Resolution of Diminished Olfactory Sensation After Treatment of Bilateral Ophthalmic Segment Aneurysms With Flow Diversion

Kelkar, Prashant; Chaaban, Mohamad R.; Walters, Beverly C.; Woodworth, Bradford A.; Deveikis, John P.; Harrigan, Mark R.

doi:10.1227/neu.0000000000000127

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…Thus, ACA, ACOM, and OA aneurysm locations display an anatomic risk factor potentially hampering olfactory function due to thromboembolic ischemic events or neurovascular compression (Hendrix et al, ). Kelkar et al () reported a case of bilateral ophthalmic aneurysms causing hyposmia which moderately improved after bilateral flow diversion and consequent aneurysm occlusion. Manconi et al () and Ito et al () have reported a case of a giant ACOM aneurysm associated with olfactory dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Olfactory dysfunction in patients undergoing supraorbital keyhole craniotomy for clipping of unruptured aneurysms

et al. 2019

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Olfactory performance has rarely been assessed in the perioperative phase of elective aneurysm surgery. Here, we assessed the risk for olfactory deterioration following surgical treatment of unruptured cerebral aneurysm via the supraorbital keyhole craniotomy. A retrospective review of patients with electively treated cerebral aneurysms who underwent perioperative assessment of olfactory function using a sniffin' sticks odor identification test between January 2015 and January 2016 was performed. A subgroup of patients without history of subarachnoid hemorrhage, without prior aneurysm treatment, and confirmed olfactory function underwent supraorbital keyhole craniotomy for aneurysm clipping. Microscopic and endoscopic videos were reviewed for this subgroup. Sixty-four patients who underwent elective aneurysm treatment either via surgical clipping or endovascular aneurysm obliteration were identified. Prior to treatment, 4/64 (6.3%) demonstrated bilateral anosmia. Collectively, 14 patients (21.9%) met subgroup criteria of supraorbital keyhole craniotomy for aneurysm clipping. Here, olfactory performance significantly decreased postoperatively on the side of craniotomy (ipsilateral, P = 0.007), whereas contralateral and bilateral olfactory function remained unaltered (P = 0.301 and P = 0.582, respectively). Consequently, 4/14 patients (28.6%) demonstrated ipsilateral anosmia 3 months after surgery. One patient (1/14, 7.1%) also experienced contralateral anosmia resulting in bilateral anosmia. Intraoperative visualization of the olfactory tract and surgical maneuvers do not facilitate prediction of olfactory outcome. The supraorbital keyhole craniotomy harbors a specific risk for unilateral olfactory deterioration. Lack of perioperative olfactory assessment likely results in underestimation of the risk for olfactory decline. Despite uneventful surgery, prediction of postoperative olfactory function and dysfunction remain challenging. Clin. Anat. 33:316-323, 2020.

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Section: Discussionmentioning

confidence: 99%

Olfactory dysfunction in patients undergoing supraorbital keyhole craniotomy for clipping of unruptured aneurysms

et al. 2019

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“…Intracranial aneurysms or neoplasms of the anterior cranial fossa may exhibit local mass effect on the arteries that supply the olfactory bulb and olfactory tract. In a recent case report a patient suffering from hyposmia and bilateral ophthalmic segment aneurysms experienced gradual resolution of his inability to smell after endovascular treatment of these aneurysms (Kelkar et al, ). While subarachnoid hemorrhage itself may be a risk factor for anosmia, potentially due to vasospasm in the arteries that supply olfactory structures, the treatment of aneurysms carries an even higher risk.…”

Section: Olfactory Nerve (Cn I)mentioning

confidence: 99%

Arterial supply of the upper cranial nerves: A comprehensive review

et al. 2014

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The arterial supply to the upper cranial nerves is derived from a complex network of branches derived from the anterior and posterior cerebral circulations. We performed a comprehensive literature review of the arterial supply of the upper cranial nerves with an emphasis on clinical considerations. Arteries coursing in close proximity to the cranial nerves regularly give rise to small vessels that supply the nerve. Knowledge of the arteries supplying the cranial nerves is of particular importance during surgical approaches to the skull base.

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Long-Term Effect of Flow Diversion on Large and Giant Aneurysms: MRI-DSA Clinical Correlation Study

et al. 2016

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Resolution of Diminished Olfactory Sensation After Treatment of Bilateral Ophthalmic Segment Aneurysms With Flow Diversion

Cited by 4 publications

References 17 publications

Olfactory dysfunction in patients undergoing supraorbital keyhole craniotomy for clipping of unruptured aneurysms

Olfactory dysfunction in patients undergoing supraorbital keyhole craniotomy for clipping of unruptured aneurysms

Arterial supply of the upper cranial nerves: A comprehensive review

Long-Term Effect of Flow Diversion on Large and Giant Aneurysms: MRI-DSA Clinical Correlation Study

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