Two patients of visual disturbance and optic perineuritis after placement of a flow diverter

Tanaka, Yūko; Nagatsuka, Hiroki; Miki, Yuma; Tetsuo, Yoshiaki; Yabuzaki, Hajime; Nakayama, Sadayoshi; Matsuda, Yoshikazu; Tsumoto, Tomoyuki; Terada, Tomoaki

doi:10.1016/j.radcr.2022.01.085

Cited by 2 publications

(7 citation statements)

References 7 publications

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“…The rapid accumulation of a large volume of thrombus within the aneurysm may provoke a more excessive inflammatory response, potentially precipitating this complication. 9 In support of this theory, several authors 7 , 10 , 11 have reported cases of posttreatment optic neuropathy even in patients treated with FD, a modality known for its potential to reduce the size of the aneurysm sac. 5 …”

Section: Discussionmentioning

confidence: 92%

“…Instances of optic neuropathy as a complication after endovascular treatment of cerebral aneurysms have been rarely documented. 1,4,[7][8][9][10][11] Among the cases reported, the majority of aneurysms were located in the paraclinoid region, treated with simple coil embolization, and predominantly classified as large aneurysms measuring more than 10 mm. 1,4,8,9 Previous studies 4,10 have suggested that the visual impairment observed after coil embolization was mainly due to direct physical compression of the adjacent optic nerve by the enlarged aneurysmal mass.…”

Section: Observationsmentioning

confidence: 99%

“…8,9 Therefore, systemic steroid therapy is commonly used to treat this complication and appears to be effective. 7,9 Here, we present a case of significant visual dysfunction after coil embolization of a paraclinoid aneurysm. The severe clinical course, in addition to the characteristic radiological and ophthalmological findings, provides important insights for a better understanding of this complication.…”

mentioning

confidence: 98%

“…Despite these advantages, there have been sparse case reports 1 , 4 , 7–9 of delayed visual impairment after endovascular treatments, including coil embolization 1 , 4 , 8 , 9 and FD treatment 7 of paraclinoid aneurysms. The delayed onset of this complication (more than 24 hours after surgery) and the fact that it typically responds well to steroid therapy suggest that the underlying mechanism goes beyond simple physical compression of the optic nerve by the aneurysmal mass.…”

mentioning

confidence: 99%

“… 8 , 9 Therefore, systemic steroid therapy is commonly used to treat this complication and appears to be effective. 7 , 9 …”

mentioning

confidence: 99%

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Visual dysfunction and neurodegeneration caused by severe inflammatory optic neuropathy after coil embolization of a paraclinoid aneurysm: illustrative case

Okuyama,

Kurisu,

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Visual impairment due to delayed optic neuropathy is a rare complication of the endovascular treatment of paraclinoid aneurysms. An inflammatory response induced in the treated aneurysm wall is a known mechanism underlying this pathophysiology. The authors describe a case with severe and progressive optic neuropathy leading to neuronal degeneration and severe visual dysfunction. OBSERVATIONS A 42-year-old female with a history of surgical clipping for a paraclinoid aneurysm presented with a recurrence. Although the patient was unaware of any visual dysfunction, a preoperative ophthalmological examination revealed mild inferior quadrantanopia in the left eye. The coil embolization procedure was uneventful; however, the following day, the patient experienced progressive visual impairment, which worsened despite the initiation of steroid therapy. Ophthalmological examination revealed a severe decrease in visual acuity and further deterioration of the visual field. Magnetic resonance imaging showed remarkable swelling and edema of the left optic nerve adjacent to the treated aneurysm. Despite continued steroid therapy, the patient’s visual function did not recover well due to subsequent optic nerve degeneration. LESSONS Optic neuropathy after endovascular procedures can lead to severe visual dysfunction. Careful management is essential, particularly when treating a symptomatic paraclinoid aneurysm, even if symptoms are only apparent on detailed examination.

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Section: Discussionmentioning

confidence: 92%

Section: Observationsmentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 99%

“… 8 , 9 Therefore, systemic steroid therapy is commonly used to treat this complication and appears to be effective. 7 , 9 …”

mentioning

confidence: 99%

See 3 more Smart Citations

Visual dysfunction and neurodegeneration caused by severe inflammatory optic neuropathy after coil embolization of a paraclinoid aneurysm: illustrative case

Okuyama,

Kurisu,

et al. 2024

Journal of Neurosurgery: Case Lessons

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How Flow Diverter Selection Can Affect the Flow Changes within a Jailed Ophthalmic Artery: A Computational Fluid Dynamics Study

Ünsal,

Güçlü,

Olcay

et al. 2024

Asian J Neurosurg

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Introduction Flow diverter (FD) stents are widely used to treat giant aneurysms by reducing blood flow into the aneurysm sac. However, choosing the optimal FD for a patient can be challenging when a nearby artery, such as the ophthalmic artery (OA), is jailed by the FD placement. This study compares the impact of two FD stents with different effective metal surface area (EMSA) values on OA occlusion. Materials and Methods A numerical model of a 59-year-old female patient with a giant aneurysm in the left internal carotid artery and a jailed OA was created based on clinical data. Two FD stents, FRED4017 and FRED4518, with different EMSA values at the aneurysm neck and OA inlet, were virtually deployed in the model. Blood flow and occlusion amount in the OA were simulated and compared between the two FD stents. Results FRED4017 had higher EMSA values than FRED4518 at the aneurysm neck (35% vs. 24.6%) and lower EMSA values at the OA inlet (15% vs. 21.2%). FRED4017 caused more occlusion in the OA than FRED4518 (40% vs. 28%), indicating a higher risk of ocular ischemic syndrome. Conclusion The EMSA value of FD stents affects the blood flow and occlusion amount in the jailed OA. Therefore, selecting an FD stent with a low EMSA value at the OA inlet may be beneficial for patients with a nearby jailed artery at the aneurysm neck.

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Two patients of visual disturbance and optic perineuritis after placement of a flow diverter

Cited by 2 publications

References 7 publications

Visual dysfunction and neurodegeneration caused by severe inflammatory optic neuropathy after coil embolization of a paraclinoid aneurysm: illustrative case

Visual dysfunction and neurodegeneration caused by severe inflammatory optic neuropathy after coil embolization of a paraclinoid aneurysm: illustrative case

How Flow Diverter Selection Can Affect the Flow Changes within a Jailed Ophthalmic Artery: A Computational Fluid Dynamics Study

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