Neuro-Ophthalmic Presentation and Surgical Results of Unruptured Intracranial Aneurysms—Prospective Helsinki Experience of 142 Patients

Koskela, Elina; Setälä, Kai; Kivisaari, Riku; Hernesniemi, Juha; Laakso, Aki

doi:10.1016/j.wneu.2014.12.017

Cited by 8 publications

(7 citation statements)

References 36 publications

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“…At the level of the midbrain, Benedikt syndrome was usually caused by ischemic stroke (n = 6/14), followed by hemorrhage (n = 4/14) and direct nervous compression (n = 3/14) [9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Weber syndrome was mainly caused by hemorrhage (n = 1/3) or infectious etiologies (n = 2/3) [4,23,24].…”

Section: Causes Of Crossed Brainstem Syndromesmentioning

confidence: 99%

“…Conversely, Millard-Gubler syndrome was mostly related to an ischemic stroke (n = 7/ 9), and rarely brought about by hemorrhage (n = 1/9) or brain abscess (n = 1/9) [38][39][40][41][42][43][44][45][46]. At the level of the medulla oblongata, Wallenberg syndrome was predominantly caused by ischemic stroke (n = 23/28), more rarely by hemorrhage (n = 2/28) or multiple sclerosis (n = 1/28) [18,. The complete data is provided in Table 2.…”

Section: Causes Of Crossed Brainstem Syndromesmentioning

confidence: 99%

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Crossed brainstem syndrome revealing bleeding brainstem cavernous malformation: an illustrative case

Beucler

Boissonneau

Ruf³

et al. 2021

BMC Neurol

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Background Since the nineteenth century, a great variety of crossed brainstem syndromes (CBS) have been described in the medical literature. A CBS typically combines ipsilateral cranial nerves deficits to contralateral long tracts involvement such as hemiparesis or hemianesthesia. Classical CBS seem in fact not to be so clear-cut entities with up to 20% of patients showing different or unnamed combinations of crossed symptoms. In terms of etiologies, acute brainstem infarction predominates but CBS secondary to hemorrhage, neoplasm, abscess, and demyelination have been described. The aim of this study was to assess the proportion of CBS caused by a bleeding episode arising from a brainstem cavernous malformation (BCM) reported in the literature. Case presentation We present the case of a typical Foville syndrome in a 65-year-old man that was caused by a pontine BCM with extralesional bleeding. Following the first bleeding episode, a conservative management was decided but the patient had eventually to be operated on soon after the second bleeding event. Discussion A literature review was conducted focusing on the five most common CBS (Benedikt, Weber, Foville, Millard-Gubler, Wallenberg) on Medline database from inception to 2020. According to the literature, hemorrhagic BCM account for approximately 7 % of CBS. Microsurgical excision may be indicated after the second bleeding episode but needs to be carefully weighted up against the risks of the surgical procedure and openly discussed with the patient. Conclusions In the setting of a CBS, neuroimaging work-up may not infrequently reveal a BCM requiring complex multidisciplinary team management including neurosurgical advice.

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Section: Causes Of Crossed Brainstem Syndromesmentioning

confidence: 99%

Section: Causes Of Crossed Brainstem Syndromesmentioning

confidence: 99%

Crossed brainstem syndrome revealing bleeding brainstem cavernous malformation: an illustrative case

Beucler

Boissonneau

Ruf³

et al. 2021

BMC Neurol

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“…Neuropathy secondary to nerve compression by an aneurysm occurs in 8%–15.4% of all aneurysms. [12] Among these cases, oculomotor nerve palsy is the most common, developing in 20% of patients with aneurysms in the cavernous sinus segment and 33% of patients with aneurysms in the posterior communicated artery. [34] Some authors have reported that 90% of patients with an oculomotor nerve palsy caused by an aneurysm recover after treatment, with the following being prognostic factors of a good recovery.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes of cerebral aneurysms presenting with optic neuropathy: A retrospective case series

et al. 2019

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Background: Optic neuropathy due to an aneurysm is relatively rare, with only a few small case series on this topic, and no randomized trials having been published until now. As such, the functional prognosis and treatment for aneurysm-induced optic neuropathy remain controversial. Objective: We quantified optic nerve injuries using an objective index (the visual impairment score) and evaluated prognostic factors of postoperative visual function. Materials and Methods: Of 960 patients treated for an unruptured intracranial aneurysm, 18 (1.9%) patients had optic neuropathy. Visual acuity and visual field were assessed before surgery and 6 months’ postoperatively. Cases were classified on the basis of treatment modality (coil embolization or flow alteration [FA]) and prognostic factors of the two treatment groups. Results: Of the 18 patients with an intracranial aneurysm and optic neuropathy, 12 (67%) were treated using coil embolization and 6 (33%) were FA. Visual function improved after surgery in 8 patients (44%), 5 (42%) in the coil embolization group, and 3 (50%) in the FA group. The visual function remained stable after surgery in 6 (33%) patients and worsened in 4 (22%). Patients with an aneurysms <15 mm in size had a favorable outcome ( P = 0.05). Conclusions: Surgical treatment improved vision in 44% of cases, with no difference in the prognosis of coil embolization and FA and no effect of the duration of symptoms on outcomes. Further, the prognosis of visual function recovery was better for aneurysms <15 mm in diameter.

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“…Koskela et al have published such a study in WORLD NEURO-SURGERY, in which they look prospectively at neuro-ophthalmic deficits after repair of UIAs, the vast majority by surgical clipping (5). This study complements another study by the same clinical team in this journal, which prospectively details the neuro-ophthalmic deficits after repair of ruptured intracranial aneurysms (4).…”

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confidence: 96%

“…It is worth commenting on some unique features of this series. The generalizability of these results may be limited due to the fact that: 1) the vast majority of patients in this series were surgically treated, including most of the unruptured posterior circulation aneurysms; and 2) the institution is a high-volume quaternary referral center with considerable expertise in aneurysm treatment, including the treatment of 263 patients with ruptured and unruptured aneurysms in 2011 alone (4,5). As the authors mention, this modern series of predominantly surgically-treated unselected UIAs provides data regarding postoperative neuro-ophthalmic deficits that can be used to compare with studies from institutions that treat UIAs mostly by endovascular means.…”

mentioning

confidence: 99%

Neuro-ophthalmic Assessment in Unruptured Intracranial Aneurysms

Tso

Macdonald

2015

World Neurosurgery

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Neuro-Ophthalmic Presentation and Surgical Results of Unruptured Intracranial Aneurysms—Prospective Helsinki Experience of 142 Patients

Cited by 8 publications

References 36 publications

Crossed brainstem syndrome revealing bleeding brainstem cavernous malformation: an illustrative case

Crossed brainstem syndrome revealing bleeding brainstem cavernous malformation: an illustrative case

Treatment outcomes of cerebral aneurysms presenting with optic neuropathy: A retrospective case series

Neuro-ophthalmic Assessment in Unruptured Intracranial Aneurysms

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