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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2020, Vol. 08 ›› Issue (03) : 205 -210. doi: 10.3877/cma.j.issn.2095-5782.2020.03.003

所属专题： 文献；

专题研究·眼科介入

合并动眼神经麻痹的颈内动脉后交通动脉段动脉瘤血管内治疗及预后分析
吴邯1, 刘永晟1, 王旭文1, 王峰1,†()   
  1. 1. 116000　辽宁大连，大连医科大学附属第一医院介入治疗科
  • 收稿日期:2020-05-19 出版日期:2020-08-25
  • 通信作者: 王峰

Endovascular treatment and prognostic analysis of posterior communicating artery aneurysms with oculomotor nerve palsy

Han Wu1, Yongsheng Liu1, Xuwen Wang1, Feng Wang1,†()   

  1. 1. Department of Interventional Therapy, the First Affiliated Hospital of Dalian Medical University, Liaoning Dalian 116000, China
  • Received:2020-05-19 Published:2020-08-25
  • Corresponding author: Feng Wang
  • About author:
    Corresponding author: Wang Feng, Email:
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引用本文：

吴邯, 刘永晟, 王旭文, 王峰. 合并动眼神经麻痹的颈内动脉后交通动脉段动脉瘤血管内治疗及预后分析[J]. 中华介入放射学电子杂志, 2020, 08(03): 205-210.

Han Wu, Yongsheng Liu, Xuwen Wang, Feng Wang. Endovascular treatment and prognostic analysis of posterior communicating artery aneurysms with oculomotor nerve palsy[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(03): 205-210.

目的

探讨合并动眼神经麻痹（oculomotor nerve palsy，ONP）的颈内动脉后交通动脉段动脉瘤的不同血管内治疗方式的恢复情况差异及影响因素。

方法

回顾性分析我院2011至2018年收治的35例合并动眼神经麻痹的颈内动脉后交通动脉段动脉瘤并经血管内治疗的病例。随访观察术后动眼神经麻痹的恢复情况，分析不同治疗方式ONP恢复情况的差异性，分析术后数字减影血管造影（digital subtraction angiography，DSA）即刻评价的栓塞与否及程度对ONP恢复的差异性，分析ONP恢复与否与年龄、动眼神经麻痹程度、蛛网膜下腔出血（subarachnoid hemorrhage，SAH）、动脉瘤大小、自发病至接受治疗的时长的关系。

结果

35例后交通动脉瘤患者，动眼神经麻痹完全恢复25例（71.4%），部分恢复6例（17.1%），未缓解4例（11.4%）；不同的血管内治疗方式，ONP的恢复没有统计学差异（P=1.00）；术后DSA即刻评价的栓塞与否及程度对ONP恢复的存在统计学差异（P<0.01），单纯支架治疗和致密栓塞后动眼神经功能恢复得更好；年龄、ONP程度、动脉瘤大小、是否SAH、治疗时间均不是ONP恢复的影响因素（P>0.05）。

结论

不同治疗方式患者的ONP恢复状态没有差异；术后即刻评价的致密栓塞及单纯支架置入，相较部分栓塞及栓塞后瘤腔显影，动眼神经恢复更好。

关键词: 颅内动脉瘤, 动眼神经麻痹, 血管内治疗, 后交通动脉瘤
Objective

To explore the different recovery of diverse endovascular treatments of oculomotor nerve palsy (ONP) induced by posterior communicating artery (PcomA) aneurysms and the influence factors of ONP recovery.

Methods

35 cases of oculomotor nerve palsy induced by posterior communicating artery aneurysms treated with endovascular therapy, admitted to our hospital from 2011 to 2018 were retrospectively studied. The oculomotor nerve function after treatment was assessed during follow-up. The difference of ONP recovery with different treatments was analyzed. The effect of the embolization or not and the degree immediately evaluated by DSA after endovascular treatment on the difference of ONP recovery were analyzed. The factors that may influence ONP recovery including age, the degree of preoperative nerve deficit, the association with SAH, type of endovascular therapy, size of the aneurysms, and timing of treatment after onset of symptoms were analyzed.

