Aneurysms of the ophthalmic segment

1990 ◽  
Vol 72 (5) ◽  
pp. 677-691 ◽  
Author(s):  
Arthur L. Day
Keyword(s):  
Carotid Artery ◽  
Ophthalmic Artery ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Visual Deficits ◽  
Clinical Presentations ◽  
Female Predominance ◽  
Operative Findings ◽  
Ophthalmic Segment Aneurysms ◽  
Fine Print

✓ The clinical, radiographic, and anatomical features in 80 patients with ophthalmic segment aneurysms were reviewed, and were categorized according to a presumed origin related to the ophthalmic (41 cases) or superior hypophyseal (39 cases) arteries. There was a marked female predominance (7:1) and high incidence of multiple aneurysms (45%) within this population. Clinical presentations included subarachnoid hemorrhage in 23 cases (29%) and visual deficits in 24 (30%); five patients exhibited both hemorrhage and visual loss. Twenty-eight aneurysms were incidentally identified. Ophthalmic artery aneurysms arose from the internal carotid artery (ICA) just distal to the ophthalmic artery, pointed superiorly or superomedially, and (when large) deflected the carotid artery posteriorly and inferiorly, closing the siphon. Abnormalities relating to vision were not identified until the aneurysm realized giant proportions. The optic nerve was typically displaced superomedially, which restricted contralateral extension until late in the clinical course; unilateral nasal field loss was seen in 12 patients. Nine patients had bilateral ophthalmic artery aneurysms which were often clipped via a unilateral craniotomy. Superior hypophyseal artery aneurysms arose just above the dural ring from the medial bend of the ICA, at the site of perforator origin to the superior aspect of the hypophysis, and had no direct association with the ophthalmic artery. The carotid artery was usually located lateral or superolateral relative to the aneurysm. These lesions could extend medially beneath the chiasm (suprasellar variant), producing a clinical and computerized tomography picture similar to a pituitary adenoma, or they could extend ventrally to burrow beneath the anterior clinoid process (paraclinoid variant). Preoperative categorization of these lesions according to their likely branch of origin provides excellent correlation with visual deficits and operative findings, and has allowed the author to clip 52 of 54 lesions, with very low operative or visual morbidity.

Abnormal origin of bilateral ophthalmic arteries

1991 ◽  
Vol 74 (2) ◽  
pp. 287-289 ◽  
Author(s):  
Jun-ichiro Hamada ◽  
Isao Kitamura ◽  
Masahito Kurino ◽  
Nobuyuki Sueyoshi ◽  
Shozaburo Uemura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Content Type ◽  
Multiple Intracranial Aneurysms ◽  
Operative Findings ◽  
Ophthalmic Arteries ◽  
Fine Print

✓ The case of a 64-year-old woman with multiple intracranial aneurysms and abnormal ophthalmic arteries arising from the bifurcation of the internal carotid artery is described. It is believed that this type of anomaly of the ophthalmic artery has not previously been reported. The neuroradiological and operative findings of this case are presented.

Subclinoid aneurysms

2003 ◽  
Vol 98 (4) ◽  
pp. 731-736 ◽  
Author(s):  
Stephen L. Nutik
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Lateral Surface ◽  
Ophthalmic Artery ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Proximal Neck ◽  
Anatomical Features ◽  
Fine Print

Object. This study was undertaken to analyze the features that define subclinoid aneurysms. Methods. Five cases of laterally directed carotid artery (CA) aneurysms adjacent to the anterior clinoid process (ACP) were identified in a series of approximately 1400 surgically treated aneurysms. These cases were selected because the aneurysms had the same features as the only previously described “subclinoid” aneurysm. The angiographic and anatomical features of the five cases were analyzed. Conclusions. Subclinoid aneurysms are a unique group of congenital berry aneurysms. They originate from the lateral surface of the CA adjacent to the ACP. They are partially or completely hidden from view at surgery by the ACP and are partially or completely proximal to the distal dural ring of the CA. The proximal neck of these lesions is located at the same level of the CA cut perpendicular to its axis of blood flow as the origin of the ophthalmic artery (OphA), but they do not originate at that or any other branch of the CA. They can only be definitively differentiated from OphA, anterior paraclinoid, and blister-like aneurysms at surgery.

