title: Clipping Versus Coiling in the Management of Posterior Communicating Artery Aneurysms with Third Nerve Palsy: A Systematic Review and Meta-Analysis.
abstract: 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.
authors.affiliation: Department of Neurosurgery, University Hospital of Caen, Caen, France; Inserm, Inserm U919, Serine Protease and Pathophysiology of the Neurovascular Unit, Centre d'Imagerie et de Neurosciences Appliquées aux Pathologies GIP Cyceron, University of Caen Lower Normandy, Caen, France. Electronic address: thomas.gaberel@hotmail.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaberel
authors.affiliation: Department of Neurosurgery, University Hospital of Caen, Caen, France.
authors.forename: Alin
authors.initials: A
authors.lastname: Borha
authors.affiliation: Department of Neurosurgery, University Hospital of Caen, Caen, France; Inserm, Inserm U919, Serine Protease and Pathophysiology of the Neurovascular Unit, Centre d'Imagerie et de Neurosciences Appliquées aux Pathologies GIP Cyceron, University of Caen Lower Normandy, Caen, France.
authors.forename: Camille
authors.initials: C
authors.lastname: di Palma
authors.affiliation: Department of Neurosurgery, University Hospital of Caen, Caen, France; Inserm, Inserm U919, Serine Protease and Pathophysiology of the Neurovascular Unit, Centre d'Imagerie et de Neurosciences Appliquées aux Pathologies GIP Cyceron, University of Caen Lower Normandy, Caen, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Emery
mesh_terms: D002536:Cerebral Arteries / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D009802:Oculomotor Nerve; D009886:Ophthalmoplegia / Q000209:etiology*; D013525:Surgical Instruments
keywords: Endovascular procedure; Intracranial aneurysm; Meta-analysis; Microsurgery; Oculomotor nerve diseases