Upper basilar artery aneurysms: Oculomotor outcomes in 163 cases

Hisham Al-Khayat, Haitham Al-Khayat, Jonathan White, David Manner, Duke Samson

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Object. The purpose of this study was to identify factors predictive of postoperative oculomotor nerve palsy among patients who undergo surgery for distal basilar artery (BA) aneurysms. The data can be used to estimate preoperative risk in this population. The natural history of oculomotor nerve palsy in patients with good outcomes is also defined. Methods. The cases of 163 patients with distal BA aneurysms, who were treated surgically between 1996 and 2002, were retrospectively studied to identify factors contributing to oculomotor nerve palsy. After the data had been collected, stepwise logistic regression procedures were used to determine the predictive effects of each variable on the development of oculomotor nerve palsy and to create a scoring system. Factors that interfered with resolution of oculomotor dysfunction in patients with good outcomes were also studied. Postoperative oculomotor nerve palsy occurred in 86 patients (52.8%) with distal BA aneurysms. The following factors were associated with postoperative oculomotor dysfunction, as determined by a categorical data analysis: 1) younger patient age (p < 0.001); 2) poor admission Hunt and Hess grade (p < 0.001); 3) use of temporary arterial occlusion (p < 0.001); 4) poor Glasgow Outcome Scale score (p < 0.001); and 5) the presence of a BA apex aneurysm that projected posteriorly (p < 0.001). For patients with good outcomes, postoperative oculomotor nerve palsy resolved completely within 3 months in 31 patients (52%) and within 6 months in 47 patients (80%). The projection of the BA aneurysm was associated with incomplete oculomotor recovery at 6 months postoperatively (p = 0.019). Conclusions. The results of this study can help identify patients with a high risk for the development of oculomotor nerve palsy. This may help neurosurgeons in preoperative planning and discussions.

Original languageEnglish (US)
Pages (from-to)482-488
Number of pages7
JournalJournal of Neurosurgery
Volume102
Issue number3
DOIs
StatePublished - Mar 2005

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Intracranial Aneurysm
Oculomotor Nerve Diseases
Glasgow Outcome Scale
Logistic Models

Keywords

  • Basilar artery aneurysm
  • Oculomotor nerve palsy
  • Posterior cerebral artery
  • Subarachnoid hemorrhage
  • Superior cerebellar artery

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Upper basilar artery aneurysms : Oculomotor outcomes in 163 cases. / Al-Khayat, Hisham; Al-Khayat, Haitham; White, Jonathan; Manner, David; Samson, Duke.

In: Journal of Neurosurgery, Vol. 102, No. 3, 03.2005, p. 482-488.

Research output: Contribution to journalArticle

Al-Khayat, Hisham ; Al-Khayat, Haitham ; White, Jonathan ; Manner, David ; Samson, Duke. / Upper basilar artery aneurysms : Oculomotor outcomes in 163 cases. In: Journal of Neurosurgery. 2005 ; Vol. 102, No. 3. pp. 482-488.
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abstract = "Object. The purpose of this study was to identify factors predictive of postoperative oculomotor nerve palsy among patients who undergo surgery for distal basilar artery (BA) aneurysms. The data can be used to estimate preoperative risk in this population. The natural history of oculomotor nerve palsy in patients with good outcomes is also defined. Methods. The cases of 163 patients with distal BA aneurysms, who were treated surgically between 1996 and 2002, were retrospectively studied to identify factors contributing to oculomotor nerve palsy. After the data had been collected, stepwise logistic regression procedures were used to determine the predictive effects of each variable on the development of oculomotor nerve palsy and to create a scoring system. Factors that interfered with resolution of oculomotor dysfunction in patients with good outcomes were also studied. Postoperative oculomotor nerve palsy occurred in 86 patients (52.8{\%}) with distal BA aneurysms. The following factors were associated with postoperative oculomotor dysfunction, as determined by a categorical data analysis: 1) younger patient age (p < 0.001); 2) poor admission Hunt and Hess grade (p < 0.001); 3) use of temporary arterial occlusion (p < 0.001); 4) poor Glasgow Outcome Scale score (p < 0.001); and 5) the presence of a BA apex aneurysm that projected posteriorly (p < 0.001). For patients with good outcomes, postoperative oculomotor nerve palsy resolved completely within 3 months in 31 patients (52{\%}) and within 6 months in 47 patients (80{\%}). The projection of the BA aneurysm was associated with incomplete oculomotor recovery at 6 months postoperatively (p = 0.019). Conclusions. The results of this study can help identify patients with a high risk for the development of oculomotor nerve palsy. This may help neurosurgeons in preoperative planning and discussions.",
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