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Chen CG, Wang JW, Li JF, Li CH, Gao BL. Factors affecting resolution of oculomotor nerve palsy following endovascular embolization of posterior communicating artery aneurysms. Neurologia 2024; 39:315-320. [PMID: 38616058 DOI: 10.1016/j.nrleng.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/13/2021] [Indexed: 04/16/2024] Open
Abstract
PURPOSE To investigate the effect of endovascular embolization of posterior communicating artery (Pcom) aneurysms on concomitant oculomotor nerve palsy (OMNP) and factors affecting the effect of treatment. MATERIALS AND METHODS Patients with the Pcom aneurysms concomitant with OMNP were retrospectively enrolled for endovascular treatment of the aneurysms. All patients had the endovascular management. The clinical effect, degree of OMNP, size of the aneurysm, type of treatment, subarachnoid hemorrhage (SAH), and time from onset to treatment were analyzed on the resolution of OMNP. RESULTS Ninety-six patients with 99 Pcom aneurysms were enrolled and treated endovascularly, with the success rate of 100%. Immediately after endovascular treatment, 75 aneurysms (75.75%) got complete occlusion, and 24 (24.24%) nearly complete occlusion. Followed up for 3-18 (mean 8.52±0.56) months, complete resolution of the OMNP was achieved in 63 patients (65.63%), partial resolution in 21 (21.88%), and non-recovery in the other 12 (12.50%). The degree of OMNP at onset, SAH, and time from onset to treatment were significantly (P<0.05) correlated with the resolution of OMNP. Univariate analysis revealed that younger age of the patient, degree of OMNP at onset, presence of subarachnoid hemorrhage, and time from disease onset to treatment were significantly (P<0.05) associated with the recovery of OMNP. Multivariate analysis revealed that the younger age, degree of OMNP at onset, and time from disease onset to treatment were significantly (P<0.05) associated with the recovery of OMNP. CONCLUSION Endovascular embolization of Pcom aneurysms concomitant with OMNP can effectively improve the OMNP symptoms, especially for patients with moderate and a shorter history of OMNP. Younger age, degree of oculomotor nerve palsy at onset, and time from onset to treatment may significantly affect recovery of oculomotor nerve palsy.
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Affiliation(s)
- C G Chen
- Department of Neurosurgery, Liaoyang City Central Hospital, Liaoyang City 111200, Liaoning Province, China
| | - J W Wang
- Department of Neurosurgery, The First Hospital of Hebei Medical University, China
| | - J F Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, China
| | - C H Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, China.
| | - B L Gao
- Department of Neurosurgery, The First Hospital of Hebei Medical University, China
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Dannhoff G, Todeschi J, Chibbaro S, Mallereau CH, Pop R, Ganau M. Letter: Risks for Oculomotor Nerve Palsy and Time to Recovery After Surgical Clipping of Posterior Communicating Artery Aneurysms: A Multicenter Retrospective Cohort Study. Neurosurgery 2024; 94:e6-e7. [PMID: 37882524 DOI: 10.1227/neu.0000000000002719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Guillaume Dannhoff
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg , France
| | - Julien Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg , France
| | - Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg , France
| | | | - Raoul Pop
- Neuroradiology Unit, Strasbourg University Hospital, Strasbourg , France
| | - Mario Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg , France
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Bathini A, Olson V, Batjer HH, Bendok BR. Commentary: Microsurgical Clipping of a Recurrent Posterior Communicating Artery Aneurysm With Intradural Anterior Clinoidectomy: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e242-e243. [PMID: 36719957 DOI: 10.1227/ons.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Abhijith Bathini
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Vita Olson
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - H Hunt Batjer
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
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Predictors of complete recovery of oculomotor nerve palsy induced by posterior communicating artery aneurysms in patients aged eighteen to sixty. J Clin Neurosci 2022; 99:212-216. [DOI: 10.1016/j.jocn.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/09/2022] [Indexed: 11/19/2022]
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Boulouis G, Soize S, Maus V, Fischer S, Lobsien D, Klisch J, Styczen H, Deuschl C, Abdullayev N, Kabbasch C, Kaiser D, Jamous A, Behme D, Janot K, Bellanger G, Cognard C, Pierot L, Gawlitza M. Flow diversion for internal carotid artery aneurysms with compressive neuro-ophthalmologic symptoms: clinical and anatomical results in an international multicenter study. J Neurointerv Surg 2021; 14:1090-1095. [PMID: 34795018 DOI: 10.1136/neurintsurg-2021-018188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Scientific data on the safety and efficacy of flow diverter stents (FDS) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms are scarce. We studied this subject in a retrospective international multicenter series, pooling data of 9 tertiary care neurointerventional departments. OBJECTIVE To investigate, in a retrospective, multicentric cohort of patients presenting with visual or oculomotor symptoms attributed to a compressive carotid artery in an unruptured intracranial aneurysm, the safety and efficacy profiles of FDS, by analyzing neuro-opthalmologic symptom evolution following FDS placement, complications, and aneurysm obliteration rates. METHODS All patients treated since 2015 with a FDS for an unruptured aneurysm of the ICA with signs of compressive cranial nerve symptoms (CN II, III, IV, VI) were included. RESULTS We treated 55 patients with 55 aneurysms; 21 (38.2%) patients had oculomotor and 15 (27.3%) visual symptoms only; 19 (34.5%) presented with a combination of both. Treatment-related morbidity/mortality occurred in 7.2% and 3.6%, respectively. At last imaging follow-up (13.1±10.5 months) rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 72%, 14%, and 14%, respectively. At last clinical follow-up after 13±10.5 months, 19/51 (37.3%) patients had recovered completely and 18/51 (35.3%) had recovered at least partially from their neuro-ophthalmological symptoms. In multivariable models, a longer delay between symptom onset and treatment was associated with higher odds for incomplete recovery and lower odds for any improvement (aOR 1.03 (95% CI 1.01 to 1.07), p=0.047 and 0.04 (0-0.81), p=0.020). Incomplete recovery was independently associated with older age and fusiform aneurysms. CONCLUSION FDS are effective to treat patients with compressive aneurysms of the ICA causing neuro-ophthalmological symptoms, especially when treatment is initiated early after symptom onset, and aneurysm occlusion is adequate. However, serious complications are not rare.
