gms | German Medical Science

Objective: Posterior communicating artery aneurysms (PcomAAs) are the second most common aneurysm, accounting for 25% of all aneurysms and 50% of internal carotid artery aneurysms. It has been estimated that oculomotor nerve palsy (ONP) occurs in up to one-third of patients with PcomAAs. Recent research showed a better outcome of ONP in patients with PcomAAs after surgical clipping when compared to endovascular coiling. Our objective was to compare the effect of clipping and coiling on recovery of ONP in the management of patients with PcomAAs.

Method: A meta-analysis of studies that compared surgical clipping with endovascular coiling was conducted by searching the literature via Pubmed, Embase and Cochrane Library databases without restricting the publication year. We extracted the following information: author names and publication year; clinical outcome (number of complete and incomplete recovery of ONP); perioperative data (number of pre-operatively complete or incomplete ONP, subarachnoid hemorrhage or not, number of complications (hydrocephalus, recurrence of PcomAAs)).

Results: Seven published reports of eligible studies involving 269 participants met the inclusion criteria. Compared with endovascular coiling, surgical clipping had no significant difference on the complete recovery of ONP [RR = 1.50, 95%CI (0.90, 2.52), p > 0.05], the total efficiency (any degree of change) on ONP [RR = 1.09, 95%CI(0.94, 1.27), p > 0.05], the overall complications [RR = 0.63, 95%CI (0.34, 1.17), p > 0.05], the efficacy on the complete recovery of ONP in patients without SAH [RR = 0.77, 95%CI (0.38, 1.56), p > 0.05], the effect on the complete recovery of ONP in patients with pre-operatively complete or incomplete ONP [RR = 1.16, 95%CI (0.59, 2.28), p > 0.05], [RR = 1.18, 95%CI (0.77, 1.80), p > 0.05]. In a comparison of small cohorts of patients with SAH (10 vs. 15) there was a significant difference on the effect on complete recovery of ONP between clipping and coiling [RR = 1.94, 95%CI (1.14,3.29), p < 0.05].

Conclusions: Although the advantages of clipping are reported in recent research, according to our results, the current clinical evidence does not indicate that clipping is significantly superior to coiling in terms of the overall recovery of ONP induced by PcomAAs. More evidence from advanced multi-center studies of large scale would be needed to provide insight into the optimal PcomA aneurysm treatment in terms of optimal ONP outcome.