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[PMID]:29212484
[Au] Autor:Chen L; Jiang L; Yang B; Subramanian PS
[Ad] Endereço:Department of Ophthalmology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan, China.
[Ti] Título:Clinical features of visual disturbances secondary to isolated sphenoid sinus inflammatory diseases.
[So] Source:BMC Ophthalmol;17(1):237, 2017 Dec 06.
[Is] ISSN:1471-2415
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Visual disturbances associated with isolated sphenoid sinus inflammatory diseases (ISSIDs) are easily misdiagnosed due to the nonspecific symptoms and undetectable anatomical location. The main objective of this retrospective case series is to investigate the clinical features of visual disturbances secondary to ISSIDs. METHODS: Clinical data of 23 patients with unilateral or bilateral visual disturbances secondary to ISSIDs from 2004 to 2014 with new symptoms were collected. Collected data including symptoms, signs, neuroimaging and pathologic diagnosis were analyzed. RESULTS: There were 14 males and 9 females, and their ages ranged from 31 to 83 years. Fifteen patients suffered blurred vision and 11 patients suffered binocular double vision, including 3 patients who had unilateral visual changes and diplopia simultaneously. Headache was observed in 18 patients, and orbit pain/ocular pain in 8 patients. Other presenting symptoms included ptosis (4 patients) and proptosis (1 patient). Only 5 patients had nasal complaints. The corrected visual acuities were between NLP to 20/20. Patients with diplopia included 5 with unilateral oculomotor nerve palsy and 6 with unilateral abducens nerve palsy. All patients performed orbital/sinus/brain radiologic examination and found responsible lesions in sphenoid sinus. All patients underwent endoscopic sinus surgery, and 9 patients were found to suffer sphenoid mucocele, 9 with fungal sinusitis, and 5 with sphenoid sinusitis. Visual disturbances improved in 6 patients, and all the patients with diplopia had a postoperative recovery. CONCLUSION: Visual disturbances resulting from ISSIDs are relatively uncommon, but it is crucial that the patient with new vision loss or diplopia and persistent headache or orbit pain be evaluated for the possibility of ISSIDs especially before corticosteroid administration.
[Mh] Termos MeSH primário: Doenças dos Seios Paranasais/complicações
Seio Esfenoidal
Transtornos da Visão/etiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Dor Ocular/etiologia
Feminino
Cefaleia/etiologia
Seres Humanos
Masculino
Meia-Idade
Doenças do Nervo Oculomotor/etiologia
Doenças dos Seios Paranasais/patologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1186/s12886-017-0634-9


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[PMID]:29230265
[Au] Autor:Maneh N; Apetse K; Diatewa BM; Domingo SA; Agba AI; Ayena KD; Balogou KA; Balo KP
[Ad] Endereço:Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.
[Ti] Título:[Juvenile myasthenia gravis in sub-Saharan Africa: a case study of two consanguine sisters born from consanguinity in Togo].
[Ti] Título:Myasthénie juvénile oculaire en Afrique Subsaharienne: cas de deux sÅ“urs germaines issues d'un mariage consanguin au Togo..
[So] Source:Pan Afr Med J;28:63, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:fre
[Ab] Resumo:Myasthenia gravis is a rare acquired autoimmune pathology causing neuromuscular transmission impairment. Juvenile onset of myasthenia gravis is often characterized by ocular involvement. We report two cases of ocular juvenile myasthenia gravis (JMG) in two siblings. They were two young girls, XA and XB, aged 11 and 9 years, of Malian origin, residing in Togo, born from first-degree of consanguinity presenting to Ophthalmology due to progressive decrease in visual acuity. XA showed visual acuity 8/10 on both eyes while XB showed improvement in visual acuity from 3/10 to 7/10 using a pinhole occluder, suggesting ametropia. XA had a 2-year history of bilateral ptosis lifting the upper eyelid of 7 mm, while XB had a 3-year history of bilateral ptosis with no lifting of the upper eyelid. Ice pack test was strongly positive in both patients. They had Cogan's lid twitch with paresis of the oculomotor nerve without diplopia. The dosage of acetylcholine receptor autoantibodies was normal. The diagnosis of JMG associated with ametropia was suspected. Ametropia was corrected by glasses and a specific treatment with pyridostigmine was initiated, but both patients were lost to follow-up. Autoimmune myasthenia gravis with inaugural ophthalmologic manifestation is rare but it can occur among children living in sub-Saharan Africa. Studies should be conducted to establish the features of this disease.
