PDF herunterladen
J Neurol Surg Rep 2014; 75(02): e230-e235
DOI: 10.1055/s-0034-1387187
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Case Report: A Troublesome Ophthalmic Artery Aneurysm

T. R. Meling
1   Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
,
W. Sorteberg
1   Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
,
S. J. Bakke
2   Department of Neuroradiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
,
E. A. Jacobsen
2   Department of Neuroradiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
,
P. Lane
3   Department of Ophthalmology, Oslo University Hospital, Ullevaal, Oslo, Norway
,
P. Vajkoczy
4   Department of Neurosurgery, Charité Universitätsmedizin Berlin, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

02. März 2014

09. Juni 2014

Publikationsdatum:
21. August 2014 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objective and Importance When treating large unruptured ophthalmic artery (OA) aneurysms causing progressive blindness, surgical clipping is still the preferred method because aneurysm sac decompression may relieve optic nerve compression. However, endovascular treatment of OA aneurysms has made important progress with the introduction of stents. Although this development is welcomed, it also makes the choice of treatment strategy less straightforward than in the past, with the potential of missteps.

Clinical Presentation A 56-year-old woman presented with a long history of progressive unilateral visual loss and magnetic resonance imaging showing a 20-mm left-sided OA aneurysm.

Intervention Because of her long history of very poor visual acuity, we considered her left eye to be irredeemable and opted for endovascular therapy. The OA aneurysms was treated with stent and coils but continued to grow, threatening the contralateral eye. Because she failed internal carotid artery (ICA) balloon test occlusion, we performed a high-flow extracranial-intracranial bypass with proximal ICA occlusion in the neck. However, aneurysm growth continued due to persistent circulation through reversed blood flow in distal ICA down to the OA and the cavernous portion of the ICA. Due to progressive loss of her right eye vision, we surgically occluded the ICA proximal to the posterior communicating artery and excised the coiled, now giant, OA aneurysm. This improved her right eye vision, but her left eye was permanently blind.

Conclusion This case report illustrates complications of the endovascular and surgical treatment of a large unruptured OA aneurysm.

Keywords

ophthalmic artery aneurysm - endovascular treatment - neurovascular surgery - complications
 

