Predictor of Visual Impairment Following Paraclinoid Aneurysm Surgery: Special Consideration of Surgical Microanatomy Related to Paraclinoid Structures

2020 ◽  
Vol 20 (1) ◽  
pp. 45-54
Author(s):  
Nakao Ota ◽  
Ioannis Petrakakis ◽  
Kosumo Noda ◽  
Takanori Miyazaki ◽  
Tomomasa Kondo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Impairment ◽  
Multivariate Logistic Regression Analysis ◽  
Visual Deficits ◽  
Microsurgical Clipping ◽  
Paraclinoid Aneurysm ◽  
Paraclinoid Aneurysms ◽  
Visual Field Deficits

Abstract BACKGROUND Microsurgical clipping with extradural anterior clinoidectomy (EDAC) for paraclinoid aneurysm is an established technique with good angiographic outcomes, although postoperative worsening of visual acuity remains a concern. Multiple reports show visual acuity deteriorating after clipping, yet the cause remains unclear. OBJECTIVE To analyze results of asymptomatic paraclinoid aneurysm surgeries treated with EDACs, specifically focusing on the microanatomy of paraclinoid structure dissection. This determined the causes of delayed visual impairment and microsurgical indications. METHODS Results of the treatment with EDAC of 94 patients with cerebral aneurysm and normal preoperative visual acuity but also full visual fields were retrospectively analyzed. RESULTS The mean aneurysm size was 6.2 (±3.3) mm. Clipping was performed in 87 cases and trapping in 7 cases. Complete angiographic occlusion was observed in 91 patients. In 26 cases, a postoperative visual deficit occurred. A total of 20 cases exhibited partial visual field deficits, including 5 who were asymptomatic. Visual deficits were only detectable by postoperative ophthalmologic testing. Six showed light perception impairment or blinding. Of the 15 patients with symptomatic partial visual field deficits, 5 showed improvement at follow-up. Visual deficits persisted in 22 patients at the last follow-up. Multivariate logistic regression analysis revealed that medial projecting aneurysm (adjusted odds ratio [OR]: 10.43) and the opening of the carotidoculomotor membrane (adjusted OR: 5.19) were significantly related to visual impairment. CONCLUSION Excess dissection of carotidoculomotor membranes causes postoperative delayed visual worsening. For treating small, asymptomatic paraclinoid aneurysms, carotidoculomotor membranes should not be opened, and microsurgical clipping should not be performed for preoperative asymptomatic medial projecting aneurysms.

Neuro-ophthalmological assessment of vision before and after radiation therapy alone for pituitary macroadenomas

1990 ◽  
Vol 72 (4) ◽  
pp. 594-599 ◽  
Author(s):  
Stephen C. Rush ◽  
Mark J. Kupersmith ◽  
Irving Lerch ◽  
Paul Cooper ◽  
Joseph Ransohoff ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Radiation Therapy ◽  
Visual Field ◽  
Visual Impairment ◽  
Optic Atrophy ◽  
Radiation Treatment ◽  
Visual Field Defects ◽  
Content Type ◽  
Pituitary Macroadenomas

✓ Between 1972 and 1988, 25 patients were treated by radiation therapy (RT) alone for pituitary macroadenomas causing visual impairment. Twenty-three patients were evaluated by a neuro-ophthalmologist before treatment and at the time of follow-up review. Radiation treatment consisted of 4000 to 5000 cGy over 4 to 5 weeks. The median follow-up period was 36 months (range 2 to 192 months). Eighteen patients (78%) experienced visual field improvement. Deterioration occurred in four patients due to tumor recurrence, tumor hemorrhage, possible optic nerve necrosis, and optic chiasm herniation. Visual field improvement occurred predominantly in patients whose pretreatment visual field defects were less than a dense hemianopsia, who did not have diffuse optic atrophy, and who were younger than the median age of 69 years (p < 0.001). Visual acuity improvement occurred in patients without diffuse optic atrophy, with only mild impairment of the visual acuity, and with only mild visual field loss prior to RT (p < 0.002). It is concluded that there is a subset of patients with pituitary macroadenomas and visual impairment for whom primary RT is a treatment option.