[Mh] Termos MeSH primário: Miastenia Gravis/diagnóstico
Doenças do Nervo Oculomotor/etiologia
Erros de Refração/etiologia
Acuidade Visual
[Mh] Termos MeSH secundário: Idade de Início
Criança
Consanguinidade
Progressão da Doença
Feminino
Seres Humanos
Perda de Seguimento
Miastenia Gravis/complicações
Miastenia Gravis/imunologia
Brometo de Piridostigmina/administração & dosagem
Togo
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
KVI301NA53 (Pyridostigmine Bromide)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.28.63.13709


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[PMID]:28387548
[Au] Autor:Kontos AP; Deitrick JM; Collins MW; Mucha A
[Ad] Endereço:UPMC Sports Medicine Concussion Program/Department of Orthopaedic Surgery and.
[Ti] Título:Review of Vestibular and Oculomotor Screening and Concussion Rehabilitation.
[So] Source:J Athl Train;52(3):256-261, 2017 Mar.
[Is] ISSN:1938-162X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Vestibular and oculomotor impairment and symptoms may be associated with worse outcomes after sport-related concussion (SRC), including prolonged recovery. In this review, we evaluate current findings on vestibular and oculomotor impairments as well as treatment approaches after SRC, and we highlight areas in which investigation is needed. Clinical researchers have intimated that recovery from SRC may follow certain clinical profiles that affect the vestibular and oculomotor pathways. Identifying clinical profiles may help to inform better treatment and earlier intervention to reduce recovery time after SRC. As such, screening for and subsequent monitoring of vestibular and oculomotor impairment and symptoms are critical to assessing and informing subsequent referral, treatment, and return to play. However, until recently, no brief-screening vestibular and oculomotor tools were available to evaluate this injury. In response, researchers and clinicians partnered to develop the Vestibular/Ocular-Motor Screening, which assesses pursuits, saccades, vestibular ocular reflex, visual motion sensitivity, and convergence via symptom provocation and measurement of near-point convergence. Other specialized tools, such as the King-Devick test for saccadic eye movements and the Dizziness Handicap Inventory for dizziness, may provide additional information regarding specific impairments and symptoms. Tools such as the Vestibular/Ocular-Motor Screening provide information to guide specialized referrals for additional assessment and targeted rehabilitation. Vestibular rehabilitation and visual-oculomotor therapies involve an active, expose-recover approach to reduce impairment and symptoms. Initial results support the effectiveness of both vestibular and visual-oculomotor therapies, especially those that target specific impairments. However, the evidence supporting rehabilitation strategies for both vestibular and oculomotor impairment and symptoms is limited and involves small sample sizes, combined therapies, nonrandomized treatment groups, and lack of controls. Additional studies on the effectiveness of screening tools and rehabilitation strategies for both vestibular and oculomotor impairment and symptoms after SRC are warranted.
[Mh] Termos MeSH primário: Traumatismos em Atletas/complicações
Concussão Encefálica/complicações
Doenças do Nervo Oculomotor/etiologia
Doenças Vestibulares/etiologia
[Mh] Termos MeSH secundário: Traumatismos em Atletas/diagnóstico
Traumatismos em Atletas/reabilitação
Concussão Encefálica/diagnóstico
Concussão Encefálica/reabilitação
Diagnóstico Precoce
Feminino
Seres Humanos
Masculino
Doenças do Nervo Oculomotor/diagnóstico
Doenças do Nervo Oculomotor/reabilitação
Síndrome Pós-Concussão/complicações
Síndrome Pós-Concussão/diagnóstico
Síndrome Pós-Concussão/reabilitação
Volta ao Esporte/fisiologia
Esportes/fisiologia
Doenças Vestibulares/diagnóstico
Doenças Vestibulares/reabilitação
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170408
[St] Status:MEDLINE
[do] DOI:10.4085/1062-6050-51.11.05


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[PMID]:28385301
[Au] Autor:Brodsky MC
[Ad] Endereço:Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota. Electronic address: brodsky.michael@mayo.edu.
