Intraoperative Awakening for Vision Examination during Ophthalmic Artery Aneurysm Clipping: Technical Case Report

2005 ◽  
Vol 56 (suppl_4) ◽  
pp. ONS-E440-ONS-E440 ◽  
Author(s):  
Peng Chen ◽  
Ian F. Dunn ◽  
Linda S. Aglio ◽  
Arthur L. Day ◽  
Kai U. Frerichs ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Ophthalmic Artery ◽  
Artery Aneurysm ◽  
The Body ◽  
External Carotid ◽  
Parent Artery ◽  
Nerve Function ◽  
Intraoperative Angiography ◽  
Aneurysm Clipping ◽  
Valuable Adjunct

Abstract OBJECTIVE AND IMPORTANCE: We present a case of a patient with an ophthalmic artery aneurysm in which the ophthalmic artery originated from the body of the aneurysm, requiring sacrifice of the ophthalmic artery to achieve complete aneurysm obliteration. We awakened the patient intraoperatively to assess optic nerve function after clipping and were able to confirm optic nerve function. Controlled intraoperative awakening proved a valuable adjunct to intraoperative angiography in determining the immediate consequences of sacrifice of the ophthalmic artery. CLINICAL PRESENTATION: The patient was a 55-year-old right-handed woman with a 3-month history of episodic blurriness in her left eye; imaging demonstrated an unruptured 5-mm left ophthalmic artery aneurysm in which the ophthalmic artery originated from the body of the aneurysm. INTERVENTION: Complete obliteration of the aneurysm required clip placement across the neck of the aneurysm, incorporating not only the aneurysm but also the ophthalmic artery. Aware that sacrifice of the ophthalmic artery was likely, we awakened the patient after clipping and before dural closure to evaluate her optic nerve function. Once fully awake, the patient was able to execute simple commands and conclusively confirm light perception in both of her eyes. She was then reanesthetized, and intraoperative angiography showed successful aneurysm obliteration and parent artery patency. CONCLUSION: The ophthalmic artery can be sacrificed during aneurysm clipping without loss of vision in many cases, most likely because of adequate collateral filling from the external carotid artery. Certainty about the visual consequences of sacrifice of the ophthalmic artery, however, is difficult to obtain preoperatively or intraoperatively. Intraoperative awakening for evaluation of optic nerve function served as a useful technique to assess the acute results of interruption of ophthalmic artery flow in this case.

Interhemispheric approach for carotid-ophthalmic artery aneurysm clipping

1987 ◽  
Vol 67 (2) ◽  
pp. 293-295 ◽  
Author(s):  
Nobuhiko Aoki
Keyword(s):  
Optic Nerve ◽  
Ophthalmic Artery ◽  
Artery Aneurysm ◽  
Content Type ◽  
Aneurysm Clipping ◽  
Interhemispheric Approach ◽  
Aneurysmal Neck ◽  
Fine Print

✓ The author reports a case in which a subchiasmal carotid-ophthalmic artery aneurysm was clipped through a bifrontal interhemispheric approach. This approach is feasible for carotid-ophthalmic artery aneurysms with a variety of anatomical correlations between the optic nerve and the aneurysmal neck.

Splitting of the optic nerve by a carotid-ophthalmic artery aneurysm

1986 ◽  
Vol 65 (4) ◽  
pp. 560-562 ◽  
Author(s):  
Robert A. Beatty
Keyword(s):  
Optic Nerve ◽  
Ophthalmic Artery ◽  
Artery Aneurysm ◽  
Content Type ◽  
Fine Print

✓ A patient with splitting of the optic nerve by a carotid-ophthalmic artery aneurysm is presented. Possible explanations for this previously unreported configuration are discussed.

Complete Transection of Optic Nerve After Endovascular Coiling of a Large Ophthalmic Artery Aneurysm

2019 ◽  
Vol 132 ◽  
pp. 81-86
Author(s):  
Barbara Verbraeken ◽  
Salah-Eddine Achahbar ◽  
Niels Kamerling ◽  
Laetitia Yperzeele ◽  
Maurits Voormolen ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Ophthalmic Artery ◽  
Artery Aneurysm ◽  
Endovascular Coiling ◽  
Complete Transection

scholarly journals Acute retinal hemorrhage after Pipeline embolization device placement for treatment of ophthalmic segment aneurysm: A case report

2018 ◽  
Vol 24 (4) ◽  
pp. 383-386
Author(s):  
Nimer Adeeb ◽  
Justin Moore ◽  
Christoph J Griessenauer ◽  
Raghav Gupta ◽  
Ahad A Fazelat ◽  
...  
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Ophthalmic Artery ◽  
Artery Aneurysm ◽  
Retinal Hemorrhage ◽  
External Carotid ◽  
Anterior Communicating Artery ◽  
Small Subset ◽  
Pipeline Embolization Device ◽  
Ophthalmic Segment Aneurysms

