Articles: ophthalmic-artery-surgery.
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Carotid-ophthalmic aneurysms arise from the internal carotid artery between the distal dural ring and the origin of the posterior communicating artery. The surgical treatment of these aneurysms usually requires anterior clinoidectomy. However, this procedure is not without complications. In the present report, we have described optic nerve mobilization after optic foraminotomy as an alternative to anterior clinoidectomy to clip superior carotid-ophthalmic aneurysms. ⋯ Optic nerve mobilization after optic foraminotomy proved to be a safe and relatively easy technique for exposing and treating superior carotid-ophthalmic aneurysms.
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Flow diversion with or without coil embolization has become the first-line treatment for large or giant paraclinoid internal carotid artery intracranial aneurysms. Oftentimes, these sizable aneurysms impose anatomical challenges to endovascular treatment through limiting both distal outflow access and maintenance of distal vessel purchase during catheter reduction, which are required for successful stent placement. Various strategies to obtain and maintain distal access within the parent vessel have been described previously; however, new techniques may need to be employed when more standard maneuvers fail. ⋯ Giant, wide-neck aneurysms present treatment challenges that may require using adjunctive devices and advanced endovascular techniques. When routine strategies for gaining distal outflow access fail, the Ricochet-Scepter technique is a viable option for achieving distal access.
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Case Reports
Rare transsellar collateral artery and secondary ophthalmic artery aneurysm in young adult with ICA aplasia.
Internal carotid artery (ICA) aplasia is a rare congenital abnormality in which the third aortic arch fails to develop. Most collateral circulation will originate from the circle of Willis, with other sites being rare. Changes in flow through the collateral vasculature result in aneurysm formation at a young age. ⋯ The present case demonstrates an extremely rare Lie type D collateralization pattern and secondary flow-rated aneurysm in the context of ICA aplasia. Patients identified with this anatomic variant should be monitored for subsequent aneurysm formation. Identification of this variant before endovascular and transsphenoidal procedures is crucial to prevent major intracranial vessel injury.
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Review Case Reports
Visual evoked potentials and intraoperative awakening in ophthalmic artery sacrifice during aneurysm clipping: two cases and literature review.
Complete aneurysm obliteration is the goal of aneurysm treatment. In selected cases, a neck remnant may be left to preserve a critical branch. Literature on ophthalmic artery sacrifice in the treatment of cerebral aneurysms and subsequent risk of vision loss is limited. ⋯ We report for the first time the use of visual evoked potential monitoring and intraoperative awakening to test visual function following intentional ophthalmic artery sacrifice to demonstrate gross vision preservation.