Microneurosurgical Management of Ophthalmic Segment of the Internal Carotid Artery Aneurysms: Single-Surgeon Operative Experience From Louisiana State University, Shreveport

Nanda, Anil; Javalkar, Vijayakumar

doi:10.1227/neu.0b013e3182039819

Cited by 49 publications

(21 citation statements)

References 30 publications

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“…In addition, optic neuropathy may develop from direct compression of the optic nerve, resulting in visual field (VF) deficits, visual acuity (VA) problems, and/or afferent pupillary defects (APDs). Although the effects of both endovascular and surgical aneurysm treatments on neuroophthalmological morbidity rates have been studied, 1,[3][4][5]8,9,11,13,15,16 the literature on this matter as a whole is diminished by the lack of prospective studies, the variable length of reported follow-up, and the lack of consensus on fundamental neuroophthalmological endpoints; for example, there is a lack of agreement whether objective findings such as "ophthalmoparesis" should be grouped with subjective findings such as "diplopia. "…”

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confidence: 99%

Neuroophthalmological outcomes associated with use of the Pipeline Embolization Device: analysis of the PUFS trial results

Sahlein

Fouladvand

Becske

et al. 2015

JNS

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. disclosure Dr. Becske is a consultant/proctor in the use of the Pipeline Embolization Device for Covidien. Dr. Saatci's institution received fees for participation in review activities from Chestnut Medical, and she received consultancy fees from ev3/Covidien. Dr. McDougall received consultancy fees from the Covidien Medical Advisory Board. Dr. Szikora and his institution received consulting fees or honoraria from Chestnut Medical, and he received consultancy fees from Stryker Neurovascular and ev3/ Covidien and speaker's and service fees for being on speakers' bureaus of Stryker Neurovascular and ev3/Covidien. Dr. Lanzino's institution received consulting fees or honoraria from ev3/Covidien and support for travel to meetings for the study or other purposes from ev3/Covidien for presentation to a FDA panel; his institution received an unrestricted educational grant from ev3/Covidien. Dr. Moran is a chief medical officer for Covidien, and he received fees from ev3/Covidien for lectures and for development of educational presentations. Dr. Woo's institution received funds for grants or for pending grants from Siemens and from MicroVention; he received royalties paid by Codman and Shurtleff for an acute stroke device after acquisition of Revasc and travel/accommodations/meeting expenses unrelated to this study from Siemens; and he is the President/CFO of Vascular Simulations. Dr. Berez was an employee of Chestnut Medical and ev3/Covidien and received patent royalties from Covidien; he has stock/stock options in Chestnut Medical and Covidien, and is a founder and employee of Chestnut; he received

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confidence: 99%

Neuroophthalmological outcomes associated with use of the Pipeline Embolization Device: analysis of the PUFS trial results

Sahlein

Fouladvand

Becske

et al. 2015

JNS

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“…Clipping may facilitate preservation of the ophthalmic artery for paraclinoid aneurysms arising near its takeoff; clipping is thought to also provide a greater reduction in mass effect and a more robust decompression of the optic nerve compared with coiling. 1,12,39,47 Coiling, on the other hand, fills the aneurysm sac and perpetuates its mass ef fect, perhaps even inducing swelling and worsening optic nerve compression. 39 The PED and other flow diverters promote thrombosis of the aneurysm while permitting blood flow to perforators incidentally covered by the stent.…”

Section: Discussionmentioning

confidence: 99%

“…1,12,39,47 Coiling, on the other hand, fills the aneurysm sac and perpetuates its mass ef fect, perhaps even inducing swelling and worsening optic nerve compression. 39 The PED and other flow diverters promote thrombosis of the aneurysm while permitting blood flow to perforators incidentally covered by the stent. 19 Of particular relevance to vision outcomes and optic nerve compression, FD pro motes reabsorption of the thrombus and theoretically di minishes mass effect.…”

Section: Discussionmentioning

confidence: 99%

Vision outcomes in patients with paraclinoid aneurysms treated with clipping, coiling, or flow diversion: a systematic review and meta-analysis

Silva

See

Dasenbrock

et al. 2017

Neurosurgical Focus

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OBJECTIVEPatients with paraclinoid aneurysms commonly present with visual impairment. They have traditionally been treated with clipping or coiling, but flow diversion (FD) has recently been introduced as an alternative treatment modality. Although there is still initial aneurysm thrombosis, FD is hypothesized to reduce mass effect, which may decompress the optic nerve when treating patients with visually symptomatic paraclinoid aneurysms. The authors performed a meta-analysis to compare vision outcomes following clipping, coiling, or FD of paraclinoid aneurysms in patients who presented with visual impairment.METHODSA systematic literature review was performed using the PubMed and Web of Science databases. Studies published in English between 1980 and 2016 were included if they reported preoperative and postoperative visual function in at least 5 patients with visually symptomatic paraclinoid aneurysms (cavernous segment through ophthalmic segment) treated with clipping, coiling, or FD. Neuroophthalmological assessment was used when reported, but subjective patient reports or objective visual examination findings were also acceptable.RESULTSThirty-nine studies that included a total of 2458 patients (520 of whom presented with visual symptoms) met the inclusion criteria, including 307 visually symptomatic cases treated with clipping (mean follow-up 26 months), 149 treated with coiling (mean follow-up 17 months), and 64 treated with FD (mean follow-up 11 months). Postoperative vision in these patients was classified as improved, unchanged, or worsened compared with preoperative vision. A pooled analysis showed preoperative visual symptoms in 38% (95% CI 28%–50%) of patients with paraclinoid aneurysms. The authors found that vision improved in 58% (95% CI 48%–68%) of patients after clipping, 49% (95% CI 38%–59%) after coiling, and 71% (95% CI 55%–84%) after FD. Vision worsened in 11% (95% CI 7%–17%) of patients after clipping, 9% (95% CI 2%–18%) after coiling, and 5% (95% CI 0%–20%) after FD. New visual deficits were found in patients with intact baseline vision at a rate of 1% (95% CI 0%–3%) for clipping, 0% (95% CI 0%–2%) for coiling, and 0% (95% CI 0%–2%) for FD.CONCLUSIONSTo the authors’ knowledge, this is the first meta-analysis to assess vision outcomes after treatment for paraclinoid aneurysms. The authors found that 38% of patients with these aneurysms presented with visual impairment. These data also demonstrated a high rate of visual improvement after FD without a significant difference in the rate of worsened vision or iatrogenic visual impairment compared with clipping and coiling. These findings suggest that FD is an effective option for treatment of visually symptomatic paraclinoid aneurysms.

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“…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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Microneurosurgical Management of Ophthalmic Segment of the Internal Carotid Artery Aneurysms: Single-Surgeon Operative Experience From Louisiana State University, Shreveport

Cited by 49 publications

References 30 publications

Neuroophthalmological outcomes associated with use of the Pipeline Embolization Device: analysis of the PUFS trial results

Neuroophthalmological outcomes associated with use of the Pipeline Embolization Device: analysis of the PUFS trial results

Vision outcomes in patients with paraclinoid aneurysms treated with clipping, coiling, or flow diversion: a systematic review and meta-analysis

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

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