Influence of surgical or endovascular treatment on visual symptoms caused by intracranial aneurysms: single-center series and systematic review

Schuss, Patrick; Güresir, Erdem; Berkefeld, Joachim; Seifert, Volker; Vatter, Hartmut

doi:10.3171/2011.5.jns101983

Cited by 45 publications

(34 citation statements)

References 29 publications

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“…One possibility is that thrombosis after coil embolization may relieve the pulsatile pressure on the optic nerve. 22 A review of prior literature suggests that 49% of patients treated endovascularly [3][4][5][6]12,23 and 63% of patients treated surgically 2,5,[8][9][10][11][23][24][25] could be expected to experience improvement in their visual symptoms (Tables 5 and 6). Treatment, of course, is not without risk.…”

Section: Discussionmentioning

confidence: 99%

Vision Outcomes and Major Complications after Endovascular Coil Embolization of Ophthalmic Segment Aneurysms

Durst¹,

Starke²,

Gaughen³

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:As aneurysms arising from the ophthalmic segment of the internal carotid artery increase in size, they can compress the optic nerve, prompting patients to present with visual disturbances. The purpose of this article is to describe the clinical and angiographic results with an emphasis on visual outcomes following the endovascular treatment of ophthalmic segment ICA aneurysms.

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Section: Discussionmentioning

confidence: 99%

Vision Outcomes and Major Complications after Endovascular Coil Embolization of Ophthalmic Segment Aneurysms

Durst¹,

Starke²,

Gaughen³

et al. 2014

AJNR Am J Neuroradiol

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“…2 The literature also provides evidence that microsurgery is superior to embolization with regard to resolution of visual symptoms, with one study reporting improvement or resolution of visual symptoms in 75% of aneurysms treated with microsurgery versus 38% of patients treated with embolization. 18 This finding may be explained by the ability of microsurgery to decompress the aneurysm through a postclipping aneurysm puncture and decompression of the aneurysm, which relieves the mass effect of the aneurysm on the anterior visual pathways. 3,12,21 Fulkerson et al 5 studied the treatment of 134 patients, 97 of whom harbored unruptured aneurysms, and observed an incidence of pretreatment ophthalmological findings in 27.8% of unruptured aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Neuro-ophthalmic effects of stenting across the ophthalmic artery origin in the treatment of intracranial aneurysms

Heller¹,

Lawlor

Hedges

et al. 2014

JNS

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Object The benefits of treating intracranial aneurysms in the region of the anterior visual pathways are well understood. However, the adverse effects of endovascular stenting across the ophthalmic artery have received little attention. The authors reviewed their experience with patients who had stents deployed across the ophthalmic artery origin. Methods Patients' medical charts and imaging studies were reviewed to identify all patients with a non–flow diverting stent deployed over the ophthalmic artery origin for the treatment of intracranial aneurysms. All patients with neuro-ophthalmic complaints were referred for formal ophthalmological evaluation. Results A total of 104 consecutive patients with 106 aneurysms were identified to meet criteria for inclusion in the study cohort. Preoperatively, 30 patients (29%) described headache symptoms and 32 patients (31%) reported visual complaints. Of the patients with preoperative headaches, 15 (54%) of 28 patients for whom follow-up was available experienced improvement in their symptoms. Of the patients with preoperative visual complaints, improvement was noted in 11 (41%) of the 27 patients for whom follow-up was available, 9 (33%) of 27 patients reported no change in visual symptoms, and 7 (26%) of 27 patients reported progression of symptoms. Visual field defects developing posttreatment were noted to occur in 8 (7.7%) of 104 patients: 3 with immediate postoperative retinal infarcts, 1 with perioperative hemianopia that resolved by the time of discharge, 1 with a subjective visual field defect, 1 with subjective migratory visual field defects, and 2 with nonspecific visual symptoms. Compressive symptoms from aneurysm mass effect were noted in 6 patients preoperatively, with 4 of those patients experiencing persistent worsening, resolution in 1 case, and no change in 1 case. One patient developed a novel cranial nerve palsy from mass effect in the immediate postoperative period. Conclusions Deployment of stents across the ophthalmic artery origin for the treatment of intracranial aneurysms appears to be relatively safe with regard to visual outcomes. Neuro-ophthalmic complaint resolution rates were comparable to endovascular procedures that do not employ stents, with headache resolution rates comparable to coil-only aneurysm obliteration and low rates of retinal ischemic events. For patients presenting with mass effect, stent-assisted coiling appears to be less effective than microsurgery with decompression for relief of compressive symptoms.

