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

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.