[Ti] Título:Marshall M. Parks Memorial Lecture: Ocular Motor Misbehavior in Children: Where Neuro-Ophthalmology Meets Strabismus.
[So] Source:Ophthalmology;124(6):835-842, 2017 Jun.
[Is] ISSN:1549-4713
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Clinical diagnosis has been supplemented by neuroimaging advances, genetic discoveries, and molecular research to generate new neurobiological discoveries pertaining to early maldevelopment of ocular motor control systems. In this focused review, I examine recent paradigm shifts that have transformed our understanding of pediatric ocular motor disease at the prenuclear and infranuclear levels. The pathogenesis of complex ocular motor disorders, such as paradoxical pupillary constriction to darkness, benign tonic upgaze of infancy, congenital fibrosis syndrome, and the constellation of unique eye movements that accompany Joubert syndrome, are elucidated.
[Mh] Termos MeSH primário: Músculos Oculomotores/inervação
Doenças do Nervo Oculomotor/diagnóstico
Estrabismo/diagnóstico
[Mh] Termos MeSH secundário: Criança
Movimentos Oculares/fisiologia
Seres Humanos
Lactente
Imagem por Ressonância Magnética
Transtornos da Motilidade Ocular/diagnóstico
Transtornos da Motilidade Ocular/fisiopatologia
Doenças do Nervo Oculomotor/fisiopatologia
Oftalmologia
Estrabismo/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; LECTURES; REVIEW
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170408
[St] Status:MEDLINE


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[PMID]:28373616
[Au] Autor:Yokosako S; Kikkawa Y; Takeda R; Ikeda T; Kurita H
[Ad] Endereço:Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center.
[Ti] Título:Oculomotor Nerve Palsy in a Patient with a Ruptured Middle Cerebral Artery Aneurysm.
[So] Source:J Med Invest;64(1.2):165-167, 2017.
[Is] ISSN:1349-6867
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:We describe a case of acute oculomotor nerve palsy caused by a ruptured middle cerebral artery (MCA) aneurysm. A 59-year-old female presenting with headache and nausea was admitted to our hospital. Her consciousness was alert, and had no other neurological deficit without left oculomotor nerve palsy. A computed tomography (CT) showed SAH extending from left sylvian cistern to basal cistern. CT angiography revealed a left MCA aneurysm which protruded toward internal carotid artery. The patient was successfully treated with surgical clipping. The oculomotor nerve palsy resolved immediately after the surgery. Perioperative radiological evaluation revealed that there were no evidence of midbrain hemorrhage or stroke, vessel anomaly of basilar, posterior cerebral or superior cerebellar artery, vasospasm, and uncal herniation. Furthermore, intraoperative findings revealed that the aneurysm was projected toward the affected carotid cistern and oculomotor nerve. From these findings and time course of oculomotor nerve palsy, it is suggested that the jet flow of bleeding from the ruptured MCA aneurysm caused oculomotor nerve palsy in the patient. J. Med. Invest. 64: 165-167, February, 2017.
[Mh] Termos MeSH primário: Aneurisma Roto/complicações
Aneurisma Intracraniano/complicações
Doenças do Nervo Oculomotor/etiologia
[Mh] Termos MeSH secundário: Aneurisma Roto/diagnóstico por imagem
Aneurisma Roto/cirurgia
Angiografia por Tomografia Computadorizada
Feminino
Seres Humanos
Imagem Tridimensional
Aneurisma Intracraniano/diagnóstico por imagem
Aneurisma Intracraniano/cirurgia
Meia-Idade
Doenças do Nervo Oculomotor/diagnóstico por imagem
Ruptura Espontânea
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.2152/jmi.64.165


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[PMID]:28176404
[Au] Autor:Tetas Pont R; Freeman C; Dennis R; Hartley C; Beltran E
[Ad] Endereço:Comparative Ophthalmology Unit, Animal Health Trust, Lanwades Park, Kentford CB8 7UU, UK.
