Oculomotor nerve palsy induced by internal carotid artery aneurysm: prognostic factors for recovery

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• 作者：Julien Engelhardt ; Jér?me Berge ; Emmanuel Cuny ; Guillaume Penchet
• 关键词：Aneurysm ; Internal carotid artery ; Oculomotor nerve palsy ; Prognosis ; Recovery ; Subarachnoid hemorrhage ; Treatment
• 刊名：Acta Neurochirurgica
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：157
• 期：7
• 页码：1103-1111
• 全文大小：354 KB
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• 作者单位：Julien Engelhardt (1)
  Jér?me Berge (2)
  Emmanuel Cuny (1) (3)
  Guillaume Penchet (1)
  
  1. CHU Pellegrin, Service de Neurochirurgie B, H?pital Pellegrin-Tripode, Place Amélie Raba-Léon, 33 076, Bordeaux Cedex, France
  2. CHU Pellegrin, Service de Neuroimagerie Diagnostique et Thérapeutique, Bordeaux, France
  3. Université de Bordeaux, Bordeaux, France
  
• 刊物主题：Neurosurgery; Interventional Radiology; Neuroradiology; Neurology; Surgical Orthopedics; Minimally Invasive Surgery;
• 出版者：Springer Vienna
• ISSN：0942-0940

文摘

Background Aneurysms at the posterior face of the internal carotid artery can lead to oculomotor nerve palsy (ONP) with an uncertain prognosis of recovery post-treatment. The aim of this study was to define the prognostic factors for ONP recovery, with particular interest in treatment modality (surgery or endovascular techniques). Method A literature review was performed to select the most pertinent prognostic factors. A retrospective study was then performed to determine whether these factors had significantly modified the prognosis of ONP recovery in our series of patients. Results In the literature, factors linked to poorer outcome were age, vascular risk factors, initial ONP severity and delay before treatment; better recovery was associated with surgical treatment. Between 2000 and 2013, 23 consecutive patients were treated in our department for ONP-inducing aneurysms: 14 by endovascular embolization and 9 by surgical clipping and aneurysm puncture. Mean follow-up was 48.8?months. After treatment, overall recovery occurred in 87?% of cases, always within 6?months. Apart from treatment modality, no selected prognostic factor significantly modified the quality or timing of ONP recovery. In the endovascular group, four patients recovered completely, seven partially and three did not recover. In the surgical group, seven patients recovered completely and two partially. Surgery was significantly associated with a more complete and earlier ONP recovery (p-lt;-.05). Conclusions Surgery was associated with a more complete and earlier ONP recovery as compared to endovascular treatment, confirming the results of previous studies. However, conclusions must be confirmed by a prospective randomized study.