  • References

  • 1 Peris-Celda M, Da Roz L, Monroy-Sosa A, Morishita T, Rhoton Jr AL. Surgical anatomy of endoscope-assisted approaches to common aneurysm sites. Neurosurgery 2014; 10 (Suppl. 01) 121-144 ; discussion 144
    CrossrefPubMedGoogle Scholar
  • 2 Meling TR, Sorteberg A, Bakke SJ, Slettebø H, Hernesniemi J, Sorteberg W. Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. J Neurosurg 2008; 108 (4) 662-671
    CrossrefPubMedGoogle Scholar
  • 3 Day AL. Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 1990; 72 (5) 677-691
    CrossrefPubMedGoogle Scholar
  • 4 Yasargil MG, Gasser JC, Hodosh RM, Rankin TV. Carotid-ophthalmic aneurysms: direct microsurgical approach. Surg Neurol 1977; 8 (3) 155-165
    PubMedGoogle Scholar
  • 5 Debrun GM, Aletich VA, Kehrli P, Misra M, Ausman JI, Charbel F. Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 1998; 43 (6) 1281-1295 ; discussion 1296–1297
    PubMedGoogle Scholar
  • 6 de Oliveira JG, Borba LA, Rassi-Neto A , et al. Intracranial aneurysms presenting with mass effect over the anterior optic pathways: neurosurgical management and outcomes. Neurosurg Focus 2009; 26 (5) E3
    PubMedGoogle Scholar
  • 7 Tawk RG, Villalobos HJ, Levy EI, Hopkins LN. Surgical decompression and coil removal for the recovery of vision after coiling and proximal occlusion of a clinoidal segment aneurysm: technical case report. Neurosurgery 2006; 58 (6) E1217 ; discussion E1217
    CrossrefPubMedGoogle Scholar
  • 8 Fulkerson DH, Horner TG, Payner TD , et al. Results, outcomes, and follow-up of remnants in the treatment of ophthalmic aneurysms: a 16-year experience of a combined neurosurgical and endovascular team. Neurosurgery 2009; 64 (2) 218-229 ; discussion 229–230
    CrossrefPubMedGoogle Scholar
  • 9 Korosue K, Heros RC. “Subclinoid” carotid aneurysm with erosion of the anterior clinoid process and fatal intraoperative rupture. Neurosurgery 1992; 31 (2) 356-359 ; discussion 359–360
    CrossrefPubMedGoogle Scholar
  • 10 Kumon Y, Sakaki S, Kohno K, Ohta S, Ohue S, Oka Y. Asymptomatic, unruptured carotid-ophthalmic artery aneurysms: angiographical differentiation of each type, operative results, and indications. Surg Neurol 1997; 48 (5) 465-472
    CrossrefPubMedGoogle Scholar
  • 11 De Jesús O, Sekhar LN, Riedel CJ. Clinoid and paraclinoid aneurysms: surgical anatomy, operative techniques, and outcome. Surg Neurol 1999; 51 (5) 477-487 ; discussion 487–488
    CrossrefPubMedGoogle Scholar
  • 12 Fries G, Perneczky A, van Lindert E, Bahadori-Mortasawi F. Contralateral and ipsilateral microsurgical approaches to carotid-ophthalmic aneurysms. Neurosurgery 1997; 41 (2) 333-342 ; discussion 342–343
    CrossrefPubMedGoogle Scholar
  • 13 Guglielmi G. History of the genesis of detachable coils. A review. J Neurosurg 2009; 111 (1) 1-8
    CrossrefPubMedGoogle Scholar
  • 14 Heran NS, Song JK, Kupersmith MJ , et al. Large ophthalmic segment aneurysms with anterior optic pathway compression: assessment of anatomical and visual outcomes after endosaccular coil therapy. J Neurosurg 2007; 106 (6) 968-975
    CrossrefPubMedGoogle Scholar
  • 15 Park HK, Horowitz M, Jungreis C , et al. Endovascular treatment of paraclinoid aneurysms: experience with 73 patients. Neurosurgery 2003; 53 (1) 14-23 ; discussion 24
    CrossrefPubMedGoogle Scholar
  • 16 Urbach H, Tschampa H, Kovács A, Greschus S, Schramm J. The enterprise stent for the treatment of intracranial aneurysms: stenting strategies. Klin Neuroradiol 2009; 19 (3) 197-203
    CrossrefPubMedGoogle Scholar
  • 17 Mericle RA, Lanzino G, Wakhloo AK, Guterman LR, Hopkins LN. Stenting and secondary coiling of intracranial internal carotid artery aneurysm: technical case report. Neurosurgery 1998; 43 (5) 1229-1234
    CrossrefPubMedGoogle Scholar
  • 18 Drake CG. Giant intracranial aneurysms: experience with surgical treatment in 174 patients. Clin Neurosurg 1979; 26: 12-95
    CrossrefPubMedGoogle Scholar
  • 19 Ferguson GG, Drake CG. Carotid-ophthalmic aneurysms: visual abnormalities in 32 patients and the results of treatment. Surg Neurol 1981; 16 (1) 1-8
    CrossrefPubMedGoogle Scholar
  • 20 Heros RC, Nelson PB, Ojemann RG, Crowell RM, DeBrun G. Large and giant paraclinoid aneurysms: surgical techniques, complications, and results. Neurosurgery 1983; 12 (2) 153-163
    CrossrefPubMedGoogle Scholar
  • 21 Hosobuchi Y. Direct surgical treatment of giant intracranial aneurysms. J Neurosurg 1979; 51 (6) 743-756
    CrossrefPubMedGoogle Scholar
  • 22 Sundt Jr TM, Piepgras DG. Surgical approach to giant intracranial aneurysms. Operative experience with 80 cases. J Neurosurg 1979; 51 (6) 731-742
    CrossrefPubMedGoogle Scholar
  • 23 Almeida GM, Shibata MK, Bianco E. Carotid-ophthalmic aneurysms. Surg Neurol 1976; 5 (1) 41-45
    PubMedGoogle Scholar
  • 24 Kattner KA, Bailes J, Fukushima T. Direct surgical management of large bulbous and giant aneurysms involving the paraclinoid segment of the internal carotid artery: report of 29 cases. Surg Neurol 1998; 49 (5) 471-480