scholarly journals Microsurgical clipping of paraclinoid aneurysms

2020 ◽  
pp. 31-40
Author(s):  
Mugurel Radoi ◽  
Ram Vakilnejad ◽  
Suditu Stefan ◽  
Florin Stefanescu
Keyword(s):  
Endovascular Coiling ◽  
Parent Artery ◽  
Excellent Outcome ◽  
Microsurgical Clipping ◽  
Paraclinoid Aneurysm ◽  
Postoperative Control ◽  
Paraclinoid Aneurysms ◽  
Operative Control ◽  
Ophthalmic Segment Aneurysms

Background. Paraclinoid aneurysm is a nonspecific term that includes ophthalmic segment aneurysms and distal cavernous internal carotid artery (ICA) aneurysms. The literature mostly described the frequency to be in the range of 1.3-5%. and a high incidence of being multiple or having a large size. Methods. A retrospective review of 18 consecutive patients surgically treated for paraclinoid aneurysm was performed. The data of all our consecutive patients were searched to obtain patient and aneurysm characteristics, treatment details, complications and follow up. Clinical outcome was graded according to the modified Rankin scale. The follow-up period varied widely from 3 to 62 months (mean 26 months). Results. Surgical clipping was performed for 15 ruptured paraclinoid aneurysms; only in 3 cases the aneurysm was unruptured. Post-operative control angiography was performed in 10 patients (55.56%), from which we reported a full occlusion of the aneurysm in 9 patients (90%). Best results were obtained in patients who preoperatively were included in 1st and 2nd grade of Hunt & Hess scale. Two months postoperative follow-up was complete for all but one patient who died 12 days after surgery, from cerebral ischemia resulting from severe cerebral vasospasm. There were excellent and good results (mRS 0–2) in 88% of the cases (15 out of 17 patients) at two months follow-up, and 94% (16 out of 17 patients) at six months follow-up. Three patients with slight disabilities, ranked mRS 1-2 at two months follow-up, improved to mRS 0, with no symptoms at all, at 6 months postoperative control. All 3 patients with a surgically treated non-ruptured paraclinoid aneurysm had an excellent outcome (mRS 0). Conclusions. Most appropriate treatment is to occlude aneurysms without compromising patency of the parent artery. Anterior clinoidectomy and microsurgical clipping can still be a standard treatment despite of recent development of endovascular coiling procedures.

scholarly journals Visual impairment in children with a brain tumor: a prospective nationwide multicenter study using standard visual testing and optical coherence tomography (CCISS study)

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
M. A. Nuijts ◽  
M. H. Degeling ◽  
I. Stegeman ◽  
A. Y. N. Schouten-van Meeteren ◽  
S. M. Imhof
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Brain Tumor ◽  
Visual Field ◽  
Visual Impairment ◽  
Visual Function ◽  
Field Testing ◽  
Optical Coherence ◽  
Visual Field Testing

Abstract Background Children with a brain tumor have a high risk of impaired vision. Up to now, visual acuity measurement, visual field testing and orthoptic testing are the most informative diagnostic investigations for the assessment of visual function. Evaluating vision in children can be challenging given the challenges in cooperation, concentration and age-dependent shifts in visual tests. Since visual loss due to a brain tumor can be progressive and irreversible, we must aim to detect visual impairment as early as possible. Several studies have shown that optical coherence tomography facilitates discovery of nerve fiber damage caused by optic nerve glioma. Consequently, early detection of potential ocular damage will effect treatment decisions and will provide timely referral to visual rehabilitation centers. Methods/design The CCISS study is a prospective, observational, multicenter cohort study in The Netherlands. Patients aged 0–18 years with a newly diagnosed brain tumor are invited for inclusion in this study. Follow-up visits are planned at 6, 12, 18 and 24 months. Primary endpoints are visual acuity, visual field and optical coherence tomography parameters (retinal nerve fiber layer thickness and ganglion cell layer – inner plexiform layer thickness). Secondary endpoints include the course of visual function (measured by visual acuity, visual field and optical coherence tomography at different follow-up visits), course of the disease and types of treatment. Discussion The CCISS study will heighten the awareness of visual impairment in different types of brain tumors in children. This study will show whether optical coherence tomography leads to earlier detection of visual impairment compared to standard ophthalmological testing (i.e. visual acuity, visual field testing) in children with a brain tumor. Furthermore, the systematic approach of ophthalmological follow-up in this study will give us insight in the longitudinal relation between the course of visual function, course of the disease and types of treatment in children with a brain tumor. Trial registration The CCISS study is prospectively registered in the Netherlands Trial Register (NTR) since April 2019. Identifier: NL7697.

