显微夹闭与介入栓塞治疗对术前伴动眼神经麻痹的颈内-后交通动脉瘤术后恢复情况对比

Postoperative recovery from oculomotor nerve palsy secondary to internal carotid-posterior communicating artery aneurysm after microsurgical clipping and endovascular coiling：a comparative study

摘要:

目的：分析显微夹闭与介入栓塞治疗伴动眼神经麻痹（oculomotor never palsy，ONP）的颈内-后交通动脉瘤（internal carotid-posterior communication artery aneurysm，IC-PcomA）患者术后ONP恢复情况，并对影响ONP恢复因素进行分析。方法：回顾性分析重庆医科大学附属第一医院神经外科50例伴ONP的IC-PcomA患者，其中行显微夹闭手术37例，介入栓塞治疗13例，对不同手术后3个月、6个月后ONP恢复程度进行对比。并对患者年龄、性别、高血压、糖尿病、动脉瘤有无破裂、治疗间隔、麻痹程度、动脉瘤直径、Hunt-Hess分级、手术方式与术后ONP恢复程度进行多因素logistic回归分析。结果：单因素分析术前各因素，治疗间隔对ONP术后恢复有统计学意义（P<0.05）；再进行logistic回归分析，治疗间隔是术后恢复的独立影响因素（P<0.05），OR为0.134（0.034，0.528），回归系数为-2.009，治疗间隔与治疗效果呈负相关，其余因素未见明显统计学差异（P>0.05）。术后3个月时，夹闭组OPN的完全恢复率（62.16%）高于介入组（38.46%），夹闭组部分恢复率（27.03%）较介入组（46.15%）低，2组比较无统计学差异（P>0.05），手术6个月后夹闭组的完全恢复率（75.68%）高于介入组（61.54%），夹闭组部分恢复率（13.51%）低于介入组（23.08%），2组比较无统计学差异（P>0.05）。结论：显微夹闭和介入栓塞均能有效改善IC-PcomA的ONP症状，总体恢复情况无统计学差异（P>0.05）。治疗间隔是术后ONP完全恢复的独立影响因素，治疗间隔越短，完全恢复率越高。

Abstract:

Objective：To compare the recovery from oculomotor never palsy（ONP） following microsurgical clipping versus endovascular coiling for internal carotid-posterior communicating artery aneurysm（IC-PcomA），and to analyze the factors that affect ONP recovery. Methods：The clinical data of 50 patients with ONP secondary to IC-PcomA were reviewed. Of these 50 patients，37 underwent microsurgical clipping and 13 underwent endovascular coiling. ONP recovery at 3 months and 6 months post-surgery was compared between the two groups. In addition，age，gender，hypertension，diabetes，presence or absence of aneurysm rupture，treatment interval，degree of paralysis，aneurysm diameter，Hunt-Hess classification，surgical procedure，and postoperative ONP recovery were subjected to multivariate logistic regression analysis. Results：Univariate analysis of various preoperative factors showed that treatment interval had a significant impact on postoperative ONP recovery（P<0.05）. Further logistic regression analysis demonstrated that treatment interval was an independent factor affecting postoperative ONP recovery（P<0.05，odds ratio=0.134[0.034-0.528]，regression coeffi－cient=-2.009） and treatment interval was negatively correlated with treatment efficacy. There were no significant correlations between treatment efficacy and other factors（all P>0.05）. At 3 months post-surgery，the microsurgical clipping group had a higher complete ONP recovery rate（62.16%） and a lower partial ONP recovery rate（27.03%） compared with the endovascular coil－ing group（38.46% and 46.15%，respectively），but the differ－ences were not statistically significant（both P>0.05）. Similarly，at 6 months post-surgery，the microsurgical clipping group had a higher complete ONP recovery rate（75.68%） and a lower partial ONP recovery rate（13.51%） than the endovascular coiling group（61.54% and 23.08%，respectively），but the differences were not sta－tistically significant（both P>0.05）. Conclusion：Both microsurgical clipping and endovascular coiling can effectively improve ONP in IC-PcomA，and overall ONP recovery is similar between the two procedures. Treatment interval is an independent factor affect－ing complete postoperative ONP recovery，where shorter treatment interval leads to higher complete recovery rate.