Results

Of the 35 patients, 31 (88.6%) recovered. Recovery was complete in 25 patients (71.4%), partial in 6 patients (17.1%), and 4 patient remained unchanged (11.4%). There was no statistical difference (P=1.00) between 3 different endovascular treatments. There was a statistical difference in the ONP recovery of whether embolization or not and the degree after endovascular treatment (P<0.01). Dense embolization and stent implatation were found with better oculomotor nerve function recovery. Age, the degree of preoperative nerve deficit, the association with SAH, the type of endovascular therapy, size of the aneurysms, and timing of treatment after onset of symptoms were not influencing factors for ONP recovery (P>0.05).

Conclusions

There was no statistical difference in ONP recovery of patients between different treatment methods. Dense embolization and stent implantation were found with better oculomotor nerve function recovery.

Key words: Intracranial aneurysm, Oculomotor nerve palsy, Endovascular therapy, posterior communicating artery aneurysms
表1 临床资料
因素 总数=35 完全恢复 部分恢复 未恢复
完全ONP 16 9(56.3%) 5(31.3%) 2(12.5%)
部分ONP 19 16(84.2%) 1(5.3%) 2(10.5%)
SAH 12 7(58.3%) 3(25.0%) 2(16.7%)
无SAH 23 18(78.3%) 3(13.0%) 2(8.7%)
<60岁 16 12(75.0%) 2(12.5%) 2(12.5%)
≥60岁 19 13(68.4%) 4(21.1%) 2(10.5%)
<10 mm* 27 21(77.8%) 5(18.5%) 1(3.7%)
≥10 mm 8 4(50.0%) 1(12.5%) 3(37.5%)
≤7 d 9 5(55.6%) 4(44.4%) -
>7 d 26 20(76.9%) 2(7.7%) 4(15.4%)
单纯支架 2 2(100.0%) - -
瘤腔显影 1 - - 1(100.0%)
部分栓塞 1 - - 1(100.0%)
致密栓塞 31 23(74.2%) 6(20.0%) 2(6.7%)
总数 35 25(71.4%) 6(17.1%) 4(11.4%)
表2 3种不同治疗方式的ONP恢复情况的差异
因素 总数=35 完全恢复 部分恢复 未恢复 P值
单纯支架治疗 2 2(100.0%) - - 0.49
单纯弹簧圈栓塞 18 14(77.8%) 1(5.6%) 3(16.7%) -
支架辅助弹簧圈栓塞 15 9(60.0%) 5(33.3%) 1(6.7%) -
总数 35 25(71.4%) 6(17.1%) 4(11.4%) ?
表3 术后DSA即刻评价栓塞与否及程度对ONP恢复情况的差异
因素 总数=35 完全恢复 部分恢复 未恢复 P值*
单纯支架治疗 2 2(100.0%) - - <0.01
瘤腔显影 1 ? ? 1（100.0%） ?
部分栓塞 1 - - 1(100.0%) ?
致密栓塞 31 22(73.3%) 6(20.0%) 2(6.7%) ?
总数 35 25(71.4%) 6(17.1%) 4(11.4%) ?
表4 ONP恢复的临床影响因素
临床因素 B SE Wald P值 EXP(B)
年龄 -0.29 1.77 0.028 0.87 0.23
ONP程度 -0.96 1.77 0.29 0.59 0.01
动脉瘤大小 2.07 1.86 1.247 0.26 0.21
是否SAH -1.348 1.66 0.42 0.42 0.01
治疗时间 -1.15 1.94 0.35 0.56 0.32
图1 典型病例1，术中DSA造影
图2 典型病例2，术中DSA造影
[1]
Zimmer DV. Oculomotor nerve palsy from posterior communicating artery aneurysm[J]. Journal of the Louisiana State Medical Society Official Organ of the Louisiana State Medical Society, 1991, 143(8): 22-25.
[2]
Kassis SZ, Jouanneau E, Tahon FB, et al. Recovery of third nerve palsy after endovascular treatment of posterior communicating artery aneurysms[J]. World Neurosurgery, 2010, 73(1): 11-16.
[3]
Friedman J, Piepgras D, Pichelmann M, et al. Small cerebral aneurysms presenting with symptoms other than rupture[J]. Neurol. 2001，57(7): 1212-1216.
[4]
Okawara S. Warning signs prior to rupture of an intracranial aneurysm[J]. J Neurosurg. 1973, 38(5): 575-580.
[5]
Soni SR. Aneurysms of the posterior communicating artery and oculomotor paresis[J]. Journal of Neurology Neurosurgery & Psychiatry, 1974, 37(4): 475-484.
[6]
