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

Abstract

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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“…Hence, it might be safe to disconnect the SHA on one side in a high percentage of cases. This hypothesis is consistent with the results of a large series of studies by Horiuchi et al on the visual outcomes of clipped SHA aneurysms 31 . Two of our patients had blood vessels from the SHA involved in blood supply to the tumor.…”

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“…Johnson et al ( 21 ) stated that homonymous hemianopsia developed after the operation in a patient who underwent SHA aneurysm embolization. Horiuchi et al ( 22 ) stated that a visual deficit of 13% was observed in a series of 70 patients with SHA aneurysms, and it was commented that unilateral sacrification could not always be performed in SHA aneurysms.…”

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“…7 A homonymous hemianopia was reported after the SHA was occluded during aneurysm em-bolization with Onyx HD-500. 15 Horiuchi et al conducted a large series on visual outcome after clipping an SHA aneurysm; 14 the overall incidence of a visual deficit was 13%, among which 1 of 18 cases experienced visual loss despite SHA preservation, 2 of 22 cases had visual loss after sacrifice of the SHA, and 6 of 20 cases endured visual deficit with an undetermined condition of the SHA. In their series, however, the authors excluded carotid cave aneurysms, an area in which two-thirds of pSHAs originate, and data did not specify whether the SHAs were primary or secondary.…”