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Affiliation(s)
| | - Sebastien Soize
- Department of Neuroradiology, Hôpital Maison Blanche, CHU Reims, Reims, France
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum,Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - Sebastian Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum,Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - Donald Lobsien
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Joachim Klisch
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Kaiser
- EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ala Jamous
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Kevin Janot
- Department of Neuroradiology, CHRU Tours, Tours, France
| | | | - Cristophe Cognard
- Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, France
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, CHU Reims, Reims, France
| | - Matthias Gawlitza
- EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany .,Department of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
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Chen CG, Wang JW, Li JF, Li CH, Gao BL. Factors affecting resolution of oculomotor nerve palsy following endovascular embolization of posterior communicating artery aneurysms. Neurologia 2021:S0213-4853(21)00125-0. [PMID: 34511274 DOI: 10.1016/j.nrl.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To investigate the effect of endovascular embolization of posterior communicating artery (Pcom) aneurysms on concomitant oculomotor nerve palsy (OMNP) and factors affecting the effect of treatment. MATERIALS AND METHODS Patients with the Pcom aneurysms concomitant with OMNP were retrospectively enrolled for endovascular treatment of the aneurysms. All patients had the endovascular management. The clinical effect, degree of OMNP, size of the aneurysm, type of treatment, subarachnoid hemorrhage (SAH), and time from onset to treatment were analyzed on the resolution of OMNP. RESULTS Ninety-six patients with 99 Pcom aneurysms were enrolled and treated endovascularly, with the success rate of 100%. Immediately after endovascular treatment, 75 aneurysms (75.75%) got complete occlusion, and 24 (24.24%) nearly complete occlusion. Followed up for 3-18 (mean 8.52±0.56) months, complete resolution of the OMNP was achieved in 63 patients (65.63%), partial resolution in 21 (21.88%), and non-recovery in the other 12 (12.50%). The degree of OMNP at onset, SAH, and time from onset to treatment were significantly (P<0.05) correlated with the resolution of OMNP. Univariate analysis revealed that younger age of the patient, degree of OMNP at onset, presence of subarachnoid hemorrhage, and time from disease onset to treatment were significantly (P<0.05) associated with the recovery of OMNP. Multivariate analysis revealed that the younger age, degree of OMNP at onset, and time from disease onset to treatment were significantly (P<0.05) associated with the recovery of OMNP. CONCLUSION Endovascular embolization of Pcom aneurysms concomitant with OMNP can effectively improve the OMNP symptoms, especially for patients with moderate and a shorter history of OMNP. Younger age, degree of oculomotor nerve palsy at onset, and time from onset to treatment may significantly affect recovery of oculomotor nerve palsy.
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Affiliation(s)
- C G Chen
- Department of Neurosurgery, Liaoyang City Central Hospital, Liaoyang City 111200, Liaoning Province, China
| | - J W Wang
- Department of Neurosurgery, The First Hospital of Hebei Medical University, China
| | - J F Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, China
| | - C H Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, China.
| | - B L Gao
- Department of Neurosurgery, The First Hospital of Hebei Medical University, China
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Wang Z, Kang X, Wang Q. Clipping versus coiling for the treatment of oculomotor nerve palsy induced by posterior communicating artery aneurysms: A comparison of effectiveness. Brain Behav 2021; 11:e2263. [PMID: 34152096 PMCID: PMC8413790 DOI: 10.1002/brb3.2263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/11/2021] [Accepted: 06/08/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A long debate has been going on in the clinical effectiveness to determine whether surgical clipping or coiling more favorable for oculomotor nerve palsy (ONP) caused by PcomAA. We aimed to perform a study, focusing on the effectiveness of ONP induced by PcomAA after treatment of surgical clipping and endovascular coiling. METHOD Potential studies were searched on PubMed, EMBASE, Web of Science, and Cochrane Library from database inception to February 2021, and STATA version 12.0 was exerted to process the pooled data. RESULTS A total of 16 articles are included in the study, hailing from the United States, South Korea, the United Kingdom, France, Germany, Korea, China, Japan, Britain, and Singapore. The results showed that the clipping group was related to a higher incidence of complete ONP recovery at follow-up (OR = 5.808, 95% CI 2.87 to 11.76, p < 0.001), the lower rates of partial ONP recovery (OR = 0.264, 95% CI 0.173 to 0.402, p < .001) and no improvement of ONP at follow-up (RD = -0.149, 95% CI -0.247 to -0.051, p = .003). In the subgroup of complete ONP recovery based on the condition of patients, clipping was associated with a higher incidence of complete ONP recovery in patients with the incomplete initial ONP (OR = 3.579, p = .020) and ruptured aneurysm (OR = 5.38, p = .020). Regarding the subgroup of complete ONP recovery based on the quality of studies, similar results also appeared. CONCLUSION Surgical clipping was more favorable to the recovery from ONP caused by PcomAA endovascular coiling due to a higher rate of recovery and recovery degree of ONP. Besides that, more evidence-based performance is necessary to supplement this opinion.
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Affiliation(s)
- Zidong Wang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong, P.R. China
| | - Xiaokui Kang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong, P.R. China
| | - Qingdong Wang
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, Shandong, P.R. China
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