Introduction Ophthalmic segment aneurysms may present with visual symptoms due to direct compression of the optic nerve. Treatment of these aneurysms with the Pipeline embolization device (PED) often results in visual improvement. Flow diversion, however, has also been associated with occlusion of the ophthalmic artery and visual deficits in a small subset of cases. Case report A 49-year-old Caucasian female presented with subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. On follow-up imaging, the patient was found to have a right asymptomatic ophthalmic segment aneurysm. Due to the irregular shape of the aneurysm and history of aneurysmal subarachnoid hemorrhage, the decision was made to treat the aneurysm with a PED. Postoperatively, the patient complained of floaters in the right eye. Detailed ophthalmologic examination showed retinal hemorrhage and cotton-wool spots on the macula. Such complication after PED placement has never been reported in the literature. Conclusion Visual complications after PED placement for treatment of ophthalmic segment aneurysms are rare. It is thought that even in cases where the ophthalmic artery occludes, patients remain asymptomatic due to the rich collateral supply from the external carotid artery branches. Here we report a patient who developed an acute retinal hemorrhage after PED placement.

Two-Stage Revascularization and Clip Reconstruction of a Giant Ophthalmic Artery Aneurysm: 3-Dimensional Operative Video

2018 ◽  
Vol 17 (3) ◽  
pp. E110-E111
Author(s):  
Sirin Gandhi ◽  
Justin R Mascitelli ◽  
Xiaochun Zhao ◽  
Tsinsue Chen ◽  
Douglas A Hardesty ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Artery Bypass ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
External Carotid ◽  
Parent Artery ◽  
Two Stage ◽  
Aneurysm Wall ◽  
Optic Strut ◽  
Patient Consent

Abstract Ophthalmic segment aneurysms (OSAs) are technically challenging lesions with a wide-neck morphology and proximity to the optic nerve. Revascularization and aneurysm trapping are occasionally needed to manage unclippable OSAs. Microsurgical treatment requires anterior clinoidectomy, optic strut drilling, and proximal/distal dural ring dissection for adequate exposure. This video demonstrates a two-stage revascularization and clip reconstruction of an OSA. A 62-yr-old woman was presented, with acute-onset expressive aphasia, right hemineglect, and hemiparesis. Neuroimaging revealed a partially thrombosed giant OSA measuring 2.5 × 2.3 cm2. Patient consent was obtained for bypassing, trapping, and decompressing the aneurysm. A pterional craniotomy was performed and an external carotid artery – radial artery graft – middle cerebral artery bypass was performed. The aneurysm was proximally occluded with a permanent clip on the clinoidal internal carotid artery (ICA). Adherence of the distal supraclinoid ICA to the aneurysm wall did not allow for aneurysm trapping. On postoperative day 8, the patient experienced acute mental status decline due to a frontal intraparenchymal hemorrhage. The aneurysm was trapped in a second surgery to occlude persistent retrograde aneurysm filling. The aneurysm sac was circumferentially dissected with temporary parent artery trapping. The OSA was opened and thrombectomized using an ultrasonic aspirator followed by trapping clip application. Postoperatively, the patient gradually returned to neurological baseline with minimal expressive aphasia. Although OSAs are preferentially treated with flow diversion, giant OSAs with significant mass effect may necessitate microsurgical clipping or trapping with decompressive thrombectomy. This case demonstrates that proximal clip occlusion may not be sufficient for aneurysm thrombosis and rupture prevention. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Intraorbital aneurysm of the ophthalmic artery

2019 ◽  
Vol 12 (4) ◽  
pp. e227044
Author(s):  
Pavitra Garala ◽  
Jasvir Virdee ◽  
Madyan Qureshi ◽  
Timothy Gillow
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Conservative Treatment ◽  
Renal Impairment ◽  
Ophthalmic Artery ◽  
Low Risk ◽  
Nerve Function ◽  
Conservative Approach ◽  
Risk Of Rupture ◽  
Visual Disturbances

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.

A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses

2007 ◽  
Vol 106 (1) ◽  
pp. 142-150 ◽  
Author(s):  
Paolo Perrini ◽  
Andrea Cardia ◽  
Kenneth Fraser ◽  
Giuseppe Lanzino
Keyword(s):  
Optic Nerve ◽  
Ophthalmic Artery ◽  
Endovascular Procedures ◽  
Middle Meningeal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Detailed Knowledge ◽  
Microsurgical Anatomy ◽  
Retinal Artery ◽  
Meningeal Artery

Object The authors studied the microsurgical anatomy of the ophthalmic artery (OphA), paying particular attention to its possibly dangerous anastomoses with the middle meningeal artery (MMA). Methods The microsurgical anatomy of the OphA and its anastomoses with the MMA were studied in 14 vessels from seven adult cadaveric heads. The origination order of the OphA branches varies in relation to whether the artery, along its intraorbital course, crosses above or below the optic nerve (ON). The central retinal artery is the first branch to course from the OphA when it crosses over the ON, and it is the second branch to course from the OphA when the artery crosses under the ON. Anastomoses between branches of the MMA and the OphA were present in the majority of the specimens examined. Conclusions Detailed knowledge of the microanatomy of the OphA and recognition of anastomoses between the external carotid artery and the OphA are critically important in avoiding disastrous complications during endovascular procedures.

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