Clinical manifestations and surgical results for paraclinoid cerebral aneurysms presenting with visual symptoms

Nonaka, Tadashi; Haraguchi, Koichi; Baba, Takeo; Koyanagi, Izumi; Houkin, Kiyohiro

doi:10.1016/j.surneu.2006.08.074

Cited by 47 publications

(34 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…21 Previous studies demonstrate that microsurgery offers definitive and durable treatment for paraclinoid aneurysms with an acceptable complication rate, 2,10,12,20,21,23,27 but recent studies document a concerning rate of new visual deficits. 15,18,19,22,24,25 In addition, the frequency of aneurysm remnants is higher in this region due to limitations in visualizing pathology on the medial wall of the ICA through the narrow corridor of the optic-carotid triangle.…”

mentioning

confidence: 99%

Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms

Kamide

Tabani

Safaee

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE While most paraclinoid aneurysms can be clipped with excellent results, new postoperative visual deficits are a concern. New technology, including flow diverters, has increased the popularity of endovascular therapy. However, endovascular treatment of paraclinoid aneurysms is not without procedural risks, is associated with higher rates of incomplete aneurysm occlusion and recurrence, and may not address optic nerve compression symptoms that surgical debulking can. The increasing endovascular management of paraclinoid aneurysms should be justified by comparisons to surgical benchmarks. The authors, therefore, undertook this study to define patient, visual, and aneurysm outcomes in the most common type of paraclinoid aneurysm: ophthalmic artery (OphA) aneurysms. METHODS Results from microsurgical clipping of 208 OphA aneurysms in 198 patients were retrospectively reviewed. Patient demographics, aneurysm morphology (size, calcification, etc.), clinical characteristics, and patient outcomes were recorded and analyzed. RESULTS Despite 20% of these aneurysms being large or giant in size, complete aneurysm occlusion was accomplished in 91% of 208 cases, with OphA patency preserved in 99.5%. The aneurysm recurrence rate was 3.1% and the retreatment rate was 0%. Good outcomes (modified Rankin Scale score 0-2) were observed in 96.2% of patients overall and in all 156 patients with unruptured aneurysms. New visual field defects (hemianopsia or quadrantanopsia) were observed in 8 patients (3.8%), decreased visual acuity in 5 (2.4%), and monocular blindness in 9 (4.3%). Vision improved in 9 (52.9%) of the 17 patients with preoperative visual deficits. CONCLUSIONS The most important risk associated with clipping OphA aneurysms is a new visual deficit. Meticulous microsurgical technique is necessary during anterior clinoidectomy, aneurysm dissection, and clip application to optimize visual outcomes, and aggressive medical management postoperatively might potentially decrease the incidence of delayed visual deficits. As the results of endovascular therapy and specifically flow diverters become known, they warrant comparison with these surgical benchmarks to determine best practices.

show abstract

mentioning

confidence: 99%

Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms

Kamide

Tabani

Safaee

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Cerebral aneurysms arising from the circle of Willis are located closely to cranial nerves such as optic and oculomotor nerves. 3,10) Therefore, aneurysms can produce compression of these nerves causing their dysfunction. However, penetration, splitting, or fenestration of cranial nerves by aneurysms is extremely rare.…”

Section: Discussionmentioning

confidence: 99%

“…3,10) However, its penetration and splitting by a cerebral aneurysm is rare. Hongo et al 5) first reported in 1981, a case of the right ICA aneurysm that penetrated and split the optic chiasm.…”

Section: Introductionmentioning

confidence: 99%

Penetration of the Optic Nerve or Chiasm by Anterior Communicating Artery Aneurysms: Three Case Reports

Horiuchi

Uchiyama

Kusano

et al. 2011

Neuro-Ophthalmology

View full text Add to dashboard Cite

Although large and giant aneurysms can induce visual disturbance by compression of the anterior visual pathway, splitting and penetration of the optic apparatus are extremely rare. The authors describe 3 patients who underwent clipping surgery for the anterior communicating artery aneurysm infiltrating into the optic nerve or chiasm. These findings were suspected on the preoperative magnetic resonance imaging and confirmed at surgery.Two aneurysms were ruptured and one unruptured. We review the literature and discuss the mechanism of cranial nerve penetration by an aneurysm.Penetration of optic nerve or chiasm Horiuchi et al. 3

show abstract

“…10,16,20) In general, unruptured large anterior communicating artery (AcomA) aneurysm is well known cause of visual loss (loss of visual acuity and visual field defect). 2,4,15,17) Here we describe a case of photophobia before onset of visual loss with chiasmal compression by an unruptured AcomA aneurysm.…”

Section: Introductionmentioning

confidence: 90%

Photophobia as the Visual Manifestation of Chiasmal Compression by Unruptured Anterior Communicating Artery Aneurysm -Case Report-

Hagihara¹,

Abe

Yoshioka³

et al. 2009

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

A 37-year-old woman presented with photophobia without visual loss associated with chiasmal compression by an unruptured anterior communicating artery (AcomA) aneurysm. She had suffered progressive photophobia for one year. Neuroimaging indicated an AcomA aneurysm attached to the chiasm. Photophobia was resolved following clipping of the aneurysm. AcomA aneurysm should be considered in patients who experience photophobia without visual loss.

show abstract

Clinical manifestations and surgical results for paraclinoid cerebral aneurysms presenting with visual symptoms

Cited by 47 publications

References 15 publications

Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms

Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms

Penetration of the Optic Nerve or Chiasm by Anterior Communicating Artery Aneurysms: Three Case Reports

Photophobia as the Visual Manifestation of Chiasmal Compression by Unruptured Anterior Communicating Artery Aneurysm -Case Report-

Contact Info

Product

Resources

About