Güresir E, Schuss P, Setzer M,et al. Posterior communicating artery aneurysm-related oculomotor nerve palsy: Influence of surgical and endovascular treatment on recovery: Single-Center Series and Systematic Review[J]. Neurosurgery, 2011(6): 1527-1533.
[7]
Zhong W, Zhang J, Shen J, et al. Posterior communicating aneurysm with oculomotor nerve palsy: Predictors of nerve recovery[J]. J Clin Neurosci, 2019, 59: 62-67.
[8]
Balossier A, Postelnicu A, Khouri S, et al. Third nerve palsy induced by a ruptured anterior communicating artery aneurysm[J]. British Journal of Neurosurgery, 2012, 26(5): 770-772.
[9]
Gu DQ, Luo B, Zhang X, et al. Recovery of posterior communicating artery aneurysm-induced oculomotor nerve paresis after endovascular treatment[J]. Clinical Neurology & Neurosurgery, 2012, 114(9): 1238-1242.
[10]
Chalouhi N, Theofanis T, Jabbour P, et al. Endovascular treatment of posterior communicating artery aneurysms with oculomotor nerve palsy: Clinical outcomes and predictors of nerve recovery[J]. American Journal of Neuroradiology, 2013, 34(4): 828-832.
[11]
Panagiotopoulos V, Ladd SC, Gizewski E, et al. Recovery of ophthalmoplegia after endovascular treatment of intracranial aneurysms[J]. AJNR Am J Neuroradiol, 2011, 32: 276-282.
[12]
Malisch TW, Guglielmi G, Viñuela F, et al. Unruptured aneurysms presenting with mass effect symptoms: Response to endosaccular treatment with Guglielmi detachable coils. Part I. Symptoms of cranial nerve dysfunction[J]. Journal Of Neurosurgery, 1998, 89(6): 956.
[13]
Signorelli F, Pop R, Ganau M, et al. Endovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms[J].J Neurointerv Surg, 2020. DOI: 10.1136/neurintsurg-2020-015802.
[14]
Molyneux AJ, Kerr RS, Yu LM, et al. International subarachnoid aneurysm trial(ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion[J]. Lancet, 2005, 366: 809-817.
[15]
Lv N, Yu Y, Xu J, et al. Hemodynamic and morphological characteristics of unruptured posterior communicating artery aneurysms with oculomotor nerve palsy[J]. Journal of Neurosurgery, 2015, 125(2): 1-5.
[16]
Stiebel-Kalish H, Maimon S, Amsalem J, et al. Evolution of oculomotor nerve paresis after endovascular coiling of posterior communicating artery aneurysms: A neuro-ophthalmological perspective[J]. Neurosurgery, 2003, 53: 1268-1273.
[17]
Hall S, Ramadan-Sadek A, Dando A, et al. The resolution of oculomotor nerve palsy due to unruptured posterior communicating artery aneurysms: A cohort study and narrative review[J]. World Neurosurgery, 2017: S1878875017312238.
[18]
McCracken DJ, Lovasik BP, McCracken CE, et al. Resolution of oculomotor nerve palsy secondary to posterior communicating artery aneurysms[J]. Journal of Neurological Surgery Part B Skull Base, 2015, 77(6): 931-939.
[19]
Leung GKK, Tsang ACO, Lui WM. Pipeline embolization device for intracranial aneurysm: A systematic review[J]. Clinical Neuroradiology, 2012, 22(4): 295-303.
[20]
Zu QQ, Liu XL, Wang B, et al. Recovery of oculomotor nerve palsy after endovascular treatment of ruptured posterior communicating artery aneurysm[J]. Neuroradiology, 2017, 59(11): 1-6.
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