Abstract 202: Vision Outcomes for Paraclinoid Aneurysms Treated with Clipping, Coiling, or Flow Diversion: A Meta-analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Michael A Silva ◽  
Alfred P See ◽  
Hormuzdiyar H Dasenbrock ◽  
Mohammad A Aziz-Sultan
Keyword(s):  
Visual Impairment ◽  
Meta Analysis ◽  
Mass Effect ◽  
Flow Diversion ◽  
High Rate ◽  
Visual Deficits ◽  
Visual Improvement ◽  
Paraclinoid Aneurysms ◽  
Aneurysm Thrombosis

Introduction: Paraclinoid aneurysms commonly present with visual impairment. They were traditionally treated with clipping or coiling, but flow diversion has recently been introduced as an alternative treatment modality. Although there is still initial aneurysm thrombosis, flow diversion is hypothesized to reduce mass effect, which may decompress the optic nerve when treating visually symptomatic paraclinoid aneurysms. We performed a meta-analysis to compare vision outcomes following clipping, coiling, or flow diversion of paraclinoid aneurysms in patients presenting with visual impairment. Methods: A systematic literature review was performed using the PubMed and Web of Science databases. Studies written in English between 1980-2016 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 flow diversion. Neuro-ophthalmologic assessment was used when reported. Results: Thirty-nine studies totaling 2458 patients (20%, 510 of whom presented with visual symptoms) met our inclusion criteria, including 309 visually symptomatic cases treated with clipping (mean follow-up, 25.9 mo), 138 treated with coiling (17.1 mo), and 63 treated with flow diversion (11 mo). Postoperative vision in these patients was classified as improved, unchanged, or declined compared to preoperative vision. We found that vision improved in 57% (95% CI 47-67) of patients after clipping, 45% (34-57) after coiling, and 73% (56-88) after flow diversion. Vision worsened in 11% (7-17) of patients after clipping, 8% (2-17) after coiling, and 7% (0-27) after flow diversion. New visual deficits were found in patients with intact baseline vision at a rate of 0.69% (0-2) for clipping, 0.53% (0-3) for coiling, and 0.80% (0-3) for flow diversion. Conclusion: Our data demonstrates a high rate of visual improvement and a low rate of iatrogenic vision impairment for patients with paraclinoid aneurysms treated with flow diversion. Further analysis is needed to compare flow diversion to clipping and coiling and inform clinical management of visually symptomatic paraclinoid aneurysms.

Retrograde Suction Decompression for Clipping of a Giant Ophthalmic Internal Carotid Artery Aneurysm: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Visish M Srinivasan ◽  
Michael Zhang ◽  
Lea Scherschinski ◽  
Alexander C Whiting ◽  
Mohamed A Labib ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Carotid Bifurcation ◽  
Aneurysm Neck ◽  
Microsurgical Clipping ◽  
Complex Anatomy ◽  
Internal Carotid Artery Aneurysm ◽  
Paraclinoid Aneurysms

