A Ruptured Intraorbital Ophthalmic Artery Aneurysm, Associated with a Dural Arteriovenous Fistula: Combined Transarterial and Transvenous Endovascular Treatment

Abstract

Transvenous treatment of dAVFs is well feasible even with very far going catheterization, in this case to the origin of the basal vein of Rosenthal.

Ophthalmic Artery Aneurysm: Flow-Induced Intracranial and Intraorbital (“Peripheral”) Ophthalmic Artery Aneurysms, Associated with a Tentorial Dural Arteriovenous Fistula, Supplied by the Ophthalmic Artery; Endovascular Treatment of the Dural Arteriovenous Fistula and One Aneurysm; and Conservative Management of the Remaining Ophthalmic Artery Aneurysms

“…Exophthalmos, visual impairment, and papilledema have been reported. Rupture of intraorbital OA aneurysms has also been reported (Kirsch and Henkes 2011;Meyerson and Lazar 1971). More than 50%, however, remain asymptomatic for a long time during their evolution.…”

Intraorbital aneurysm of the ophthalmic artery

“…A haemorrhagic presentation with rapid onset proptosis and visual loss is rare with only two reported cases 6 7. The most common presentations include visual loss, exophthalmos and headache.…”

“…They can also be asymptomatic and the rupture rate is thought to be low 3. There are currently 21 reports of intraorbital OA aneurysms 7–10. Eleven patients were noted to have concurrent vascular abnormalities including arteriovenous (AV) fistulae, AV malformations or cavernous malformation and other aneurysms.…”

“…Ten cases were treated conservatively and the outcome of nine of these patients were either unchanged or improved. There was an equal distribution of patients that improved, remained stable and lost vision after undergoing surgical intervention by means of aneurysm clipping or embolisation 7 8 10. The circulation to the eye can be compromised when surgical approaches are taken and preservation of this circulation needs to be considered when deciding which surgical approach to undertake.…”

Spontaneous Regression of a True Intracanalicular Fusiform Ophthalmic Artery Aneurysm After Endovascular Treatment of an Associated Dural Arteriovenous Fistula

“…The most unusual angiographic finding in our case was the spontaneous regression of the untreated right ophthalmic trunk aneurysm. The association between ophthalmic trunk aneurysms and other vascular malformations has been previously reported, although spontaneous aneurysm regression after the treatment of the vascular malformation was not detected in any of them(2,3).Kawaguchi et al(5) reported a case with a symptomatic (frontal headaches) anterior fossa DAVF fed by an OphA harboring an unruptured aneurysm of the intraorbital segment. The DAVF was surgically obliterated, although angiographic images or information about the state of the aneurysm during follow-up were not reported.…”