Postoperative efficacy observation of unruptured intracraniai aneurysm caused oculomotor nerve palsy

Objective To observe the surgical effect for unruptured intracranial aneurysm caused oculomotor nerve palsy.Methods Twenty-seven patients with unruptured intracranial aneurysms caused oculomotor nerve palsy were admitted and treated in Xuanwu Hospital,Capital Medical University from January 2005 to July 2009.Nineteen patients were treated with endovascular intervention and 8 were treated with surgical clipping.The aneurysmal characteristics,treatment strategies,and clinical outcome were observed. Results①Fifteen patients with posterior communicating artery aneurysms,the mean diameter of the aneurysms was 6.6 ± 0.6 mm.Twelve patients with the intracranial internal carotid artery other location artery aneurysm,the mean diameter was 22.5 ± 3.0 mm.There was statistical significance between the two groups (P0.05).②The aneurysm of 8 patients were treated with surgical clipping,seven were completely occluded after surgery,one had a residual aneurysm neck.The aneurysm of 19 patients were treated with interventional method,sixteen were completely obliterated,three had residual necks.③Of the patients treated with surgery,the symptoms of oculomotor nerve palsy in 7 patients disappeared completely and in one patient improved;Of the patients with interventional treatment,the symptoms disappeared completely in 17,and improved in one.There was no significant difference of therapeutic efficacy between the two groups( P 0.05).The time period of symptom disappearance and improvement in 27 patients was 15 d to 24 months.④ Twenty-six patients were followed up for 6 to 48 months;one was lost to follow-up after 3 months.Twenty-three patients with completely occluded aneurysms did not had aneurysm recanalization and regrowth.The aneurysm necks did not enlarged in 4 patients with residual aneurysm neck.One patient had postoperative complications after the surgery,and his speech remained slow at 6 months. Conclusion The unruptured intracranial aneurysms affecting oculomotor nerve should be treated aggressively. Both microsurgery and interventional method can achieve satisfactory clinical effect.