Articles: ophthalmic-artery-surgery.
-
These video cases present some unique technical tenets for microsurgical clipping of proximal internal carotid artery aneurysms (Video 1). The first patient is a 49-year-old woman with a history of a prior ruptured and treated right middle cerebral artery aneurysm who was found to have growth of known left middle cerebral artery and left internal carotid artery ophthalmic segment aneurysms on radiographic studies. An intradural clinoidectomy with Sonopet, with proximal control at cervical carotid and wide sylvian fissure exposure with ample sharp dissection of the aneurysm anatomy, allowed safe clipping of the ophthalmic aneurysm in this case. ⋯ A similar controlled intradural clinoidectomy, with proximal cervical ICA control and aneurysmal segment trapping, allowed safe aneurysm exclusion. For patients with multiple aneurysms such as in these cases, the deeper proximal aneurysm should generally be treated first. The videos illustrate some key technical points in this regard.
-
Spontaneous cervical artery dissection (sCAD) is a major cause of stroke in young adults. Multiple sCAD is a rarer, more poorly understood presentation of sCAD that has been increasingly attributed to cervical trauma such as spinal manipulation or genetic polymorphisms in extracellular matrix components. ⋯ Endovascular intervention by placement of Pipeline embolization devices and Atlas stents in bilateral internal carotid arteries was successfully performed. No syndromic or systemic etiology was discovered during a thorough workup.
-
Journal of neurosurgery · Dec 2018
Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms.
OBJECTIVEWhile most paraclinoid aneurysms can be clipped with excellent results, new postoperative visual deficits are a concern. New technology, including flow diverters, has increased the popularity of endovascular therapy. However, endovascular treatment of paraclinoid aneurysms is not without procedural risks, is associated with higher rates of incomplete aneurysm occlusion and recurrence, and may not address optic nerve compression symptoms that surgical debulking can. ⋯ CONCLUSIONSThe most important risk associated with clipping OphA aneurysms is a new visual deficit. Meticulous microsurgical technique is necessary during anterior clinoidectomy, aneurysm dissection, and clip application to optimize visual outcomes, and aggressive medical management postoperatively might potentially decrease the incidence of delayed visual deficits. As the results of endovascular therapy and specifically flow diverters become known, they warrant comparison with these surgical benchmarks to determine best practices.
-
Flow-diverter stents (FDSs) are an upgrade in the treatment of intracranial aneurysms. However, complications concerning covered branches have been reported, especially the ophthalmic artery (OA). The purpose of our study was to evaluate the long-term ophthalmic complication rate of carotid-ophthalmic aneurysms (COA) without visual pathways compression, treated by a FDS covering the OA by performing an exhaustive ophthalmic examination. ⋯ Patients treated by FDS for COA have a good long-term clinical ophthalmic outcome. However, extensive ophthalmic examination shows a high percentage of minor ophthalmic modifications. Interventional neuroradiologists should be aware of these possible complications when choosing to treat these aneurysms with FDS.
-
Comparative Study
Optic Canal Decompression: A Comparison Of Two Surgical Techniques.
The optic canal is a bony channel that connects the anterior cranial fossa and orbit and contains the optic nerve and ophthalmic artery. It can be affected by several pathologies, leading to compression of the nerve nearby or inside the canal, leading to visual impairment. The usual technique to decompress the canal is through a craniotomy, but recently endoscopic endonasal approaches (EEAs) have surfaced as an interesting alternative due to direct access to the canal without the need for manipulation of neurovascular structures. ⋯ The decision for an approach for optic canal decompression should be based on the site of the pathology and localization of canal involvement. Both techniques are equivalent in terms of proportion of nerve decompression.