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World Neurosurgery Mar 2016To compare surgical clipping with endovascular coiling in terms of recovery from oculomotor nerve palsy (ONP) in the management of posterior communicating artery (PCoA)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare surgical clipping with endovascular coiling in terms of recovery from oculomotor nerve palsy (ONP) in the management of posterior communicating artery (PCoA) aneurysms causing third nerve palsy.
METHODS
We conducted a systematic review of the literature and meta-analysis.
RESULTS
The meta-analysis included 11 relevant studies involving 384 patients with third nerve palsy caused by PCoA aneurysms at baseline, of whom 257 (67.0%) were treated by clipping and 127 were treated by coiling (33.0%). Pooled odds ratios of the impact of clipping or coiling on complete ONP recovery, lack of ONP recovery, and procedure-related death were calculated. The overall complete ONP recovery rate was 42.5% in the coiling group compared with 83.6% in the clipping group. The increase in complete ONP recovery in the clipping group corresponds to an overall pooled Mantel-Haenszel odds ratio of 4.44 (95% confidence interval = 1.66-11.84). Subgroup analysis revealed a clear benefit of clipping over coiling in patients with ruptured aneurysms, but not in patients with unruptured aneurysms. No procedure-related deaths were reported by any of the 11 studies.
CONCLUSIONS
Surgical clipping of PCoA aneurysms causing third nerve palsy achieves better ONP recovery than endovascular coiling; this could be particularly true in the case of ruptured aneurysms. In view of the purely observational data, statements about this effect should be made with great caution. A randomized trial would better address the therapeutic dilemma, but pending the results of such a trial, we recommend treating PCoA aneurysms causing ONP with surgery.
Topics: Cerebral Arteries; Humans; Intracranial Aneurysm; Neurosurgical Procedures; Oculomotor Nerve; Ophthalmoplegia; Surgical Instruments
PubMed: 26409080
DOI: 10.1016/j.wneu.2015.09.026 -
Journal of Child Neurology Jun 2012Ophthalmoplegic migraine is a poorly understood neurologic syndrome characterized by recurrent bouts of head pain and ophthalmoplegia. By reviewing cases presenting to... (Review)
Review
Ophthalmoplegic migraine is a poorly understood neurologic syndrome characterized by recurrent bouts of head pain and ophthalmoplegia. By reviewing cases presenting to our centers in whom the phenotype has been carefully dissected, and systematically reviewing all published cases of ophthalmoplegic migraine in the magnetic resonance imaging (MRI) era, this review sets out to clearly define the syndrome and discuss possible etiologies. We found that in up to one-third of patients, the headache was not migrainous or associated with migrainous symptoms. In three-quarters of the cases involving the third nerve, there was focal nerve thickening and contrast enhancement on MRI. Observational data suggest systemic corticosteroids may be beneficial acutely. The etiology remains unclear, but may involve recurrent bouts of demyelination of the oculomotor nerve. "Ophthalmoplegic migraine" is a misnomer in that it is probably not a variant of migraine but rather a recurrent cranial neuralgia. A more appropriate name might be "ophthalmoplegic cranial neuropathy."
Topics: Adolescent; Adrenal Cortex Hormones; Child; Cranial Nerve Diseases; Databases, Bibliographic; Female; Humans; Magnetic Resonance Imaging; Male; Ophthalmoplegia; Ophthalmoplegic Migraine; Young Adult
PubMed: 22241707
DOI: 10.1177/0883073811426502 -
Neurosurgery Jun 2011Compression of the third nerve resulting in oculomotor nerve palsy (ONP) is a common initial symptom and in some cases the only neurological deficit in patients with... (Review)
Review
Posterior communicating artery aneurysm-related oculomotor nerve palsy: influence of surgical and endovascular treatment on recovery: single-center series and systematic review.
BACKGROUND
Compression of the third nerve resulting in oculomotor nerve palsy (ONP) is a common initial symptom and in some cases the only neurological deficit in patients with posterior communicating artery (PcomA) aneurysms.
OBJECTIVE
To analyze the resolution of ONP after surgical or endovascular treatment in comparison with its spontaneous course.
METHODS
Between June 1999 and April 2008, 5 of 914 consecutive patients with ruptured and 10 of 344 with unruptured intracranial aneurysms causing ONP were treated at our institution. ONP was recorded at admission and at follow-up. The electronic database MEDLINE was searched for published studies of PcomA aneurysm-caused ONP. Two reviewers independently extracted data.
RESULTS
Overall, 26 studies and 15 patients of the current series totaling 201 PComA aneurysms met the inclusion criteria. A total of 132 patients underwent surgical clipping, 54 patients were treated endovascularly, and 15 patients remained untreated. Surgical treatment was associated with a significantly higher rate of complete ONP resolution (55% vs 32%; P=.006; odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3-5.1) and ONP resolution of any degree (92% vs 74%; P=.001; OR, 4.3; 95% CI, 1.8-10.4) compared with endovascularly treated patients. In the multivariate analyses, surgical clipping was significantly associated with ONP resolution of any degree (P<.0001; OR, 12.2; 95% CI, 3-49) and of complete resolution (P=.006; OR, 7.1; 95% CI, 1.8-28).
CONCLUSION
The present data indicate that ONP caused by PComA aneurysms resolves in a significantly higher portion of patients after surgical treatment compared with endovascular coiling and the spontaneous course.
Topics: Endovascular Procedures; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Oculomotor Nerve Diseases; Surgical Instruments; Vascular Surgical Procedures
PubMed: 21311376
DOI: 10.1227/NEU.0b013e31820edd82