Abstract Microsurgical clipping of large paraclinoid aneurysms is challenging because of the complex anatomy of the dural rings, lack of easy proximal control, and wide aneurysm necks. Proximal retrograde suction decompression, or the Dallas technique, can reduce aneurysm turgor and, with aspiration of the trapped cervical and supraclinoid internal carotid arteries (ICAs), can collapse the aneurysm to aid microsurgical clipping.1-5  A woman in her late 30s presented with decreased right-eye visual acuity. Informed written consent was obtained for microsurgical management and publication. Upon cervical exposure of the carotid bifurcation, we performed a standard pterional craniotomy, trans-sylvian exposure, and intradural anterior clinoidectomy. After burst suppression and cross-clamping of the carotid, we inserted an angiocatheter at the common carotid artery (CCA). Distal temporary clips were placed on the posterior communicating artery and C7 ICA. With the cervical ICA unclamped, retrograde suction was continuously applied to deflate the aneurysm. We applied 2 pairs of fenestrated-booster clips to the aneurysm dome and a fifth clip to the aneurysm neck. After restoration of flow, indocyanine green angiography and Doppler assessments were performed. The proximal clip was converted into a curved clip to optimize ICA flow.  Postoperative angiography confirmed complete occlusion of the aneurysm. The patient was discharged on postoperative day 3, with stable visual acuity.6 This video demonstrates that retrograde suction decompression via the cervical CCA can be safely performed to facilitate clipping of complex paraclinoid ICA aneurysms. Comprehensive planning of temporary aneurysm trapping for suction decompression and permanent clip construct for aneurysm occlusion are needed for effective aneurysm repair.

Twenty-year outcomes in patients with newly diagnosed glaucoma: mortality and visual function

2018 ◽  
Vol 102 (12) ◽  
pp. 1663-1666
Author(s):  
Christopher King ◽  
Justin C Sherwin ◽  
Gokulan Ratnarajan ◽  
John F Salmon
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Open Angle Glaucoma ◽  
Survival Curve ◽  
Visual Outcome ◽  
Field Analysis ◽  
Time To Death ◽  
Kaplan Meier ◽  
Two Stages

Background/aimsTo determine the mortality within 20 years of diagnosis of chronic open-angle glaucoma (COAG) and visual acuity and visual field progression of a cohort followed for 20 years.MethodsTwenty years following the diagnosis of COAG in 68 of 436 (16%) patients seen in a glaucoma case-finding clinic, visual and mortality outcomes were audited from medical records. Causes of death were obtained from general practitioner records and death certificates. Probability of death was calculated using a Kaplan-Meier survival curve. The visual field of each eye of survivors was graded using a nine-stage severity scale. Visual outcome was analysed at the 20-year follow-up visit.ResultsFrom 68, 14 (21%) were lost to follow-up. In the remaining 54, 20 (37%) were alive 20 years after diagnosis. Of 63% who died, mean age of death was 84 years, most commonly due to vascular disease. Mean age at presentation of those who died was 73.7 years versus 63.2 years for survivors (P=0.001). The median time to death was 16 years. On visual field analysis, nearly half (48.9%) of eyes did not deteriorate, but 28.3% eyes deteriorated by more than two stages. Those who died had worse final visual acuity than survivors (P<0.001). Three who died were registered severely visually impaired mainly from macular disease, but no survivors were registered (P<0.001).ConclusionIn this cohort, approximately two-thirds of patients with glaucoma died within 20 years of diagnosis. In most older patients with glaucoma, the overall goal of preventing visual handicap and blindness is achievable 20 years after diagnosis.

Cardiovascular health and near visual impairment among older adults in the Republic of Congo: a population-based study

2020 ◽  
Author(s):  
Antoine Gbessemehlan ◽  
Catherine Helmer ◽  
Cécile Delcourt ◽  
Farid Boumediene ◽  
Bébène Ndamba-Bandzouzi ◽  
...  
Keyword(s):  
Older Adults ◽  
Visual Acuity ◽  
Visual Impairment ◽  
Cardiovascular Health ◽  
Central Africa ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Logistic Regression Models ◽  
Sub Saharan

Abstract Background Visual impairment (VI) and determinants of poor cardiovascular health are very common in sub-Saharan Africa. However, we do not know whether these determinants are associated to VI among older adults in this region. This study aimed at investigating the association between the determinants of poor cardiovascular health and near VI among older adults living in Congo. Methods Participants were Congolese older adults aged ≥ 65 years included in EPIDEMCA-FU (Epidemiology of Dementia in Central Africa - Follow-up) population-based cohort. Near VI was defined as visual acuity &lt; 20/40 measured at 30 cm. Associations between determinants of poor cardiovascular health collected at baseline and near visual acuity measured at 1 st follow-up were investigated using multivariable logistic regression models. Results Among the 549 participants included, 378 (68.8% [95% Confidence Interval: 64.9%-72.7%]) had near VI. Of the determinants of poor cardiovascular health explored, we found that having high BMI ≥ 25 kg/m 2 (Odds Ratio= 2.15 [95% CI: 1.25–3.68]), diabetes (OR=2.12 [95% CI: 1.06–4.25]) and hypertension (OR=1.65 [95% CI: 1.02–2.64]) were independently associated with near VI. Conclusions Several determinants of poor cardiovascular health were associated to near VI in this population. This study suggests that promoting a good cardiovascular health could represent a target for VI prevention among older adults.

