Results, Outcomes, and Follow-Up of Remnants in the Treatment of Ophthalmic Aneurysms

Fulkerson, Daniel H.; Horner, Terry G.; Payner, Troy D.; Leipzig, Thomas J.; Scott, John A.; DeNardo, Andrew J.; Redelman, Kathleen; Goodman, Julius M.

doi:10.1227/01.neu.0000337127.73667.80

Cited by 54 publications

(32 citation statements)

References 70 publications

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“…Visual deficits associated with clipping surgery for paraclinoid carotid artery aneurysm can be caused by vascular compromise, manipulation of the optic nerve, thermogenic effects from high-speed drilling of the clinoid process, or other unknown causes. 3,5,6,10,19,20 For the patient in Case 2, surgical manipulation was the most likely cause of the postoperative visual worsening because VEPs were attenuated during the suction decompression procedure.…”

Section: Paraclinoid Carotid Artery Aneurysm and Visual Functionmentioning

confidence: 99%

“…Of these 6 patients, visual field defects occurred in 2 patients, visual acuity diminution in 1, and transient palsies of the sixth cranial nerve in 3. In 2009, Fulkerson et al 6 reported that new visual loss occurred in 6 (4.8%) of 126 ophthalmic aneurysm patients who underwent craniotomy. In contrast, Barami et al reported that vision impairment associated with clipping for paraclinoid carotid artery aneurysms might comprise up to 20% of cases at 6-month follow-up examination.…”

Section: Paraclinoid Carotid Artery Aneurysm and Visual Functionmentioning

confidence: 99%

“…However, postoperative visual complications may be caused by ischemia associated with SHA sacrifice. [3][4][5][6]9,10,20 In 2007, Goto et al 9 reported that the temporary occlusion of the SHA in the contralateral approach for SHA aneurysms attenuated VEPs and that the preservation of the SHA avoided vision complications. This report indicates a possibility that a unilateral SHA supplies the bilateral optic apparatus or that no circumferential anastomosis is present between right and left SHAs in rare cases.…”

Section: Sha and Visual Functionmentioning

confidence: 99%

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Role of superior hypophyseal artery in visual function impairment after paraclinoid carotid artery aneurysm surgery

Horiuchi

Goto

Tanaka

et al. 2015

JNS

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A ccording to the related branching artery or anatomical relationships, there are many classifications of intradural proximal carotid artery aneurysms. In the literature, the term "paraclinoid carotid aneurysm" is often used because it includes all carotid artery aneurysms originating from the internal carotid artery (ICA) between the distal dural ring and the origin of the posterior communicating artery. 11,12,21 The superior hypophyseal artery (SHA) is well known as a branching artery of paraclinoid carotid artery aneurysms 16,21,22 and supplies the pituitary stalk, optic nerve, and chiasm. 8,14,18 Therefore, sacrifice of the SHA may be a factor for postoperative visual impairment. 4,9,13 Although a few case reports have described postoperative visual impairment associated with SHA occlusion, 4,9,13 only small series of SHA aneurysm surgery cases have focused on postoperative visual function and intraoperative SHA status. We report our experience with 72 SHA aneurysms in 70 patients and our analysis of the postoperative visual function associated with the SHA. MethodsThis study was approved by the institutional review board at the Shinshu University School of Medicine. Patient PopulationBetween January 1991 and December 2013, a total of 181 patients harboring 190 paraclinoid carotid artery anabbreviatioNs ICA = internal carotid artery; SHA = superior hypophyseal artery; VEP = visual evoked potential. subMitted June 3, 2014. accePted December 29, 2014. iNclude wheN citiNg Published online February 20, 2015; DOI: 10.3171/2014.12.JNS141218. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. This study was partly supported by the Japan Society for the Promotion of Science KAKENHI grant no. 25462251 (to T.H). obJect Although a number of studies have assessed the surgical treatment of paraclinoid-segment carotid artery aneurysms and resulting visual complications, less attention has been given to the results with respect to the superior hypophyseal artery (SHA). The authors evaluated the relationship between the aneurysm, the SHA itself, and postoperative visual function in patients with ruptured and unruptured SHA aneurysms. Methods From January 1991 through December 2013, 181 patients with 190 paraclinoid carotid artery aneurysms received treatment at Shinshu University Hospital and its affiliated hospitals. The authors retrospectively analyzed charts, operative records, operative videos, and neuroimaging findings for these patients with or without postoperative visual complications. results The authors identified 72 SHA aneurysms in 70 patients (mean age 58 years). Of 69 patients (1 patient died) evaluated, postoperative visual complications occurred in 9 (13.0%). Although the aneurysm size and SHA sacrifice did not lead to postoperative visual impairment, simultaneous treatment of bilateral aneurysms was a risk factor for postoperative visual complications. coNclusioNs Unilateral SHA impairment may be safe (i.e., i...