Ventral paraclinoid carotid aneurysms

1988 ◽  
Vol 69 (3) ◽  
pp. 340-344 ◽  
Author(s):  
Stephen L. Nutik
Keyword(s):  
Carotid Artery ◽  
Ophthalmic Artery ◽  
Ventral Surface ◽  
Posterior Communicating Artery ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Multiple Aneurysms ◽  
High Incidence ◽  
Carotid Aneurysms ◽  
Fine Print

✓ A series of 15 patients with 17 ventral paraclinoid carotid artery aneurysms is presented. With this type of aneurysm the neck is at or just distal to the level of the ophthalmic artery and proximal to the posterior communicating artery on the ventral surface of the carotid artery. There is a high incidence of female patients and multiple aneurysms. At surgery, the aneurysms are hidden by the anterior clinoid process and often have an intracavernous component. The neck of the aneurysm is usually intradural and can be clipped.

Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms

1987 ◽  
Vol 66 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Allan J. Fox ◽  
Fernando Viñuela ◽  
David M. Pelz ◽  
Sydney J. Peerless ◽  
Gary G. Ferguson ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ophthalmic Artery ◽  
Cerebral Aneurysms ◽  
Artery Occlusion ◽  
Content Type ◽  
Occlusion Test ◽  
Permanent Occlusion ◽  
Proximal Occlusion ◽  
Ischemic Events ◽  
Fine Print

✓ Of 68 patients with unclippable aneurysms treated by proximal artery occlusion with detachable balloons, permanent occlusion was achieved in 65; of these patients, 37 had carotid artery aneurysms below the origin of the ophthalmic artery, 21 had aneurysms arising from the supraclinoid portion of the carotid artery, six had basilar trunk aneurysms, and one had a distal vertebral aneurysm. Examination for treatment selection included assessment of the circle of Willis by compression angiography and xenon blood flow studies, with the ultimate evaluation being test occlusion under systemic heparinization with the balloon temporarily placed in the desired position. Of 67 patients who underwent a formal occlusion test, eight with carotid artery aneurysms did not initially tolerate the occlusion test, and ischemic signs disappeared instantaneously with deflation and removal of the balloon. During test occlusion, two additional patients had ischemic events that proved to be embolic; these reversed immediately upon balloon deflation. Of the 65 patients in whom permanent occlusion was effected by detachable balloon, there were nine instances of delayed cerebral events. One of these was a seizure leading to respiratory arrest and resuscitation 3 days following occlusion in a patient who had presented with seizures. The other eight cases were delayed ischemic events; seven were completely reversed and one patient had residual weakness in one leg (1.5% permanent morbidity). Extracranial-intracranial bypass procedures were performed in 25 of the 65 cases. All aneurysms of the carotid artery below the level of the ophthalmic artery presented angiographic proof of complete thrombosis. Ten of 21 aneurysms arising from the supraclinoid portion of the carotid artery were completely thrombosed by proximal occlusion alone, without additional trapping procedures. Similarly, in three of six basilar trunk aneurysms, proximal occlusion alone initiated complete aneurysm thrombosis without trapping. The conclusion is that proximal balloon occlusion for unclippable cerebral aneurysms is a convenient, safe, and effective way of producing arterial occlusion in these cases.

Supraophthalmic carotid infusion for brain-tumor chemotherapy

1983 ◽  
Vol 58 (4) ◽  
pp. 616-618 ◽  
Author(s):  
John P. Kapp ◽  
Robert L. Ross ◽  
Elton M. Tucker
Keyword(s):  
Brain Tumor ◽  
Carotid Artery ◽  
Ophthalmic Artery ◽  
Chemotherapeutic Agent ◽  
Ocular Complications ◽  
Content Type ◽  
Remote Manipulation ◽  
Flowing Blood ◽  
Brain Tumor Chemotherapy ◽  
Fine Print

✓ The ocular complications of intracarotid infusion of drugs for brain-tumor chemotherapy may be eliminated by infusion of the chemotherapeutic agent into the carotid artery above the origin of the ophthalmic artery. The authors have developed a catheter that can negotiate the carotid siphon. This catheter is not balloon-tipped but incorporates a flexible tip with an expanded end to facilitate drag by flowing blood. The exit hole is placed to allow remote manipulation of the tip by hydraulic forces. Using this catheter, the authors have been consistently able to infuse the supraophthalmic carotid artery.

