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Minim Invasive Neurosurg 2009; 52(1): 39-43
DOI: 10.1055/s-0028-1104565
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Visual Worsening after Incomplete Coiling of a Small Asymptomatic Aneurysm: Case Report and Review of the Literature

M. Killer 1 , G. Baltsavias 2 , M. Huemer 3 , B. Richling 4
  • 1Department of Neurology/Neuroscience Institute, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
  • 2Department of Neurosurgery, Interbalkan Medical Center, Thessalonica, Greece
  • 3Department of Neurology, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Austria
  • 4Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
Further Information

Publication History

Publication Date:
26 February 2009 (online)

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Abstract

Objective: Complications with increased mass effect on surrounding structures have as yet only been noted after coiling of large, giant, and thrombosed aneurysms. We describe a case of optic chiasm compression after incomplete coil embolization of a small ICA aneurysm and discuss the potential mechanisms causing this phenomenon.

Case Report: A 57-year-old male presented with an incidental, 7-mm diameter, C2 segment, ICA aneurysm. Endovascular intervention with platinum coils resulted in 80% obliteration. Approximately three weeks later the patient developed visual changes which progressed over 10 days to a homonymous hemianopsia with a central scotoma. A pterional craniotomy was performed to decompress and to definitively clip the aneurysm. Histological evaluation of the aneurysm showed sinusoidal vessels, filled with proliferated endothelial cells and being encapsulated by fibrous tissue, suspicious for exposure to systemic blood pressure.

Conclusion: Even small aneurysms undergoing incomplete coil embolization may affect surrounding, eloquent neural structures due to unexpected tissue formation in the aneurysm.

Key words

aneurysm - endovascular coiling - mass effect - decompression

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Correspondence

M. KillerMD 

Department of Neurology/Neuroscience Institute

Christian Doppler Clinic

Paracelsus Medical University

Ignaz-Harrer Straße 79

5020 Salzburg

Austria

Phone: +43/662/4483 560 58

Fax: +43/662/4483 30 04

Email: m.killer@salk.at