RESUMO
BACKGROUND: Aneurysms of the posterior communicating segment of carotid artery (PcomA) have a high risk of rupture; when these nonruptured aneurysms are associated with oculomotor nerve palsy (ONP), the risk of rupture increases compared with asymptomatic nonruptured PcomA. OBJECTIVE: To retrospectively analyze the risk factors involved in ONP secondary to PcomA aneurysm and to study the factors involved in the recovery time of ONP once it is established. METHODS: This was a retrospective study of patients from 10 neurosurgery centers from October 2008 to December 2020. We analyzed age at diagnosis, presence of compressive neuropathy of the oculomotor nerve, presence of aneurysm rupture, largest aneurysm diameter, aneurysm projection, smoking, hypertension, diabetes, time between diagnosis and surgical treatment, as well as the outcome. RESULTS: Approximately 1 in 5 patients (119/511 23.3%) with a PcomA presented with ONP. We found that patients with aneurysms measuring greater than or equal to 7.5 mm were 1.6 times more likely to have ONP than those with aneurysms smaller than 7.5 mm. In our study, the prevalence of smoking in the PcomA + ONP group was 57.76%, and we also found that smokers were 2.51 times more likely to develop ONP. A total of 80.7% showed some degree of improvement, and 45.4% showed complete improvement with a median recovery time of 90 days. CONCLUSION: This study showed that 80.7% of patients with PcomA aneurysms undergoing surgical treatment with aneurysm clipping showed some degree of improvement of the ONP, with a median time to recovery between 90 and 120 days.
Assuntos
Aneurisma Roto , Procedimentos Endovasculares , Aneurisma Intracraniano , Doenças do Nervo Oculomotor , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/cirurgia , Estudos Retrospectivos , Doenças do Nervo Oculomotor/epidemiologia , Doenças do Nervo Oculomotor/cirurgia , Doenças do Nervo Oculomotor/complicações , Procedimentos Endovasculares/efeitos adversos , Aneurisma Roto/epidemiologia , Aneurisma Roto/cirurgia , Aneurisma Roto/complicações , Resultado do TratamentoRESUMO
Objective: to describe the incidence and the different etiologies of oculomotor palsy in neurosurgical patients. Methods: Hospital records from the last 3 years were retrospectively reviewed. Five formalin-fixed adults heads were examined using X6 to X40 magnification. A correlation between clinical findings, anatomical studies and MRI images was performed. Results: medical records from 382 patients operated on at our department were reviewed. Of these, 16 patients underwent complete oculomotor palsy before brain surgery. Two patients had a mesencephalic tumor, 6 patients underwent uncal herniation due to a fast-growing intracranial mass, one patient had a superior cerebellar artery aneurysm, 3 patients had a posterior communicating artery aneurysm, one patient had a cavernous sinus meningioma. An analysis of the clinical, anatomical and MRI/ angiography data of 5 cases are presented in this study. Conclusion: oculomotor palsy is a relatively common finding in neurosurgical practice. The fact that it can be caused by different etiologies should be considered in order to arrive to the appropiate diagnosis and treatment. Anatomical knowledge of third nerve is very important when dealing with oculomotor palsy (AU)