[Ti] Título:CLINICAL AND MAGNETIC RESONANCE IMAGING FEATURES OF IDIOPATHIC OCULOMOTOR NEUROPATHY IN 14 DOGS.
[So] Source:Vet Radiol Ultrasound;58(3):334-343, 2017 May.
[Is] ISSN:1740-8261
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Ophthalmoplegia/ophthalmoparesis (internal, external, or both) has been reported in dogs secondary to neoplasia affecting the oculomotor nerve and is usually given a poor prognosis. The purpose of this retrospective study was to describe the clinical findings, magnetic resonance imaging (MRI) findings, management, outcome, and follow-up in a group of canine cases with idiopathic oculomotor neuropathy. Inclusion criteria included cases with ophthalmoplegia/ophthalmoparesis (internal, external or both) as sole neuroophthalmologic signs, complete ophthalmic and neurologic examination, head MRI, and a minimum follow-up period of 1 year. Dogs with progressive neurological signs not related to oculomotor neuropathy were excluded. Fourteen cases met the inclusion criteria. All cases were unilaterally affected. Magnetic resonance imaging showed equivocal enlargement of the oculomotor nerve in three cases, mild enlargement in five, and marked enlargement in six. Contrast enhancement was present in 12 cases, being marked in six. When present, the contrast enhancement was focal in eight cases and diffuse in four. The median follow-up time was 25 months. External ophthalmoparesis improved in seven cases, five cases under no treatment and two under systemic corticosteroid therapy. The clinical signs in the other seven cases remained unchanged. Idiopathic oculomotor neuropathy should be included as a differential diagnosis in dogs presenting with unilateral ophthalmoplegia/ophthalmoparesis (internal, external, or both) with the absence of other neurologic and ophthalmic signs, and with the MRI findings restricted to the oculomotor nerve. Idiopathic oculomotor neuropathy has a good prognosis as the clinical signs do not deteriorate and they can improve without treatment.
[Mh] Termos MeSH primário: Doenças do Cão/diagnóstico por imagem
Doenças do Nervo Oculomotor/veterinária
Oftalmoplegia/veterinária
[Mh] Termos MeSH secundário: Animais
Diagnóstico Diferencial
Cães
Feminino
Imagem por Ressonância Magnética/veterinária
Masculino
Doenças do Nervo Oculomotor/diagnóstico por imagem
Oftalmoplegia/diagnóstico por imagem
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171027
[Lr] Data última revisão:
171027
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170209
[St] Status:MEDLINE
[do] DOI:10.1111/vru.12478


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[PMID]:28165559
[Au] Autor:Gao G; Gu DQ; Zhang Y; Yu J; Chen Y; Chao YJ; Wei JJ; Fu XM; Niu CS
[Ad] Endereço:Shandong University, Jinan, Shandong, China. lkkfi170@sina.com.
[Ti] Título:Comparison of the efficacy of surgical clipping and embolization for oculomotor nerve palsy due to a posterior communicating artery aneurysm.
[So] Source:Eur Rev Med Pharmacol Sci;21(2):292-296, 2017 Jan.
[Is] ISSN:2284-0729
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To aim at the efficacies of surgical clipping and endovascular embolization for oculomotor nerve palsy (ONP) as treatments for posterior communicating artery aneurysm (PcoAA), and the comparison and various influencing factors of the treatments. PATIENTS AND METHODS: An analysis of the clinical data of 52 enrolled PcoAA patients with ONP who had treatment in the Department of Neurosurgery in Anhui Provincial Hospital from January 2011 to June 2015 was conducted. There were 23 patients among a total underwent surgical clippings and others 29 patients received endovascular embolization treatment. Then, the age, gender, aneurysm size and rupture status, onset duration, preoperative ONP severity and postoperative recovery degree of ONP of patients in the two groups were compared. RESULTS: The final ONP outcomes of the 52 PcoAA patients consisted of 27 full recovery patients (51.9%), 21 partial recovery patients (40.4%), and 4 no recovery patients (7.7%). (1) Within the 23 patients in the surgical clipping group, subarachnoid hemorrhage (SAH) occurred in 16 patients, and no SAH occurrence in the other 7 patients; the final ONP evaluation showed 18 patients fully recovered (78.3%) and 5 patients partially recovered (21.7%). Within the 29 patients in the endovascular embolization group, SAH occurred in 18 patients, and no SAH occurrence in the other 11 patients; the final ONP evaluation showed 9 patients fully recovered (31%), 16 patients partially recovered in 16 patients (55.2%) and 4 no recovery patients (13.8%). (2) The postoperative ONP recovery was analyzed with multivariate logistic regression, and the treatment method was an independent factor for ONP recovery (OR = 0.041, 95% CI: 0.007-0.261, p < 0.01). CONCLUSIONS: When compared with the endovascular embolization, the surgical clipping showed a better efficacy in the recovery from PcoAA related ONP.
