Objective: To compare the advantages in respect of recovery from oculomotor nerve paralysis(ONP) between endovascular coiling and surgical clipping in the treatment of cases with posterior communicating artery (PComA) aneurysms in China.
Methods: By retrieving PubMed, Cochrane Library, Embase, Chinese Biomedicine Database(CMB), Chinese National Knowledge Infrastructure(CNKI) and other domestic literature database, we collect relevant studies of cases in China from 2004 to 2015. Using Review Manager (RevMan) version 5.0 software, we perform a systematic review of literature and conduct meta-analysis.
Result: The meta-analysis included 12 related studies involving 712 Chinese patients with ONP secondary to PComA aneurysms, of whom 302(42.4%) were treated by endovascular coiling while 410(57.6%) received surgical clipping. Surgical clipping (298 of 410 patients, or 72.7%) resulted in greater complete recovery from ONP compared with endovascular coiling (151 of 302 patients, or 50.0%), in correspond to overall pooled odds ratio (OR) of 0.39 [confidence interval (CI) =0.19-0.83, P = 0.01]. The subgroup analysis reveal a significant benefit of surgical clipping over endovascular coiling in cases with preoperative ruptured aneurysms(P=0.01)or complete initial ONP(P=0.002).
Conclusion: Better resolution of ONP with PComA aneurysms is more commonly associated with clipping than coiling, which could be especially true in the patients with preoperative ruptured aneurysms or complete initial ONP. A randomized trial including more cases is expected to elaborate this effect.