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Hong Z, Noonan JE, Mitchell PJ, Hardy TG. Peripheral Ophthalmic Artery Aneurysm Associated with Multifocal Intracranial and Extracranial Aneurysms: Case Report and Literature Review. Case Rep Ophthalmol 2023; 14:257-266. [PMID: 37383172 PMCID: PMC10294283 DOI: 10.1159/000530475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/28/2023] [Indexed: 06/30/2023] Open
Abstract
Peripheral ophthalmic artery aneurysm is a rare disease entity. We review the relevant literature and report a case of fusiform aneurysm involving the entire intraorbital ophthalmic artery in association with multiple intracranial and extracranial aneurysms, diagnosed on digital subtraction angiography. The patient suffered irreversible blindness secondary to compressive optic neuropathy which did not improve after a 3-day trial of intravenous methylprednisolone. Autoimmune screen was normal. The underlying cause is unknown.
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Affiliation(s)
- Zixin Hong
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan E. Noonan
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Peter J. Mitchell
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Thomas G. Hardy
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
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Furst T, Mattingly TK, Williams ZR, Schartz D, Bender MT. A novel endovascular treatment for true ophthalmic aneurysms: A case report. FRONTIERS IN OPHTHALMOLOGY 2022; 2:940479. [PMID: 38983550 PMCID: PMC11182110 DOI: 10.3389/fopht.2022.940479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/26/2022] [Indexed: 07/11/2024]
Abstract
Introduction Cerebral aneurysms located along the internal carotid artery at the origin of the ophthalmic artery can be treated through open surgery or endovascular technique. The former affords more certainty of aneurysm obliteration, while the latter poses less risk to vision. Flow diversion is an increasingly accepted treatment for side-wall carotid aneurysms, although location at the branch point of the ophthalmic artery is known to moderate occlusion outcomes. Case presentation We present a case of a middle-aged female patient with a morphologically irregular 4-mm ophthalmic artery aneurysm (OphA) and a smaller superior hypophyseal artery (SHA) aneurysm whose successful and uncomplicated obliteration by flow diversion with adjunctive coiling was predicted via a balloon test occlusion (BTO). BTO was employed prior to stent placement to confirm a) ophthalmic artery distal collateralization with external carotid artery (ECA) branches and b) preserved arterial flow in the retina visualized via fundoscopy. At 1 year following angiography, the patient had no postoperative deficits and benefitted from complete occlusion of the OphA and SHA. Conclusion OphAs constitute a complex surgical disease that is historically associated with high visual morbidity. We present a novel advanced endovascular technique of BTO followed by flow diversion with adjunctive coiling that successfully obliterated an OphA while preserving vision.
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Affiliation(s)
- Taylor Furst
- Department of Neurological Surgery, University of Rochester Medical Center, NY, Rochester, United States
| | - Thomas K Mattingly
- Department of Neurological Surgery, University of Rochester Medical Center, NY, Rochester, United States
| | - Zoë R Williams
- Department of Ophthalmology, University of Rochester Medical Center, NY, Rochester, United States
| | - Derrek Schartz
- Department of Imaging Sciences, University of Rochester Medical Center, NY, Rochester, United States
| | - Matthew T Bender
- Department of Neurological Surgery, University of Rochester Medical Center, NY, Rochester, United States
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Song J, Mao Y. Giant Aneurysm Management. Adv Tech Stand Neurosurg 2022; 44:133-160. [PMID: 35107677 DOI: 10.1007/978-3-030-87649-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The treatment of giant aneurysms has always been a challenge in the field of neurovascular disease. Giant aneurysms are larger in size and are associated with thrombosis development and the calcification of the aneurysmal wall and neck, which often interfere with direct clipping. Most giant aneurysms have a wide neck with an incomplete thrombus, making complete embolization almost impossible. Giant aneurysms of different sites have entirely different hemodynamic characteristics. Moreover, aneurysms at the same site may exhibit very different hemodynamics among different individuals. Therefore, careful assessment of each case is required before and during treatment to develop and carry out an individualized treatment plan.
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Affiliation(s)
- Jianping Song
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. .,Neurosurgical Institute of Fudan University, Shanghai, China. .,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China. .,National Center for Neurological Disorders, Shanghai, China.