[Mh] Termos MeSH primário: Embolização Terapêutica
Aneurisma Intracraniano/cirurgia
Doenças do Nervo Oculomotor/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Paralisia/fisiopatologia
Recuperação de Função Fisiológica
Estudos Retrospectivos
Hemorragia Subaracnóidea
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170724
[Lr] Data última revisão:
170724
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170207
[St] Status:MEDLINE


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[PMID]:28153623
[Au] Autor:Jacquesson T; Frindel C; Cotton F
[Ad] Endereço:Department of Neurosurgery B, Skull Base Multi-disciplinary Unit, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; Department of Anatomy, University of Lyon 1, Lyon, France; CREATIS Laboratory, CNRS UMR 5220 - INSERM U1044, Villeurbanne, France. Electronic address: timothee.jacquesson@neurochirurgie.fr.
[Ti] Título:Diffusion Tensor Imaging Tractography Detecting Isolated Oculomotor Nerve Damage After Traumatic Brain Injury.
[So] Source:World Neurosurg;100:707.e5-707.e7, 2017 Apr.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A 24-year-old woman was hit by a bus and suffered an isolated complete oculomotor nerve palsy. Computed tomography scan did not show a skull base fracture. T2*-weighted magnetic resonance imaging revealed petechial cerebral hemorrhages sparing the brainstem. T2 constructive interference in steady state suggested a partial sectioning of the left oculomotor nerve just before entering the superior orbital fissure. Diffusion tensor imaging fiber tractography confirmed a sharp arrest of the left oculomotor nerve. This recent imaging technique could be of interest to assess white fiber damage and help make a diagnosis or prognosis.
[Mh] Termos MeSH primário: Lesões Encefálicas Traumáticas/complicações
Lesões Encefálicas Traumáticas/diagnóstico por imagem
Imagem de Tensor de Difusão
Traumatismos do Nervo Oculomotor/complicações
Traumatismos do Nervo Oculomotor/diagnóstico por imagem
Nervo Oculomotor/diagnóstico por imagem
[Mh] Termos MeSH secundário: Acidentes de Trânsito
Diagnóstico Diferencial
Imagem de Difusão por Ressonância Magnética
Feminino
Seres Humanos
Doenças do Nervo Oculomotor/diagnóstico por imagem
Doenças do Nervo Oculomotor/etiologia
Tomografia Computadorizada por Raios X
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170204
[St] Status:MEDLINE


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[PMID]:28152321
[Au] Autor:Agarwal R; Kanaujia V; Mishra P; Phadke RV; Sharma K
[Ad] Endereço:a Department of Ophthalmology , Sanjay Gandhi Post Graduate Institute of Medical Sciences , Lucknow , India.
[Ti] Título:A case report of rim enhancing lesion at the orbital apex.
[So] Source:Orbit;36(1):27-29, 2017 Feb.
[Is] ISSN:1744-5108
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:We report a case of partial third nerve palsy resulting from a cystic lesion located at the orbital apex. Imaging was suggestive of cystic schwanomma but histopathology of the lesion confirmed epidermoid cyst, which is a rare tumour of the orbit.
