Journal Article

E-057 Among patients with posterior communicating artery aneurysms and oculomotor nerve palsy, early microsurgery is associated with a more rapid cranial palsy resolution, while endovascular approaches yield comparable recovery rates in the long term: a systematic review and meta-analysis

Orscelik, A, Elawady, S, Sowlat, M, Abo Kasem, R, Musmar, B, Matsukawa, H, Cunningham, C, Spiotta, A

2024

Overview

BackgroundMany studies have compared microsurgery with endovascular treatment (EVT) regarding favorable oculomotor nerve palsy (ONP) recovery outcomes in cases associated with posterior communicating artery (PComA) aneurysms. however there is no consensus on the optimum treatment and time course of recovery outcomes of ONP, Thus, this meta-analysis aimed to compare the PComA-associated ONP recovery rates in the short term and long term.MethodsA systematic review and meta-analysis were conducted by searching PubMed, Embase, Scopus, and Web of Science databases. The extracted data included patient demographics, details on treatment modalities and timing, and characteristics of PComA aneurysms ONP caused by 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).ResultsA total of 40 studies met the inclusion criteria. According to the meta-analysis of follow-up results, microsurgery was associated with higher rates of favorable ONP recovery outcomes at 1 month (0.53 vs 0.17, P <0.01), 3 months (0.69 vs 0.33, P<0.01), 6 months (0.79 vs 0.48, P<0.01), and 12 months follow-up (0.90 vs 0.64), after 12 months, comparable recovery outcomes were identified [18 months: (0.87 vs 0.64, P-value = 0.36); ≥24 months: (0.86 vs 0.72 P-Value = 0.26)] and among patients ≥ 60 years, early treatment, ≤ 7 mm aneurysms, ruptured aneurysms, and partial ONP at presentation.ConclusionMicrosurgery demonstrates better recovery of ONP within the first 12 months when compared to EVT. Nevertheless, prolonged follow-up reveals comparable favorable ONP recovery outcomes between microsurgery and EVT over the extended term. These results imply the necessity for tailoring treatment selection by assessing the risks and advantages on an individual basis, considering both short-term and long-term outcomes.Abstract E-057 Figure 1Disclosures R. Abo Kasem: None. H. Matsukawa: None. S. Elawady: None. C. Cunningham: None. A. Orscelik: None. B. Musmar: None. M. Sowlat: None. A. Spiotta: None.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Aneurysms / Meta-analysis / Microsurgery / Neurological disorders / SNIS 21st annual meeting electronic poster abstracts / Systematic review