Kang hu, genping cai, liang fu, lili huang, wei huang, wenhao wang, changchun liu.(2021).Effects of surgical clipping and endovascular embolization on the recovery of oculomotor nerve paralysis caused by posterior communicating artery aneurysm.Neurology asia, 26(3), 471¿478.Https://doi.Org/10.54029/2021vnw.Abstract background and objectives: our study aimed to explore the therapeutic effects of surgical clipping and endovascular embolization on the recovery of oculomotor nerve paralysis (onp) caused by posterior communicating artery aneurysm (pcomaa).Methods: the clinical data of patients with intracranial pcomaa and onp were retrospectively analyzed.All patients were treated with surgical clipping or endovascular embolization, then followed up for no less than 12 months.Logistic regression analysis was performed to analyze the potential risk factors influencing onp recovery.Results: among 128 patients of onp caused by pcomaa, 96 patients were treated with surgical clipping and 32 patients with endovascular embolization, respectively.Time from initial onp onset to complete or partial recovery was 85.3 ± 36.8 days for patients receiving surgical clipping, and 135.7 ± 41.3 days for patients treated with endovascular embolization.The recovery rate was 94 (97.9%) in the surgical clipping group and 22 (68.8%) in the endovascular embolization group, and significant difference was shown between the two groups (p 0.001).Logistic regression analyses demonstrated that the complete or partial recovery of onp in the surgical clipping group was significantly better than that in the endovascular embolization group (or, 5.582; 95%ci,.023-15.405; p 0.001).Moreover, time from initial symptom onset to receiving treatment also affect onp recovery (or, 0.893; 95% ci, 0.820-0.972; p = 0.009).Conclusion: surgical clipping was superior to endovascular embolization in the recovery of onp caused by pcomaa, and patients who received early intervention could result in better onp recovery.Medtronic review of the literature article found that the 32 patients who were treated with endovascular embolization were treated with axium coils delivered through echelon microcatheters.Those with wide neck aneurysms additionally had a solitaire stent placed; however, these cases were not specified in the article.Those treated with surgical clipping were not treated with a medtronic device.All patients treated had pre-existing oculomotor nerve paralysis (onp) caused by posterior communicating artery aneurysm (pcomaa).The average age of the endovascular embolization group was 52 years and the majority of patients (53.1%) were male.The article reviewed patient recovery from pre-existing onp symptoms as well other post-operative adverse events.10 patients did not have resolution of onp symptoms and 12 had only partial recovery.Serious post-operative adverse events described include: 6 patients had post-operative hydrocephalus.For 5 of these patients, no additional treatment was described.However 1 patient required ventriculo-peritoneal shunt placement after multiple lumbar punctures to release the blood cerebrospinal fluid.1 patient had significant cerebral vasospasm.1 patient had developed aphasia.
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Additional information received reported that there had never been an adverse event related to medtronic products that affected the success or failure of the operation.Axium coils, echelon microcatheters, and solitaire stents were routinely used for aneurysm interventional surgery in this hospital.
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