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Section: Paraclinoid Carotid Artery Aneurysm and Visual Functionmentioning

confidence: 99%

Section: Paraclinoid Carotid Artery Aneurysm and Visual Functionmentioning

confidence: 99%

Section: Sha and Visual Functionmentioning

confidence: 99%

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Role of superior hypophyseal artery in visual function impairment after paraclinoid carotid artery aneurysm surgery

Horiuchi

Goto

Tanaka

et al. 2015

JNS

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“…The prevalence of pretreatment visual symptoms has been reported to occur in 23%-32% of patients with ICA aneurysms in previously reported studies, a rate comparable to the 29% of patients with visual complaints at initial presentation in the current series. 2,4,5 Resolution of visual symptoms caused by intracranial aneurysms following treatment has been reported to be more successful in instances in which the target aneurysm was treated within 3 months of visual symptom onset. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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. New visual deficits were observed in 4.8% of patients undergoing craniotomy for microsurgical clipping without worsening visual deficits in the 26 patients undergoing coil embolization.…”

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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Outcome After Surgical Treatment of Paraclinoid Carotid Aneurysms

Pasqualin

Meneghelli

Cozzi

et al. 2016

Acta Neurochirurgica Supplement

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Surgery on paraclinoid carotid aneurysms is technically demanding and entails considerable risks, especially to visual function. The aim of this study was to evaluate the clinical and visual outcome after surgery in 66 patients with paraclinoid carotid aneurysms (30 ruptured and 36 unruptured) treated between 1990 and 2014. Thirty-six aneurysms were of standard size, and 30 were large (16-20 mm) or giant (>20 mm); the Barami classification was used in every case. During surgery, multiple clips were needed in 25 % of patients with standard, and in 80 % of patients with large-giant aneurysms; temporary carotid occlusion was performed on 11 % of patients with standard and 63 % with large-giant aneurysms. Postoperatively, a cerebrospinal fluid fistula was repaired surgically in two patients. At the 3-month follow-up, the modified Rankin Score (mRS) was favorable (0-2) in 63 % of patients with ruptured and in 97 % with unruptured aneurysms; four patients presenting with large hematomas died. Postoperative visual impairment (worsening or newly developing deficit) was noted in 25 % of cases with standard and 14 % of cases with large-giant ruptured aneurysms, and, respectively, in 10 % with standard and 31 % with large-giant unruptured aneurysms. It has been concluded that surgery remains a reasonable choice in the management of patients with paraclinoid carotid aneurysms.

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Results, Outcomes, and Follow-Up of Remnants in the Treatment of Ophthalmic Aneurysms

Abstract: Despite the difficulties presented by ophthalmic aneurysms, these lesions can be successfully managed by a multidisciplinary team. Imaging follow-up of patients is important, as there is a risk of aneurysm regrowth after either coiling or clipping.

Cited by 54 publications

References 70 publications

Role of superior hypophyseal artery in visual function impairment after paraclinoid carotid artery aneurysm surgery

Role of superior hypophyseal artery in visual function impairment after paraclinoid carotid artery aneurysm surgery

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

Outcome After Surgical Treatment of Paraclinoid Carotid Aneurysms

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