scholarly journals Efficacy of 27-Gauge Vitrectomy with Internal Limiting Membrane Peeling for Epiretinal Membrane in Glaucoma Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Masaaki Yoshida ◽  
Hiroshi Kunikata ◽  
Shiho Kunimatsu-Sanuki ◽  
Toru Nakazawa
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Epiretinal Membrane ◽  
Internal Limiting Membrane ◽  
Threshold Sensitivity ◽  
Mean Deviation ◽  
Normal Test ◽  
Microincision Vitrectomy Surgery ◽  
Test Points

Purpose. To evaluate the efficacy of epiretinal membrane (ERM) surgery for patients with ERM and glaucoma. Methods. We reviewed the medical records of 20 consecutive ERM patients with glaucoma, who underwent 27-gauge microincision vitrectomy surgery (27GMIVS) with internal limiting membrane (ILM) peeling. The preoperative and 6-month postoperative visual field was tested with the Humphrey Field Analyzer (HFA) 24-2 program. Changes in threshold sensitivity in the HFA test points were analyzed point-by-point, with points classified into groups based on sensitivity as abnormal (less than 5th percentile in pattern deviation) or normal (all other points) and based on location as central (12 central points) or peripheral (all other points) with a linear mixed-effects model. Results. Visual acuity and mean deviation improved postoperatively (P<0.001 for both) in all patients. Threshold sensitivity in central or peripheral points that were abnormal preoperatively improved postoperatively (P=0.006 or P<0.001, respectively). Threshold sensitivity also improved in the central normal test points (P=0.03), but not in the peripheral normal points (P=0.12). Conclusion. Visual acuity improved, and there was no visual field progression, after ERM surgery in glaucomatous eyes during a 6-month postoperative follow-up, suggesting that ERM and ILM removal using 27GMIVS may be effective even in glaucomatous eyes.

scholarly journals Acute Zonal Occult Outer Retinopathy in a Patient Suffering from Epilepsy: Five-Year Follow-Up

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1276
Author(s):  
Izabella Karska-Basta ◽  
Bożena Romanowska-Dixon ◽  
Dorota Pojda-Wilczek ◽  
Alina Bakunowicz-Łazarczyk ◽  
Agnieszka Kubicka-Trząska ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Multimodal Imaging ◽  
Fundus Autofluorescence ◽  
Medical Intervention ◽  
Fundus Photography ◽  
Unknown Etiology ◽  
Visual Field Examination ◽  
Laboratory Findings

We report an unprecedented case of a young patient with epilepsy coexisting with acute zonal occult outer retinopathy (AZOOR), a rare white dot syndrome of unknown etiology, associated with damage to the large zones of the outer retina. Recently, it has been established that epileptic episodes contribute to an inflammatory response both in the brain and the retina. A 13-year-old male patient with epilepsy was referred by a neurologist for an ophthalmologic consultation due to a sudden deterioration of visual acuity in the left eye. The examination, with a key role of multimodal imaging including color fundus photography, fluorescein angiography, indocyanine green angiography (ICGA), fundus autofluorescence (FAF), swept-source optical coherence tomography (SS-OCT) with visual field assessment, and electroretinography indicated AZOOR as the underlying entity. Findings at the first admission included enlargement of the blind spot in visual field examination along a typical trizonal pattern, which was revealed by FAF, ICGA, and SS-OCT in the left eye. The right eye exhibited no abnormalities. Seminal follow-up revealed no changes in best corrected visual acuity, and multimodal imaging findings remain unaltered. Thus, no medical intervention is required. Our case and recent laboratory findings suggest a causative link between epilepsy and retinal disorders, although this issue requires further research.

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