[Mh] Termos MeSH primário: Cisto Epidérmico/diagnóstico
Doenças Orbitárias/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Cisto Epidérmico/fisiopatologia
Cisto Epidérmico/cirurgia
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Doenças do Nervo Oculomotor/diagnóstico
Doenças do Nervo Oculomotor/fisiopatologia
Procedimentos Cirúrgicos Oftalmológicos
Doenças Orbitárias/fisiopatologia
Doenças Orbitárias/cirurgia
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170203
[St] Status:MEDLINE
[do] DOI:10.1080/01676830.2017.1279644


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[PMID]:28006728
[Au] Autor:Zheng F; Dong Y; Xia P; Mpotsaris A; Stavrinou P; Brinker G; Goldbrunner R; Krischek B
[Ad] Endereço:Department of Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany.
[Ti] Título:Is clipping better than coiling in the treatment of patients with oculomotor nerve palsies induced by posterior communicating artery aneurysms? A systematic review and meta-analysis.
[So] Source:Clin Neurol Neurosurg;153:20-26, 2017 Feb.
[Is] ISSN:1872-6968
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Posterior communicating artery aneurysms (PcomAAs) are the second most common aneurysm, accounting for 25% of all aneurysms and 50% of internal carotid artery aneurysms. It has been estimated that oculomotor nerve palsy (ONP) occurs in up to one-third of patients with posterior communicating artery (PcomA) aneurysms. Recent research showed a better outcome of ONP in patients with PcomAA after surgical clipping when compared to endovascular coiling. We compared the effect of clipping and coiling on recovery of ONP in the management of patients with PcomAAs. METHODS: A meta-analysis of studies that compared surgical clipping with endovascular coiling was conducted by searching the literature via Pubmed, Embase and Cochrane Library databases without restricting the publication year. We extracted the following information: author names and publication year; clinical outcome (number of complete and incomplete recovery of ONP); perioperative data (number of pre-operatively complete or incomplete ONP, subarachnoid hemorrhage or not, number of complications (hydrocephalus, recurrence of PcomAA)). Except for author names and publication year, the data was pooled to perform a mean effect size estimate. The effects of two treatment modalities were then analyzed. RESULTS: Nine published reports of eligible studies involving 297 participants met the inclusion criteria. Overall, compared with endovascular coiling, surgical clipping had no statistically significant difference on the complete recovery of ONP, although there was an obvious trend in favor of clipping [RR=1.48, 95%CI (0.95, 2.29), p=0.08]. There was no significant difference in the total efficiency (any degree of change) on ONP [RR=1.08, 95%CI (0.94, 1.25), p>0.05], the overall complications [RR=0.60, 95%CI (0.33, 1.10), p>0.05], the efficacy on the complete recovery of ONP in patients without SAH [RR=0.83, 95%CI (0.53, 1.31), p>0.05], the effect on the complete recovery of ONP in patients with pre-operatively complete or incomplete ONP [RR=1.12, 95%CI (0.68, 1.85), p>0.05], [RR=1.12, 95%CI (0.79, 1.59), p>0.05]. In a comparison of a small cohort of patients that had suffered an SAH (17 vs. 22) there was a significant difference on the effect on complete recovery of ONP between clipping and coiling [RR=1.70, 95%CI (1.08, 2.67), p<0.05]. CONCLUSIONS: A superiority of clipping over coiling for the complete recovery of oculomotor nerve palsy in patients that had suffered an SAH from a ruptured aneurysm of the posterior communicating artery was found in the present meta-analysis. Limited by the relatively small sample sizes included, there were no significant differences observed in the clinical outcome between coiling and clipping in the treatment of unruptured PcomAA causing ONP. More evidence from advanced multi-center studies of large scale is needed to provide insight into the optimal treatment for outcome of ONP caused by PcomAAs.
[Mh] Termos MeSH primário: Aneurisma Roto/terapia
Procedimentos Endovasculares/normas
Aneurisma Intracraniano/terapia
Procedimentos Neurocirúrgicos/normas
Doenças do Nervo Oculomotor/terapia
Avaliação de Resultados (Cuidados de Saúde)
[Mh] Termos MeSH secundário: Aneurisma Roto/complicações
Seres Humanos
Aneurisma Intracraniano/complicações
Doenças do Nervo Oculomotor/etiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161223
[St] Status:MEDLINE



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