Document Type

Article

Publication Date

12-18-2024

Comments

This article is the author's final published version in Neurosurgical review, Volume 47, Issue 1, December 2024, Article number 904.

The published version is available at https://doi.org/10.1007/s10143-024-03149-7.

This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2024

Abstract

Recent advancements in endovascular treatment (EVT) and different views on optimal management for posterior communicating artery (PComA) aneurysms with oculomotor nerve palsy (ONP) highlight a need to compare recovery timelines between microsurgery and EVT; heterogeneous outcomes and influencing factors may also affect results. A comprehensive systematic review and meta-analysis were conducted by searching PubMed, Embase, Scopus, and Web of Science databases. The extracted data encompassed patient demographics, details on treatment modalities and timing, and characteristics of PComA aneurysms ONP caused by either unruptured or ruptured aneurysms. The primary outcome was ONP favorable recovery, defined as the resolution of admission symptoms, except for subtle ptosis and mild pupillary asymmetry. We used random effect models to calculate odds ratios (OR) and pool prevalence with their corresponding 95% confidence intervals (CI). A total of 40 studies met the inclusion criteria. Overall, microsurgical clipping of PComA aneurysms demonstrated a significantly higher likelihood of ONP recovery compared to EVT at 1,3,6, and 12 months follow-up. However, recovery rates were comparable in long-term follow-up [18 months: (0.87 vs. 0.64, P-value = 0.36); ≥24 months: (0.86 vs. 0.72 P-Value = 0.26)]. The recovery outcomes for early treatment were similar when assessed during the 6-month follow-up (0.75 vs. 0.56, P-value = 0.07). Our findings suggest microsurgery leads to prompt ONP recovery from PComA aneurysms, while EVT shows potential for delayed favorable recovery; both treatments yield short-term recovery when administered early. A case-by-case approach is recommended, emphasizing a comprehensive understanding of patient factors in relation to the immediate and sustained effects of each treatment.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Additional Files
Electronic Supplementary Material.docx (79 kB)

PubMed ID

39692993

Language

English

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