    CrossrefPubMedGoogle Scholar
  • 25 Nutik SL. Ventral paraclinoid carotid aneurysms. J Neurosurg 1988; 69 (3) 340-344
    CrossrefPubMedGoogle Scholar
  • 26 Nutik S. Carotid paraclinoid aneurysms with intradural origin and intracavernous location. J Neurosurg 1978; 48 (4) 526-533
    CrossrefPubMedGoogle Scholar
  • 27 Giannotta SL, McGillicuddy JE, Kindt GW. Gradual carotid artery occlusion in the treatment of inaccessible internal carotid artery aneurysms. Neurosurgery 1979; 5 (4) 417-421
    CrossrefPubMedGoogle Scholar
  • 28 Swearingen B, Heros RC. Common carotid occlusion for unclippable carotid aneurysms: an old but still effective operation. Neurosurgery 1987; 21 (3) 288-295
    CrossrefPubMedGoogle Scholar
  • 29 Fox AJ, Viñuela F, Pelz DM , et al. Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 1987; 66 (1) 40-46
    CrossrefPubMedGoogle Scholar
  • 30 Hodes JE, Aymard A, Gobin YP , et al. Endovascular occlusion of intracranial vessels for curative treatment of unclippable aneurysms: report of 16 cases. J Neurosurg 1991; 75 (5) 694-701
    CrossrefPubMedGoogle Scholar
  • 31 Fox JL. Microsurgical treatment of ventral (paraclinoid) internal carotid artery aneurysms. Neurosurgery 1988; 22 (1 Pt 1) 32-39
    PubMedGoogle Scholar
  • 32 Higashida RT, Halbach VV, Barnwell SL , et al. Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients. AJNR Am J Neuroradiol 1990; 11 (4) 633-640
    PubMedGoogle Scholar
  • 33 Higashida RT, Halbach VV, Hieshima GB, Weinstein PR, Hoyt WF. Treatment of a giant carotid ophthalmic artery aneurysm by intravascular balloon embolization therapy. Surg Neurol 1988; 30 (5) 382-386
    CrossrefPubMedGoogle Scholar
  • 34 Dowd CF, Halbach VV, Higashida RT, Barnwell SL, Hieshima GB. Endovascular coil embolization of unusual posterior inferior cerebellar artery aneurysms. Neurosurgery 1990; 27 (6) 954-961
    CrossrefPubMedGoogle Scholar
  • 35 Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 1991; 75 (1) 8-14
    CrossrefPubMedGoogle Scholar
  • 36 Litofsky NS, Viñuela F, Giannotta SL. Progressive visual loss after electrothrombosis treatment of a giant intracranial aneurysm: case report. Neurosurgery 1994; 34 (3) 548-550 ; discussion 551
    CrossrefPubMedGoogle Scholar
  • 37 Katayama S, Fujita K, Takeda N, Okamura Y. Stent graft placement for the treatment of giant aneurysm at the proximal cavernous internal carotid artery. A case report. Interv Neuroradiol 2006; 12 (Suppl. 01) 117-120
    PubMedGoogle Scholar
  • 38 Drake CG, Peerless SJ, Ferguson GG. Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation. J Neurosurg 1994; 81 (5) 656-665
    CrossrefPubMedGoogle Scholar
  • 39 Kothandaram P, Dawson BH, Kruyt RC. Carotid-ophthalmic aneurysms. A study of 19 patients. J Neurosurg 1971; 34 (4) 544-548
    CrossrefPubMedGoogle Scholar
  • 40 Larson JJ, Tew Jr JM, Tomsick TA, van Loveren HR. Treatment of aneurysms of the internal carotid artery by intravascular balloon occlusion: long-term follow-up of 58 patients. Neurosurgery 1995; 36 (1) 26-30 ; discussion 30
    PubMedGoogle Scholar
  • 41 Nishioka H. Results of the treatment of intracranial aneurysms by occlusion of the carotid artery in the neck. J Neurosurg 1966; 25 (6) 660-704
    CrossrefPubMedGoogle Scholar
  • 42 Samson DS, Boone S. Extracranial-intracranial (EC-IC) arterial bypass: past performance and current concepts. Neurosurgery 1978; 3 (1) 79-86
    CrossrefPubMedGoogle Scholar
  • 43 Streefkerk HJ, Wolfs JF, Sorteberg W, Sorteberg AG, Tulleken CA. The ELANA technique: constructing a high flow bypass using a non-occlusive anastomosis on the ICA and a conventional anastomosis on the SCA in the treatment of a fusiform giant basilar trunk aneurysm. Acta Neurochir (Wien) 2004; 146 (9) 1009-1019 ; discussion 1019
    PubMedGoogle Scholar
  • 44 Sorteberg W, Sorteberg A, Lindegaard KF, Boysen M, Nornes H. Transcranial Doppler ultrasonography-guided management of internal carotid artery closure. Neurosurgery 1999; 45 (1) 76-87 ; discussion 87–88
    CrossrefPubMedGoogle Scholar
  • 45 Gelber BR, Sundt Jr TM. Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass. J Neurosurg 1980; 52 (1) 1-10
    CrossrefPubMedGoogle Scholar
  • 46 Serbinenko FA, Filatov JM, Spallone A, Tchurilov MV, Lazarev VA. Management of giant intracranial ICA aneurysms with combined extracranial-intracranial anastomosis and endovascular occlusion. J Neurosurg 1990; 73 (1) 57-63
    CrossrefPubMedGoogle Scholar
  • 47 Romani R, Elsharkawy A, Laakso A, Kangasniemi M, Hernesniemi J. Tailored anterior clinoidectomy through the lateral supraorbital approach: experience with 82 consecutive patients. World Neurosurg 2012; 77 (3–4) 512-517
    CrossrefPubMedGoogle Scholar
  • 48 Mattingly T, Kole MK, Nicolle D, Boulton M, Pelz D, Lownie SP. Visual outcomes for surgical treatment of large and giant carotid ophthalmic segment aneurysms: a case series utilizing retrograde suction decompression (the “Dallas technique”). J Neurosurg 2013; 118 (5) 937-946
    CrossrefPubMedGoogle Scholar