Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0037-1598116
Direct Surgery of Previously Coiled Large Internal Carotid Ophthalmic Aneurysm for the Purpose of Optic Nerve Decompression
Publication History
23 September 2016
21 December 2016
Publication Date:
17 February 2017 (online)
![](https://www.thieme-connect.de/media/jnlsr/201701/lookinside/thumbnails/10-1055-s-0037-1598116_160043-1.jpg)
Abstract
Background Progressive visual loss after coil embolization of a large internal carotid ophthalmic aneurysm has been widely reported. It is generally accepted that the primary strategy for this complication should be conservative, including steroid therapy; however, it is not well known as to what approach to take when the conservative therapy is not effective.
Case Presentation We report a case of a 55-year-old female presenting with progressive visual loss after the coiling of a ruptured large internal carotid ophthalmic aneurysm. As the conservative therapy had not been effective, we performed neck clipping of the aneurysm with optic canal unroofing, anterior clinoidectomy, and partial removal of the embolized coils for the purpose of optic nerve decompression. After the surgery, the visual symptom was improved markedly.
Conclusions It is suggested that direct surgery for the purpose of optic nerve decompression may be one of the options when conservative therapy is not effective for progressive visual disturbance after coil embolization.
-
References
- 1 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 (05) 471-480
- 2 Beretta F, Andaluz N, Zuccarello M. Aneurysms of the ophthalmic (C6) segment of the internal carotid artery: treatment options and strategies based on a clinical series. J Neurosurg Sci 2004; 48 (04) 149-156
- 3 Hoh BL, Carter BS, Budzik RF, Putman CM, Ogilvy CS. Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team. Neurosurgery 2001; 48 (01) 78-89 , discussion 89–90
- 4 Iihara K, Murao K, Sakai N. , et al. Unruptured paraclinoid aneurysms: a management strategy. J Neurosurg 2003; 99 (02) 241-247
- 5 Kanagalingam S, Gailloud P, Tamargo RJ, Subramanian PS, Miller NR. Visual sequelae after consensus-based treatment of ophthalmic artery segment aneurysms: the Johns Hopkins experience. J Neuroophthalmol 2012; 32 (01) 27-32
- 6 Yadla S, Campbell PG, Grobelny B. , et al. Open and endovascular treatment of unruptured carotid-ophthalmic aneurysms: clinical and radiographic outcomes. Neurosurgery 2011; 68 (05) 1434-1443 , discussion 1443
- 7 Molyneux AJ, Kerr RS, Yu LM. , et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366 (9488): 809-817
- 8 Durst CR, Starke RM, Gaughen J. , et al. Vision outcomes and major complications after endovascular coil embolization of ophthalmic segment aneurysms. AJNR Am J Neuroradiol 2014; 35 (11) 2140-2145
- 9 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 (06) 968-975
- 10 Loumiotis I, D'Urso PI, Tawk R. , et al. Endovascular treatment of ruptured paraclinoid aneurysms: results, complications, and follow-up. AJNR Am J Neuroradiol 2012; 33 (04) 632-637
- 11 Meling TR, Sorteberg W, Bakke SJ, Jacobsen EA, Lane P, Vajkoczy P. Case report: a troublesome ophthalmic artery aneurysm. J Neurol Surg Rep 2014; 75 (02) e230-e235
- 12 Schmidt GW, Oster SF, Golnik KC. , et al. Isolated progressive visual loss after coiling of paraclinoid aneurysms. AJNR Am J Neuroradiol 2007; 28 (10) 1882-1889
- 13 Schuss P, Güresir E, Berkefeld J, Seifert V, Vatter H. Influence of surgical or endovascular treatment on visual symptoms caused by intracranial aneurysms: single-center series and systematic review. J Neurosurg 2011; 115 (04) 694-699
- 14 Stracke CP, Krings T, Möller-Hartmann W, Mahdavi A, Klug N. Severe inflammatory reaction of the optic system after endovascular treatment of a supraophthalmic aneurysm with bioactive coils. AJNR Am J Neuroradiol 2007; 28 (07) 1401-1402
- 15 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 (06) E1217 , discussion E1217
- 16 Turner RD, Byrne JV, Kelly ME. , et al. Delayed visual deficits and monocular blindness after endovascular treatment of large and giant paraophthalmic aneurysms. Neurosurgery 2008; 63 (03) 469-474 , discussion 474–475
- 17 Szikora I, Marosfoi M, Salomváry B, Berentei Z, Gubucz I. Resolution of mass effect and compression symptoms following endoluminal flow diversion for the treatment of intracranial aneurysms. AJNR Am J Neuroradiol 2013; 34 (05) 935-939
- 18 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 (01) 40-46
- 19 Daou B, Chalouhi N, Starke RM. , et al. Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients. J Neurosurg 2016; 125 (06) 1337-1343
- 20 Shi L, Yuan Y, Guo Y, Yu J. Intracranial post-embolization residual or recurrent aneurysms: Current management using surgical clipping. Interv Neuroradiol 2016; 22 (04) 413-419
- 21 Guyer DR, Miller NR, Long DM, Allen GS. Visual function following optic canal decompression via craniotomy. J Neurosurg 1985; 62 (05) 631-638
- 22 Matsuyama T, Shimomura T, Okumura Y, Sakaki T. Mobilization of the internal carotid artery for basilar artery aneurysm surgery. Technical note. J Neurosurg 1997; 86 (02) 294-296
- 23 Yang Y, Wang H, Shao Y, Wei Z, Zhu S, Wang L. Extradural anterior clinoidectomy as an alternative approach for optic nerve decompression: anatomic study and clinical experience. Neurosurgery 2006; 59 (02) 253-262