Prognostic analysis of endovascular embolization and surgical clipping for posterior communicating artery aneurysm caused oculomotor nerve palsy

Objective To investigate the prognosis of endovascular embolization and surgical clipping in the treatment of posterior communicating artery aneurysm(PcoAA) caused ocular motor nerve palsy(OMNP).Methods The clinical data of 23 patients with PcoAA accompanied with unilateral oculomotor palsy treated from January 2010 to February 2012 were analyzed retrospectively.Thirteen of them were treated with endovascular embolization and 10 were treated with surgical clipping.The different treatment modalities that might affect OMNP prognostic factors were compared,including whether having preoperative subarachnoid hemorrhage(SAH),severity of preoperative OMNP,the diameter of aneurysm,and timing of treatment.Results ①Of the 13 patients in the endovascular embolization group,9 had SAH and 4 had no SAH on admission.The diameter of aneurysm in 7 patients was ≤7 mm and in 6 was 7 mm;4 had partial OMNP and 9 had complete OMNP,9,2 and 2 patients underwent early surgery,midterm surgery,and late surgery.Finally,5 patients recovered completely,4 recovered partially,and 4 did not recover.The final modified Rankin scale scores of the patients were 0 to 13.②Of the 10 patients in the surgical clipping group,7 had SAH and 3 had no SAH on admission.The aneurysm diameter in 7 patients was ≤7 mm and in 3 was 7 mm,3 patients had partial OMNP and 7 had complete OMNP,7,2,and 1 patients underwent early surgery,mid-surgery,and late surgery.Finally,8 patients recovered completely,1 recovered partially,and 1 did not recover.The final modified Rankin score scores were 0 in 9 patients and 1 in 1 patient.③13 patients recovered completely during the follow-up period(6 months),5 recovered partially,and 5 did not recover.The complete recovery rate in patients with part OMNP was significantly higher than that in the patients with complete OMNP.The recovery rate in patients who received early surgery were also higher than that in those who received mid-surgery and late surgery.Conclusion Surgical clipping treatment may directly eliminate the damage of oculomotor nerve by PcoAA.On the aspects of the recovery degree of OMNP,the surgical clipping is better than endovascular embolization,and the recovery effect of early embolization therapy is even better