Anterior paraclinoid aneurysms

2002 ◽  
Vol 96 (6) ◽  
pp. 1000-1005 ◽  
Author(s):  
Hiroyuki Kinouchi ◽  
Kazuo Mizoi ◽  
Yoshihide Nagamine ◽  
Noritaka Yanagida ◽  
Shigeki Mikawa ◽  
...  
Keyword(s):  
Special Group ◽  
Anterior Clinoid Process ◽  
Dorsal Wall ◽  
Content Type ◽  
Paraclinoid Aneurysm ◽  
Paraclinoid Aneurysms ◽  
Proximal Internal Carotid Artery ◽  
Female Predominance ◽  
Intradural Space ◽  
Fine Print

Object. The characteristics of a previously unclassified paraclinoid aneurysm arising from the anterolateral (dorsal) wall of the proximal internal carotid artery were retrospectively analyzed in seven patients (five women and two men) who were treated surgically for an aneurysm in this unusual location. Methods. One patient presented with subarachnoid hemorrhage (SAH) caused by rupture of this aneurysm. The lesions were found incidentally (five cases) or during investigation of SAH due to another aneurysm (one case). There was a female predominance in this series; all female patients harbored multiple aneurysms. All patients underwent surgery. Removal of the anterior clinoid process was necessary because the proximal neck of the aneurysm was closely adjacent to the dural ring. Conclusions. This special group of aneurysms is very rare, is located exclusively in the intradural space, and carries the risk of SAH. The results of surgical treatment for this aneurysm are quite satisfactory.

Bilateral giant carotid-ophthalmic aneurysms

1975 ◽  
Vol 42 (5) ◽  
pp. 589-592 ◽  
Author(s):  
Francisco Garcia-Bengochea ◽  
Frank H. Deland
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Content Type ◽  
Giant Aneurysms ◽  
Unusual Combination ◽  
Fine Print

✓ The authors describe a patient with bilateral giant aneurysms of the internal carotid artery in the region of the ophthalmic artery. This case illustrates the feasibility of successful intracranial surgical treatment for this unusual combination.

Recurrent retinal ischemia beyond cervical carotid occlusions

1981 ◽  
Vol 55 (4) ◽  
pp. 532-542 ◽  
Author(s):  
Roger W. Countee ◽  
Thurairasah Vijayanathan ◽  
Pamela Chavis
Keyword(s):  
Carotid Artery ◽  
Ophthalmic Artery ◽  
Clinical History ◽  
Retinal Ischemia ◽  
External Carotid Artery ◽  
External Carotid ◽  
Content Type ◽  
Anticoagulant Drug ◽  
Nonsurgical Patients ◽  
Fine Print

✓ Seventeen patients with persistent amaurosis fugax ipsilateral to angiographically documented internal carotid artery (ICA) occlusions in the neck have been treated by the authors over the past 5 years. Complete cerebral arteriography in each case demonstrated that the symptomatic ophthalmic artery was perfused exclusively by the ipsilateral external carotid artery (ECA), which invariably had an obstructive and/or ulcerative lesion at its origin, and/or an adjacent residual “stump” of the occluded ICA. In nine patients, retinal artery branch emboli were visible on funduscopy. One patient had angiographic evidence of intracranial embolization via the ophthalmic artery from the ECA. Although ipsilateral superficial temporal-middle cerebral artery anastomosis in one patient, and endarterectomy of a contralateral carotid stenosis in another patient, failed to relieve symptoms, endarterectomy of the ECA with resection of the “stump” of the occluded ICA effectively terminated symptoms in 10 of 11 patients. Anticoagulant drug therapy promptly abolished symptoms in four nonsurgical patients as well as in two patients with failed operations. It is concluded that recurrent retinal ischemia beyond cervical carotid occlusions frequently results from microembolism via the ipsilateral ECA. Patients with this mechanism of postocclusion recurrent ischemia can be identified on the basis of clinical history, ophthalmological examinations, and complete cerebral arteriography. Termination of embolic phenomena should be the major treatment goal in these individuals, and ECA endarterectomy is recommended. Anticoagulant drugs are an effective alternative treatment in patients who are poor surgical risks.