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Lu G, Chung J, Park JC, Ahn JS, Kwun BD, Lee DH. Comparison of Visual Outcomes of Ophthalmic Artery Aneurysms Treated with Microsurgical Clipping and Endovascular Coiling. Neurointervention 2022; 17:18-27. [PMID: 35045591 PMCID: PMC8891588 DOI: 10.5469/neuroint.2020.00185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Post-treatment visual deficit is a major concern associated with both microsurgical clipping and endovascular coiling for the treatment of ophthalmic artery (OphA) aneurysms of the internal carotid artery. We aimed to compare the safety and effectiveness of the 2 modalities. MATERIALS AND METHODS We retrospectively reviewed and compared the baseline characteristics and postoperative visual and angiographic outcomes of OphA aneurysms treated by clipping or coiling between January 2010 and August 2018 at our hospital. In addition, the balloon occlusion test was performed to evaluate the safety of OphA occlusion. RESULTS This study included 56 aneurysms treated by clipping and 82 aneurysms treated by coiling. Both the immediate and follow-up rates of incomplete aneurysm occlusion were comparable between the 2 groups (21.4% vs. 22.0%; 24.4% vs. 23.6%). The incidence of post-treatment visual deficits was higher in the clipping group than in the coiling group (16.1% vs. 2.4%; P=0.010). We observed total ipsilateral OphA occlusion in 6 patients and near occlusion in 3 patients during endovascular coiling; however, only 1 patient with near OphA occlusion showed a post-treatment visual field defect. CONCLUSION OphA aneurysms treated by endovascular coiling exhibited an aneurysm occlusion rate similar to that of microsurgical clipping with fewer post-treatment visual deficits. The total occlusion of OphA with adequate collaterals did not cause post-treatment visual deficits.
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Affiliation(s)
- Guangdong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jaewoo Chung
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Maruyama D, Nanto M, Ogita S, Kishida K, Fujiwara G, Murakami M, Murakami N, Hashimoto N. Super-selective balloon test occlusion with electrophysiological monitoring to occlude angiographically invisible posterior communicating artery perforators with unruptured aneurysm. Acta Neurochir (Wien) 2022; 164:169-172. [PMID: 34850290 DOI: 10.1007/s00701-021-05074-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022]
Abstract
Balloon test occlusion (BTO) can predict the ischemic complication risk associated with arterial occlusion. We present a case of an unruptured, broad-necked internal carotid artery-posterior communicating artery (PcomA) aneurysm that was successfully embolized after super-selective BTO of fetal PcomA with electrophysiological monitoring. The proximal portion of the PcomA was internally occluded without causing major neurological deficits, although we observed a small new infarction in the ipsilateral anterior thalamus postoperatively. We recognized small perforators arising from the proximal PcomA during a previous clipping surgery. Super-selective BTO with electrophysiological monitoring could be useful for functional preservation after infarction from angiographically invisible perforators.
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Affiliation(s)
- Daisuke Maruyama
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
| | - Masataka Nanto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shogo Ogita
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kengo Kishida
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Gaku Fujiwara
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Mamoru Murakami
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Nobukuni Murakami
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Sattur M, Saway BF, Lena J, Spiotta A. Endovascular Management of a Giant Skull Base Cavernous Aneurysm: Parent Artery Occlusion Is Still a Relevant Strategy. Cureus 2021; 13:e13643. [PMID: 33824796 PMCID: PMC8012178 DOI: 10.7759/cureus.13643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cavernous carotid aneurysms (CCAs) are usually considered benign as the natural history of the condition is often asymptomatic; however, CCAs can reach giant proportions and become symptomatic, thus requiring treatment. The introduction of flow diverters has revolutionized management of this condition. However, the parent artery geometry in giant lesions may prove exceedingly difficult to navigate and deploy stents satisfactorily. In such cases, indirect surgical treatment such as proximal occlusion of internal carotid artery (ICA) should be employed. Preoperative balloon test occlusion is indicated before permanent occlusion to identify patients who demonstrate hemispheric ischemia (for possible bypass), but it requires understanding of important operative complications and technical nuances. Endovascular parent artery sacrifice is an effective modality to achieve proximal occlusion. Here, we describe the step-wise management approach in a 53-year-old female with a giant, left CCA presenting with headache and cavernous sinus syndrome who was ultimately successfully treated with endovascular coiling and ICA occlusion. The management of complex lesions such as giant skull base aneurysms requires a sound understanding of vascular anatomy, tools available for evaluation, and physiological interpretation of diagnostic and therapeutic modalities to obtain excellent clinical results and patient satisfaction.
