其余因素未见明显统计学差异(P>0.05)。术后3个月时,夹闭组OPN的完全恢复率(62.16%)高于介入组(38.46%),夹闭组部分恢复率(27.03%)较介入组(46.15%)低,2组比较无统计学差异(P>0.05),手术6个月后夹闭组的完全恢复率(75.68%)高于介入组(61.54%),夹闭组部分恢复率(13.51%)低于介入组(23.08%),2组比较无统计学差异(P>0.05)。结论:显微夹闭和介入栓塞均能有效改善IC-PcomA的ONP症状,总体恢复情况无统计学差异(P>0.05)。治疗间隔是术后ONP完全恢复的独立影响因素,治疗间隔越短,完全恢复率越高。

Objective:To compare the recovery from oculomotor never palsy(ONP)following microsurgical clipping versus endovascular coiling for internal carotid-posterior communicating artery aneurysm(IC-PcomA),and to analyze the factors that affect ONP recovery.Methods:The clinical data of 50 patients with ONP secondary to IC-PcomA were reviewed. Of these 50 patients,37 underwent microsurgical clipping and 13 underwent endovascular coiling. ONP recovery at 3 months and 6 months post-surgery was compared between the two groups. In addition,age,gender,hypertension,diabetes,presence or absence of aneurysm rupture,treatment interval,degree of paralysis,aneurysm diameter,Hunt-Hess classification,surgical procedure,and postoperative ONP recovery were subjected to multivariate logistic regression analysis. Results:Univariate analysis of various preoperative factors showed that treatment interval had a significant impact on postoperative ONP recovery(P<0.05). Further logistic regression analysis demonstrated that treatment interval was an independent factor affecting postoperative ONP recovery(P<0.05,odds ratio =0.134[0.034-0.528],regression coefficient=-2.009)and treatment interval was negatively correlated with treatment efficacy. There were no significant correlations between treatment efficacy and other factors(all P>0.05). At 3 months post-surgery,the microsurgical clipping group had a higher complete ONP recovery rate(62.16%)and a lower partial ONP recovery rate(27.03%) compared with the endovascular coiling group(38.46% and 46.15%,respectively),but the differences were not statistically significant(both P>0.05). Similarly,at 6 months post-surgery,the microsurgical clipping group had a higher complete ONP recovery rate(75.68%) and a lower partial ONP recovery rate(13.51%)than the endovascular coiling group(61.54% and 23.08%,respectively),but the differences were not statistically significant(both P>0.05). Conclusion:Both microsurgical clipping and endovascular coiling can effectively improve ONP in IC-PcomA,and overall ONP recovery is similar between the two procedures. Treatment interval is an independent factor affecting complete postoperative ONP recovery,where shorter treatment interval leads to higher complete recovery rate.