Some observations on aneurysms of the proximal internal carotid artery

1979 ◽  
Vol 51 (2) ◽  
pp. 151-154 ◽  
Author(s):  
Jonathan Punt
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Content Type ◽  
Multiple Aneurysms ◽  
Proximal Internal Carotid Artery ◽  
High Incidence ◽  
Fine Print

✓ The author reports on 41 aneurysms of the proximal internal carotid artery (PICA) demonstrated in 36 patients with subarachnoid hemorrhage. The patients included a striking preponderance of women, and there was a high incidence of multiple aneurysms. In cases with multiple aneurysms the PICA aneurysm was usually found incidentally, a more distal aneurysm on the internal carotid artery being the source of hemorrhage. An infundibulum at the origin of a posterior communicating artery was unusually common in these patients. The origin of the ophthalmic artery is proposed as the angiographic landmark of the level at which the internal carotid artery penetrates the dura mater.

Radiometric analysis of paraclinoid carotid artery aneurysms

2002 ◽  
Vol 96 (4) ◽  
pp. 649-653 ◽  
Author(s):  
Yuichiro Tanaka ◽  
Kazuhiro Hongo ◽  
Tsuyoshi Tada ◽  
Hisashi Nagashima ◽  
Tetsuyoshi Horiuchi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Horizontal Line ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Aneurysm Neck ◽  
Radiometric Analysis ◽  
Paraclinoid Aneurysms ◽  
The Mean ◽  
Fine Print

Object. Classification of paraclinoid carotid artery (CA) aneurysms based on their associated branching arteries has been confusing because superior hypophyseal arteries (SHAs) are too fine to appear opacified on cerebral angiograms. The authors performed a retrospective radiometric analysis of surgically treated paraclinoid aneurysms to elucidate their angiographic and anatomical characteristics. Methods. A retrospective analysis was made of 85 intradural paraclinoid aneurysms in which the presence or absence of branching arteries had been determined at the time of surgical clipping. The lesions were classified as supraclinoid, clinoid, and infraclinoid aneurysms based on their relation to the anterior clinoid process on lateral angiograms of the CA. The direction of the aneurysms were measured according to angles formed between the medial portion of the horizontal line crossing the aneurysm sac and the center of the aneurysm neck on anteroposterior angiograms. Branching arteries were associated with 68 aneurysms, of which 28 were ophthalmic artery (OphA) lesions (32.9%) and 40 were SHA ones (47.1%); associated branching arteries were absent in 17 aneurysms (20%). Twenty-five aneurysms (29.4%) were located at the supraclinoidal level, 46 (54.1%) at the clinoidal, and 14 (16.5%) at the infraclinoidal. The majority of aneurysms identified at the supraclinoidal level were OphA lesions (44%) or those unassociated with branching arteries (48%), with mean directions of 57° or 67°, respectively. At the clinoidal level, the mean directions of aneurysms were 76° in six lesions unassociated with branching arteries (13%), 43° in 16 OphA lesions (35%), and −11° in 24 SHA ones (52%). All aneurysms at the infraclinoidal level arose at the origin of the SHAs, with a mean direction of −29°, and most of these were embedded in the carotid cave. Conclusions. Aneurysms arising from the SHA can be distinguished from those not located at an arterial division by cerebral angiography, because SHA lesions are usually located at the medial or inferomedial wall of the internal carotid artery at the clinoidal or infraclinoidal level. Their distribution correlates well with the reported distribution of SHA origins. The carotid cave aneurysm is a kind of SHA lesion that originates at the most proximal intradural CA.

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