Clinical Study Of Endovascular Embolization In The Treatment Of Internal Carotid Artery-posterior Communicating Segment Aneurysm With Oculomotor Nerve Palsy

Objective To investigate the surgical timing,technical key points,prognostic effect and related influencing factors of endovascular embolization for posterior communicating segment aneurysms of the internal carotid artery with oculomotor nerve palsy.Methods Clinical data of aneurysms treated by embolization in our hospital from January 2014 to June 2018 were retrospectively collected.All the patients were diagnosed with posterior communicating segment aneurysms of the internal carotid artery with oculomotor nerve palsy,and other factors causing oculomotor nerve palsy were excluded,such as: diabetes,trauma,syphilis infection,and so on.The relevant clinical data of all patients included in the study,including gender,age,first symptoms,time from onset to surgery,aneurysm location and morphology,embolization method,embolization immediate Raymond grading,postoperative mRs score,and recovery of oculomotor nerve palsy,were analyzed and studied.Results 42 cases of the patients were included in the study with a total of 48aneurysms(21 aneurysms on the left side,15 aneurysms on the right side,12 aneurysms on both sides),and the aneurysms,related to ONP,were unilateral,all of them were embolized,two other aneurysms which were not related to the symptoms of ONP were on the symmetric part,among them,one reached Raymond I embolism,the other one for Raymond II embolism.A total of 42 responsible aneurysms were embolized,and the immediate Raymond grading of embolization showed that 34 aneurysms were grade I,6 aneurysms were grade II,and 2 aneurysms were grade III.After 6-12 months follow-up,DSA reexaminationshowed that there were no coil displacement,aneurysm enlargement or stent stenosis in the original 42 responsible aneurysms,39 aneurysms were Raymond I and 3 aneurysms were Raymond II.Regarding the recovery of oculomotor nerve palsy,27 cases recovered completely and 15 cases partially.Follow-up prognostic mRs score: 0 point in 25 cases,1point in 3 cases,2 points in 12 cases,3 points in 2 cases.Single-factor analysis showed that Fisher grade,degree of embolism(Roymond grade),intraoperative cerebral vasospasm,and pulmonary embolism were correlated with overall prognosis(P < 0.05),and preoperative ONP degree,hypertension,Fisher's grade,embolism degree(Roymond grade),and surgical timing were correlated with postoperative recovery of oculomotor nerve palsy(P < 0.05).Then,multiple factor analysis was completed,suggesting that preoperative ONP degree was an independent influence on ONP recovery(P < 0.05).Conclusion Endovascular embolization for posterior communicating segment aneurysms of ICA with ONP is effective,with fewer postoperative complications and faster recovery,and the dysfunction of oculomotor nerve is largely recovered,and ONP with milder symptoms before the operation is more likely to achieve complete recovery.