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Affiliation(s)
- Mithun Sattur
- Department of Neurological Surgery, Medical University of South Carolina, Charleston, USA
| | - Brian F Saway
- Department of Neurological Surgery, Medical University of South Carolina, Charleston, USA
| | - Jonathan Lena
- Department of Neurological Surgery, Medical University of South Carolina, Charleston, USA
| | - Alejandro Spiotta
- Department of Neurological Surgery, Medical University of South Carolina, Charleston, USA
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Michishita S, Ishibashi T, Yuki I, Urashima M, Karagiozov K, Kodama T, Kan I, Nishimura K, Kato N, Ikemura A, Murayama Y. Visual complications after coil embolization of internal carotid artery aneurysms at the ophthalmic segment. Interv Neuroradiol 2021; 27:622-630. [PMID: 33615875 DOI: 10.1177/1591019921996886] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Coil embolization of aneurysms of the ophthalmic segment of the internal carotid artery (ICA-OphA ANs) has potential risks of visual complications. We analyzed this risk and focused on the relationship of the ophthalmic artery (OphA) origin with the aneurysm neck. METHODS From January 2003 to April 2018, 179 unruptured ICA-OphA ANs were treated with endovascular surgery in our institution. Two ruptured and four aneurysms with missing data were excluded. Finally, 173 unruptured aneurysms were included in this study. The aneurysms were classified into three groups according to the location of the OphA origin: Separate, Shared, and Dome type. We retrospectively assessed visual complications based on the relationship between types of aneurysm and postoperative angiographic findings for the OphA. RESULTS Visual deficits remained permanent in eleven cases (6.4%). In the Dome type, visual complications were significantly more frequent compared to the Separate type. Change in the OphA flow was significantly associated with a higher complication rate of 2.9%, but patients with changed OphA flow had a significant rate of 7.5% (p = 0.020). We found no significant difference in the incidence of visual complications concerning the use of perioperative antithrombotic therapy. CONCLUSIONS The location of OphA origin regarding the aneurysmal neck and postoperative OphA flow were significantly correlated with the visual outcome after coil embolization for ICA-OphA ANs. Post-procedural flow in the OphA was an important factor affecting the rate of ischemic retinal complications. Retinal embolic events occurred with preserved flow in the OphA, albeit at a lower rate.
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Affiliation(s)
- Shotaro Michishita
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ichiro Yuki
- Department of Neurological Surgery, University of California Irvine, Irvine, CA, USA
| | - Mitsuyoshi Urashima
- Department of Innovation for Medical Information, The Jikei University School of Medicine, Tokyo, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomonobu Kodama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kengo Nishimura
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Kato
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ayako Ikemura
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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Garala P, Virdee J, Qureshi M, Gillow T. Intraorbital aneurysm of the ophthalmic artery. BMJ Case Rep 2019; 12:12/4/e227044. [PMID: 31015236 DOI: 10.1136/bcr-2018-227044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intraorbital ophthalmic artery (OA) aneurysms are rare. They can be asymptomatic or present with visual disturbances, exophthalmos and headaches. We present a case of a 57-year-old man who presented with reduced vision, diplopia and exophthalmos. A carotid artery angiogram identified a right OA aneurysm. Due to the low risk of rupture and the patient's comorbidities including cardiac and renal impairment, a conservative approach was followed. A few weeks post presentation, the patient's vision and optic nerve function had improved. This case reiterates the importance of considering conservative treatment for patients with intraorbital OA aneurysms.
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Affiliation(s)
- Pavitra Garala
- Department of Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Jasvir Virdee
- Department of Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Madyan Qureshi
- Department of Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Timothy Gillow
- Department of Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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Balasundaram P, Sebastian LJD, Jain N, Prabhakar A, Garg A, Gaikwad S. Management of Arterial Pseudoaneurysms of the Neck in a Pediatric Population: An Endovascular Case Series and Review of Literature. World Neurosurg 2019; 125:e273-e281. [PMID: 30684708 DOI: 10.1016/j.wneu.2019.01.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arterial pseudoaneurysms of the neck are rarely reported in the pediatric population and no dedicated large series are available. Trauma and infection are the most common causes for these aneurysms, with congenital and collagen vascular disorders being the less common causes. These lesions can be life threatening, especially when they present with bleeding or airway compromise. METHODS We searched our radiology information system for all cases of pediatric neck aneurysm presented between June 2015 and May 2018. These cases were analyzed for clinicoepidemiologic variables, clinical presentation, imaging findings, management, and follow-up. RESULTS Six children were included in the study (male/female ratio, 5:1), with a mean age of 7.8 years (range, 2.5-15 years). Four presented acutely with either bleeding or rapidly enlarging neck swelling, whereas 2 presented with slowly increasing pulsatile swelling. One had a traumatic cause, 2 had infections, and 1 had infective cervical lymphadenitis complicated by iatrogenic injury whereas no definite causative mechanisms could be accounted for in 2 patients. Two of the children were managed by trapping of the aneurysm and 2 only by proximal parent vessel occlusion. The other 2 children were treated with stent graft deployment across the aneurysm neck to reconstruct the parent vessel. All the patients were doing well during the follow-up period (mean, 14.8 months). CONCLUSIONS Endovascular means of treatment for pediatric neck aneurysms is relatively simple and safe. Although parent vessel sacrifice is the gold-standard management, vessel-preserving strategies can be tried in select cases with favorable anatomy.
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Affiliation(s)
- Parthiban Balasundaram
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nishchint Jain
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anuj Prabhakar
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shailesh Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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