title: A retrospective comparison of the influence of surgical clipping and endovascular embolization on recovery of oculomotor nerve palsy in patients with posterior communicating artery aneurysms.
abstract: BACKGROUND
  Oculomotor nerve palsy (ONP) is a common symptom of posterior communicating artery aneurysms (PcomAAs). Surgical clipping and endovascular embolization are used to treat PcomAAs with ONP.
  
  
  OBJECTIVE
  To analyze the impact of these 2 techniques on recovery of ONP caused by PcomAAs.
  
  
  METHODS
  The clinical data for 176 patients with intracranial PcomAAs with ONP admitted to the Department of Neurosurgery, Sichuan Provincial People's Hospital, between June 2008 and May 2013 who undergone surgical clipping or endovascular embolization were studied retrospectively. The 2 treatment groups were compared with respect to age, sex, aneurysm size, levels of hypertension and hyperlipidemia, preadmission ONP duration, subarachnoid hemorrhage (SAH), complete ONP, postoperative recovery time from ONP symptoms, and degree of recovery. The follow-up duration was a minimum of 12 months. Multivariate Cox regression was used for analysis.
  
  
  RESULTS
  A total of 132 patients were treated by surgical clipping, and 44 were treated by endovascular embolization. Significant differences were found in postoperative recovery time (83.87 ± 34.70 days for clipping and 137.45 ± 44.94 days for embolization, P < .001) and recovery rates (130 [98.5%] for clipping and 30 [68.2%] for embolization, P < .001). The period between ONP onset and admission was associated with recovery. Postoperative complications included significant cerebral vasospasms (6 in the clipping group and 2 in the embolization group) and hydrocephalus (16 in the clipping group and 9 in the embolization group).
  
  
  CONCLUSIONS
  Simultaneous elimination of 2 injury mechanisms, compression and pulsation, when treating the oculomotor nerve by surgical clipping may be more advantageous than endovascular embolization to treat ONP caused by PcomAA.
authors.affiliation: Department of Neurosurgery, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China.
authors.forename: Haibin
authors.initials: H
authors.lastname: Tan
authors.forename: Guangfu
authors.initials: G
authors.lastname: Huang
authors.forename: Tian
authors.initials: T
authors.lastname: Zhang
authors.forename: Jinping
authors.initials: J
authors.lastname: Liu
authors.forename: Zhili
authors.initials: Z
authors.lastname: Li
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D015840:Oculomotor Nerve Diseases / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000150:complications