Compression of the visual pathway by anterior cerebral artery aneurysm

Bakker, S. L. M.; Hasan, D.; Bijvoet, Henk W. C.

doi:10.1111/j.1600-0404.1999.tb07347.x

Cited by 13 publications

(8 citation statements)

References 12 publications

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“…7 Nevertheless, several studies have reported aneurysms in any portion of the circle of Willis producing compression over the visual pathways. 3,6,7,11,15 Although paraclinoidal aneurysms represent only 5% of intracranial aneurysms, they are the most common cause of visual complaints caused by aneurysmal compression of the ON and chiasm. 8 In this study, paraclinoidal (in 8 patients) and ACoA (in 5 patients) aneurysms also represented the majority of the cases (86.6%).…”

Section: Aneurysms Characteristics and Patterns Of Visual Field Lossmentioning

confidence: 99%

Intracranial aneurysms presenting with mass effect over the anterior optic pathways: neurosurgical management and outcomes

Oliveira¹,

Borba²,

Rassi-Neto³

et al. 2009

FOC

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Object Intracranial aneurysms may grow closer to anterior optic pathways, causing mass effect over these anatomical structures, including visual deficit. The authors retrospectively reviewed a series of aneurysms in patients presenting with visual field deficit caused by mass effect, to analyze the aneurysm's characteristics, the neurosurgical management of these aneurysms, as well as their clinical, visual, and radiological outcomes. Methods The authors reviewed the medical charts, neuroimaging examination results, and surgical videos of 15 patients presenting with visual symptoms caused by an aneurysm's mass effect over the anterior optic pathways. These patients were treated at the Department of Neurosurgery, Center of Neurology and Neurosurgery Associates, Hospital Beneficência Portuguesa de São Paulo, Brazil. Statistical analysis was performed to identify the variables related to partial or total recovery of the visual symptoms. Results All patients underwent microsurgical clip placement and emptying of their aneurysms. After a mean follow-up of 38.5 months, the mean postoperative Glasgow Outcome Scale score was 4.33, and the visual outcomes were as follows: 1 patient (6.6%) unchanged, 7 (46.6%) improved, and 7 (46.6%) experienced complete recovery from visual deficits. The variables that influenced the visual outcomes were the size of the aneurysm (p = 0.039), duration of the visual symptoms (p = 0.002), aneurysm wall calcification (p = 0.010), and intraluminal thrombosis (p = 0.007). Postoperative examination using digital subtraction angiography showed complete aneurysm occlusion in 14 (93.3%) of the 15 patients. Conclusions Intracranial aneurysms causing mass effect over the anterior optic pathways usually present with complex features. The best treatment option must include not only the aneurysm occlusion but also relief of the mass effect. Microsurgical clip placement with reduction of aneurysmal mass effect achieved improvement in visual ability or recovery from visual impairment, as well as total aneurysm occlusion, in 93.3% of the study group. Therefore, this option is well supported as the first choice of treatment for intracranial aneurysms presenting with mass effect over the anterior visual pathways.

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Section: Aneurysms Characteristics and Patterns Of Visual Field Lossmentioning

confidence: 99%

Intracranial aneurysms presenting with mass effect over the anterior optic pathways: neurosurgical management and outcomes

Oliveira¹,

Borba²,

Rassi-Neto³

et al. 2009

FOC

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show abstract

“…Cases of acute visual loss caused by cerebral aneurysms have been reported previously in the literature. Anterior communicating artery (ACoA) rupture,[726] ACoA aneurysm enlargement,[3] anterior cerebral artery (ACA) aneurysm rupture,[2] carotid-ophthalmic aneurysm enlargement,[11] and mycotic cavernous pseudoaneurysm enlargement[19] have resulted in sudden monocular blindness. Carotid dissection has also caused sudden monocular loss of vision.…”

Section: Discussionmentioning

confidence: 99%

Posterior communicating artery aneurysm rupture mimicking apoplexy

Bonfield

Gardner²

2011

Surg Neurol Int

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Background:Cerebral aneurysm rupture can lead to devastating neurological complications and present a complex problem to treat. We report a unique case of a ruptured posterior communicating artery (PCoA) aneurysm presenting with sudden and complete vision loss.Case Description:A 39-year-old man presented with the acute onset of severe headache and complete bilateral vision loss. The patient described headaches for several months prior to presentation. However, prior to the day of presentation, he had no visual disturbance. A CT angiogram (CTA) and magnetic resonance imaging (MRI) of the brain revealed a 1.6-cm, non-contrast enhancing suprasellar mass, eccentric to the left side, consistent with hemorrhagic mass. There was no obvious aneurysm or vascular malformation. The sella tursica was normal in appearance. The patient was taken for an immediate endoscopic endonasal transtuberculum approach for optic nerve decompression. Hematoma without an associated tumor was encountered and partially evacuated before aborting with resultant partial improvement in vision. A subsequent cerebral angiogram revealed an irregularly shaped, postero-laterally pointing, 2.5-mm left PCoA aneurysm. The patient was then taken for open clipping of the ruptured aneurysm. A large, fibrinous capsule was found over the superolateral aspect of the aneurysm. The ruptured aneurysm was secured with clips and the surrounding hematoma was evacuated.Conclusion:In the immediate postoperative period, the patient regained vision in the nasal field of his right eye. This case illustrates a unique presentation of a ruptured PCoA aneurysm, and thus must be considered in the differential diagnosis of a suprasellar hemorrhage resulting in visual loss in absence of a recognizable associated tumor.

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“…Optic chiasmal syndrome can be caused by a variety of lesions, in-cluding tumors and carotid artery aneurysms 1 ; however, reports of bitemporal field loss from compression by an abnormal vessel are rare. 2 We describe a patient with a nonprogressive bitemporal hemianopia in whom there appeared to be compression of the optic chiasm by an elongated right anterior cerebral artery (ACA).…”

Section: Bitemporal Hemianopia Caused By An Intracranial Vascular Loopmentioning

confidence: 99%

“…Vascular compression of the optic chiasm causing a bitemporal field defect is most often due to an aneurysm of the ACA, internal carotid artery, or anterior communicating artery. 1 Rare cases of dolichoectatic and atherosclerotic ACAs that cause bitemporal hemianopia have been reported, but direct chiasmal i m p i n g e m e n t h a s n o t b e e n described. The field defect in such cases is thought to result from traction on small perforating vessels causing a chiasmal infarction.…”

Section: Bitemporal Hemianopia Caused By An Intracranial Vascular Loopmentioning

confidence: 99%

Bitemporal Hemianopia Caused by an Intracranial Vascular Loop

Chen¹

2008

Arch Ophthalmol

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Compression of the visual pathway by anterior cerebral artery aneurysm

Cited by 13 publications

References 12 publications

Intracranial aneurysms presenting with mass effect over the anterior optic pathways: neurosurgical management and outcomes

Intracranial aneurysms presenting with mass effect over the anterior optic pathways: neurosurgical management and outcomes

Posterior communicating artery aneurysm rupture mimicking apoplexy

Bitemporal Hemianopia Caused by an Intracranial Vascular Loop

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