gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Recovery of aneurysm related oculomotor nerve palsy depending on operative or endovascular treatment

Meeting Abstract

  • P. Schuss - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • E. Güresir - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • J. Beck - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • J. Platz - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • H. Vatter - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.02-05

DOI: 10.3205/09dgnc115, URN: urn:nbn:de:0183-09dgnc1159

Veröffentlicht: 20. Mai 2009

© 2009 Schuss et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: Oculomotor nerve palsy (ONP) caused by intracranial aneurysms is a well-known clinical entity. Our objective was to analyse the recovery of ONP after surgical decompression or endovascular treatment with reduction of aneurysm pulsatility.

Methods: Between June 1999 and April 2008, 6 of 914 consecutive patients with ruptured and 14 of 344 consecutive patients with unruptured intracranial aneurysms causing oculomotor nerve palsy were treated. Oculomotor nerve palsy was recorded at admission, after 3 and 6 months, and after one year.

Results: Overall 4 of 20 patients (20%) with oculomotor nerve palsy underwent surgical clipping of the symptomatic aneurysm. 12 patients (60%) were treated endovascularly and 4 patients (20%) remained untreated due to small aneurysm size or multimorbidity (all unruptured). After 3 months, 3 of the 4 patients (75%) treated with clipping and 5 of 12 patients (42%) treated endovascularly recovered from their deficit. 6 months after treatment, all surgically treated patients and 5 of the 12 endovascularly treated patients recovered from their deficit (p=0.08, OR 12, CI 0.5-278). The grade of aneurysm occlusion (total vs. subtotal) did not influence the rate of recovery (p=1.0). Aneurysm location was the posterior communicating artery in 15 patients and basilar tip in 5 patients. There was no difference in recovery rates concerning aneurysm location (p=1.0). 2 of the 4 patients without treatment recovered from their deficit after 6 months. Meta-analysis, including the current data, revealed a significant difference of oculomotor nerve palsy recovery after 6 months favouring clipping (p<0.001; OR 7.7; 95% CI 2 - 22). 25 of 30 patients after clipping vs. 28 of 71 patients after coiling recovered completely from ONP.

Conclusions: Oculomotor nerve palsy caused by intracranial aneurysms can recover after surgical clipping or coiling. The rate of recovery seems to be higher after surgical clipping, which might influence surgical decision-making.