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Original research
Endovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms
  1. Francesco Signorelli1,
  2. Raoul Pop2,3,
  3. Mario Ganau4,
  4. Helene Cebula4,
  5. Antonino Scibilia4,
  6. Paolo Gallinaro4,
  7. Ismail Zaed4,
  8. Julien Todeschi4,
  9. Etienne Lefevre5,6,
  10. Beniamino Nannavecchia4,
  11. Francois Severac7,
  12. Hugo Andres Coca4,
  13. Francis Turjman8,
  14. Rodolfo Maduri9,
  15. Rémy Beaujeux3,
  16. Francois Proust4,
  17. Salvatore Chibarro4
  1. 1Neurosurgery, University Hospital of Bari, Bari, Italy
  2. 2Interventional Radiology, Institut Hospitalo-Universitaire, Strasbourg, France
  3. 3Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, Alsace, France
  4. 4Neurosurgery, University Hospitals Strasbourg, Strasbourg, Alsace, France
  5. 5Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
  6. 6Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
  7. 7Public Healthcare Department, University Hospitals Strasbourg, Strasbourg, Alsace, France
  8. 8Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
  9. 9Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  1. Correspondence to Dr Raoul Pop, Neuroradiologie Interventionnelle, Hopitaux Universitaires de Strasbourg, Strasbourg, France; pop.raoul{at}gmail.com

Abstract

Background There is no consensus regarding the best treatment option for unruptured aneurysms of the posterior communicating artery (PCom) presenting with oculomotor nerve palsy (ONP). We aimed to assess predictors of ONP recovery in a multicenter series of consecutive patients.

Materials and methods A retrospective review of prospective databases in three tertiary neurosurgical centers was carried out, selecting patients with ONP caused by unruptured PCom aneurysms, treated by surgical clipping or embolization, between January 2006 and December 2013. Patient files and imaging studies were used to extract ophthalmological assessments, treatment outcomes, and follow-up data. Predictors of ONP recovery during follow-up were explored using univariate and multivariate analyses.

Results We identified 55 patients with a median ONP duration before treatment of 11 days (IQR 4.5–18); the deficit was complete in 27 (49.1%) and incomplete in 28 (50.9%) cases. Median aneurysm size was 7 mm (IQR 5–9). Twenty-four (43.6%) patients underwent surgical clipping and 31 (56.4%) embolization as the primary treatment. Overall, ONP improved in 40 (72.7%) patients and persisted/recurred in 15 (27.3 %). Surgery, interval to complete treatment <4 weeks, aneurysm recurrence during follow-up, and retreatment during follow-up were significantly correlated with ONP outcome in the univariate analysis. In the multivariate analysis, independent predictors of ONP improvement were interval to complete treatment <4 weeks (OR 5.15, 95% CI 1.37 to 23.71, p=0.015) and aneurysm recurrence during follow-up (OR 0.1, 95% CI 0.02 to 0.47, p=0.003).

Conclusion There was no significant difference in ONP recovery between surgical clipping and embolization. The best predictor for ONP recovery was timely, complete, and durable aneurysm exclusion.

  • aneurysm
  • cranial nerve
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Footnotes

  • FS and RP are joint first authors.

  • Twitter @RaoulPop25

  • FS and RP contributed equally.

  • Contributors All authors have made a substantial contribution to all categories established by the ICMJE guidelines on authorship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the institutional review board of the French National Neurosurgery Society (reference No IRB-00011687).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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