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Review
. 2021 Aug;11(8):e2263.
doi: 10.1002/brb3.2263. Epub 2021 Jun 21.

Clipping versus coiling for the treatment of oculomotor nerve palsy induced by posterior communicating artery aneurysms: A comparison of effectiveness

Zidong Wang  1 , Xiaokui Kang  1 , Qingdong Wang  2
Affiliations
Review

Clipping versus coiling for the treatment of oculomotor nerve palsy induced by posterior communicating artery aneurysms: A comparison of effectiveness

Zidong Wang et al. Brain Behav. 2021 Aug.

Abstract

Background: A long debate has been going on in the clinical effectiveness to determine whether surgical clipping or coiling more favorable for oculomotor nerve palsy (ONP) caused by PcomAA. We aimed to perform a study, focusing on the effectiveness of ONP induced by PcomAA after treatment of surgical clipping and endovascular coiling.

Method: Potential studies were searched on PubMed, EMBASE, Web of Science, and Cochrane Library from database inception to February 2021, and STATA version 12.0 was exerted to process the pooled data.

Results: A total of 16 articles are included in the study, hailing from the United States, South Korea, the United Kingdom, France, Germany, Korea, China, Japan, Britain, and Singapore. The results showed that the clipping group was related to a higher incidence of complete ONP recovery at follow-up (OR = 5.808, 95% CI 2.87 to 11.76, p < 0.001), the lower rates of partial ONP recovery (OR = 0.264, 95% CI 0.173 to 0.402, p < .001) and no improvement of ONP at follow-up (RD = -0.149, 95% CI -0.247 to -0.051, p = .003). In the subgroup of complete ONP recovery based on the condition of patients, clipping was associated with a higher incidence of complete ONP recovery in patients with the incomplete initial ONP (OR = 3.579, p = .020) and ruptured aneurysm (OR = 5.38, p = .020). Regarding the subgroup of complete ONP recovery based on the quality of studies, similar results also appeared.

Conclusion: Surgical clipping was more favorable to the recovery from ONP caused by PcomAA endovascular coiling due to a higher rate of recovery and recovery degree of ONP. Besides that, more evidence-based performance is necessary to supplement this opinion.

Keywords: clip; coil; oculomotor nerve palsy; posterior communicating artery aneurysms.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study selection process
FIGURE 2
FIGURE 2
Forest plot of the odds ratio of the complete oculomotor nerve palsy recovery
FIGURE 3
FIGURE 3
Forest plot of the odds ratio of the partial oculomotor nerve palsy recovery
FIGURE 4
FIGURE 4
Forest plot of the rate differences of no oculomotor nerve palsy improvement
FIGURE 5
FIGURE 5
Forest plot of the odds ratio of the complete oculomotor nerve palsy recovery in patients with a ruptured aneurysm
FIGURE 6
FIGURE 6
Forest plot of the odds ratio of the complete oculomotor nerve palsy recovery in patients with complete initial ONP
See this image and copyright information in PMC

References

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