Effect of surgical clipping versus endovascular coiling on recovery from oculomotor nerve palsy in patients with posterior communicating artery aneurysms: A retrospective comparative study and meta-analysis
SA Khan1, A Agrawal2, CE Hailey3, TP Smith4, S Gokhale5, MJ Alexander6, GW Britz7, AR Zomorodi2, DL McDonagh8, ML James8
1 Department of Anaesthesiology, Duke University Medical Centre, Durham, USA; Department of Anaesthesiology, Singapore General Hospital, Singapore
2 Department of Surgery (Neurosurgery) & Radiology, Duke University Medical Centre, Durham, USA
3 University of North Carolina Medical School, Chapel Hill, North Carolina, USA
4 Division of Vascular and Interventional Radiology, Duke University Medical Centre, Durham, USA
5 Department of Neurology, Division of Neurocritical Care, Duke University Medical Centre, Durham, USA
6 Cedars-Sinai Medical Centre, Los Angeles, CA, USA
7 Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA
8 Department of Anaesthesiology, Duke University Medical Centre, Durham, USA
S A Khan
Duke University Medical Centre, Box 3094, Durham, North Carolina 27710, USA
Source of Support: None, Conflict of Interest: None
Background: Oculomotor nerve palsy (OMNP) is a well-recognized complication of posterior communicating artery (PCOM) aneurysms. Only a few comparative studies have assessed the effect of clipping versus coiling on recovery from OMNP in PCOM aneurysms. A retrospective review and meta-analysis was conducted to assess the relationship between PCOM aneurysm treatment and OMNP.
Materials and Methods: Medical records of all patients presenting between January 2000 and February 2013 with intracranial aneurysm were searched. All patients with OMNP secondary to PCOM aneurysm were included for analysis. Patients undergoing surgical clipping or endovascular coiling were compared with respect to complete resolution of OMNP after aneurysm surgery (i.e., primary outcome). A meta-analysis of published studies of OMNP associated with PCOM aneurysm was performed after a MEDLINE search.
Results: Seventeen patients with OMNP secondary to PCOM aneurysms met the inclusion criteria. Surgical clipping (seven of eight patients, or 87.5%) resulted in greater complete resolution of OMNP compared with endovascular coiling (four of nine patients, or 44.4%), P = 0.13. A meta-analysis of similar studies revealed that complete resolution of OMNP was more commonly associated with surgical clipping (36 of 43 patients, or 83.7%) than with endovascular coiling (29 of 55 patients, or 52.7%), yielding an adjusted odds ratio (OR) of 6.04 [confidence interval (CI) =1.88-19.45, P = 0.003]. Multivariate analysis found that the degree of pre-operative OMNP (OR = 0.07, CI = 0.02-0.28, P = 0.001) and surgical clipping (OR = 6.37, CI = 1.73-23.42, P = 0.005) were significant factors that affected the complete recovery of OMNP.
Conclusion: Complete recovery of OMNP with PCOM aneurysms is more commonly associated with surgical clipping than with endovascular coiling. Also, the degree of pre-operative OMNP and the treatment modality are significant factors that affect the complete recovery of OMNP.