不同治疗策略对动脉瘤性动眼神经麻痹的疗效

Effect of different treatment strategies on aneurysmal oculomotor nerve palsy

目的探讨显微外科动脉瘤夹闭术、血管内介入栓塞术等治疗方法对动脉瘤性动眼神经麻痹(OMNP)疗效的影响。方法分析新疆医科大学第一附属医院2018年1月—2020年10月收治的25例颅内动脉瘤伴OMNP患者的临床资料、随访结果,比较显微外科动脉瘤夹闭术和血管内介入栓塞术以及术前不同程度OMNP患者术后动眼神经功能恢复的情况。结果该组患者术后平均住院(9.72±3.82)d,出院时OMNP症状完全恢复3例(12.0%),部分恢复10例(40.0%),无恢复12例(48.0%),无加重患者。术后6个月随访时OMNP症状完全恢复6/25例(24.0%),其中栓塞组2/10例(20%),夹闭组4/14例(28.6%);部分恢复10/25例(40.0%),其中栓塞组5/10例(50%),夹闭组5/14例(35.7%);无恢复9/25例(36.0%),其中栓塞组3/10例(30%),夹闭组5例/14(35.7%)。结论显微外科动脉瘤夹闭术和血管内介入栓塞术均可改善动脉瘤性OMNP。

Objective To investigate the effect of different treatment methods such as microsurgical aneurysm clipping and endovascular embolization on the treatment outcome of aneurysmal oculomotor nerve palsy(OMNP).Methods A retrospective analysis was performed for the clinical treatment and follow-up results of 25 patients with intracranial aneurysm and OMNP who were admitted to The First Affiliated Hospital of Xinjiang Medical University from January 2018 to October2020,and postoperative recovery of oculomotor nerve function was compared between the patients undergoing microsurgical aneurysm clipping and those undergoing intravascular embolization,as well as between the patients with different severities of OMNP before surgery.Results For all 25 patients,the mean length of hospital stay was 9.72±3.82 days after surgery;at discharge,3 patients(12.0%)achieved complete recovery of OMNP symptoms,10(40.0%)achieved partial recovery,and 12(48.0%)had no recovery,and no aggravation was observed. Of all 25 patients at the 6-month follow-up after surgery,6(24.0%)achieved complete recovery of OMNP symptoms,among whom 2 underwent embolization and accounted for 20%(2/10)of the embolization group and 4 underwent clipping and accounted for 28.6%(4/14)of the clipping group;10(40.0%)achieved partial recovery,among whom 5 underwent embolization and accounted for 50%(5/10)of the embolization group and 5 underwent clipping and accounted for 35.7%(5/14)of the clipping group;9(36.0%)had no recovery,among whom 3 underwent embolization and accounted for 30%(3/10)of the embolization group and 5 underwent clipping and accounted for 35.7%(5/14)of the clipping group.Conclusions Both microsurgical aneurysm clipping and endovascular embolization can improve aneurysmal OMNP.