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“…Clipping may facilitate preservation of the ophthalmic artery for paraclinoid aneurysms arising near its takeoff; clipping is thought to also provide a greater reduction in mass effect and a more robust decompression of the optic nerve compared with coiling. 1,12,39,47 Coiling, on the other hand, fills the aneurysm sac and perpetuates its mass ef fect, perhaps even inducing swelling and worsening optic nerve compression. 39 The PED and other flow diverters promote thrombosis of the aneurysm while permitting blood flow to perforators incidentally covered by the stent.…”

Section: Discussionmentioning

confidence: 99%

Vision outcomes in patients with paraclinoid aneurysms treated with clipping, coiling, or flow diversion: a systematic review and meta-analysis

Silva

See

Dasenbrock

et al. 2017

Neurosurgical Focus

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OBJECTIVEPatients with paraclinoid aneurysms commonly present with visual impairment. They have traditionally been treated with clipping or coiling, but flow diversion (FD) has recently been introduced as an alternative treatment modality. Although there is still initial aneurysm thrombosis, FD is hypothesized to reduce mass effect, which may decompress the optic nerve when treating patients with visually symptomatic paraclinoid aneurysms. The authors performed a meta-analysis to compare vision outcomes following clipping, coiling, or FD of paraclinoid aneurysms in patients who presented with visual impairment.METHODSA systematic literature review was performed using the PubMed and Web of Science databases. Studies published in English between 1980 and 2016 were included if they reported preoperative and postoperative visual function in at least 5 patients with visually symptomatic paraclinoid aneurysms (cavernous segment through ophthalmic segment) treated with clipping, coiling, or FD. Neuroophthalmological assessment was used when reported, but subjective patient reports or objective visual examination findings were also acceptable.RESULTSThirty-nine studies that included a total of 2458 patients (520 of whom presented with visual symptoms) met the inclusion criteria, including 307 visually symptomatic cases treated with clipping (mean follow-up 26 months), 149 treated with coiling (mean follow-up 17 months), and 64 treated with FD (mean follow-up 11 months). Postoperative vision in these patients was classified as improved, unchanged, or worsened compared with preoperative vision. A pooled analysis showed preoperative visual symptoms in 38% (95% CI 28%–50%) of patients with paraclinoid aneurysms. The authors found that vision improved in 58% (95% CI 48%–68%) of patients after clipping, 49% (95% CI 38%–59%) after coiling, and 71% (95% CI 55%–84%) after FD. Vision worsened in 11% (95% CI 7%–17%) of patients after clipping, 9% (95% CI 2%–18%) after coiling, and 5% (95% CI 0%–20%) after FD. New visual deficits were found in patients with intact baseline vision at a rate of 1% (95% CI 0%–3%) for clipping, 0% (95% CI 0%–2%) for coiling, and 0% (95% CI 0%–2%) for FD.CONCLUSIONSTo the authors’ knowledge, this is the first meta-analysis to assess vision outcomes after treatment for paraclinoid aneurysms. The authors found that 38% of patients with these aneurysms presented with visual impairment. These data also demonstrated a high rate of visual improvement after FD without a significant difference in the rate of worsened vision or iatrogenic visual impairment compared with clipping and coiling. These findings suggest that FD is an effective option for treatment of visually symptomatic paraclinoid aneurysms.

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Influence of surgical or endovascular treatment on visual symptoms caused by intracranial aneurysms: single-center series and systematic review

Cited by 45 publications

References 29 publications

Vision Outcomes and Major Complications after Endovascular Coil Embolization of Ophthalmic Segment Aneurysms

Vision Outcomes and Major Complications after Endovascular Coil Embolization of Ophthalmic Segment Aneurysms

Neuro-ophthalmic effects of stenting across the ophthalmic artery origin in the treatment of intracranial aneurysms

Vision outcomes in patients with paraclinoid aneurysms treated with clipping, coiling, or flow diversion: a systematic review and meta-analysis

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