Abstract 1122‐000086: Comparison of Surgical Clipping vs Endovascular Coiling for Posterior Projecting Anterior Communicating Artery Aneurysm

Introduction : We wanted to evaluate the feasibility and results of endovascular treatment in patients with a posteriorly projecting A Com aneurysm and compare surgical clipping with endovascular coiling for posterior projecting anterior communicating artery aneurysm in terms of peroperative technical feasibility and possible complications such as rupture,perioperative complications and postoperative mortality and morbidity. Methods : .Total 6 cases were studied,3 of them (n = 3, 50%)were operated by surgical clipping and 3 (n = 3.50%) underwent endovascular coiling.Average age was 52yrs, 90% were hypertensive, 80% were smokers. All presented through emergency with subarachnoid hemorrhage.2 of the patients in each surgical and endovascular group presented at ER with Hunt and Hess grade 3 (n = 2,33.3%) the others were at Hunt and Hess grade 2 (n = 4,66.6%). The average time from hemorrhage to surgery and coiling was 25days. Outcome assessed using modified Rankin score and a score of 2 was considered satisfactory. Results : In the surgically treated arm 2 patients had mRS of 2 while the 3 rd one had 4.In the endovascular coiling group 1 had mRS of 1,1 had mRS2 and 3 rd had m RS of 3. Despite the very small sample size the outcome in terms of mRS indicated slightly better results for patients undergoing coiling Conclusion: Endovascular coiling is better in the treatment of posteriorly projecting anterior communicating artery aneurysm. Conclusions : Endovascular coiling is better in the treatment of posteriorly projecting anterior communicating artery aneurysm.

Posterior ischemic optic neuropathy with acute monocular vision loss following clipping of anterior communicating artery aneurysm. A case report and review of literature

Background: The acute postoperative monocular vision loss following anterior communicating artery aneurysm clipping secondary to posterior ischemic optic neuropathy (PION) a rare presentation. Case Description: A 32-year old patient presented with a spontaneous holocranial thunderclap headache for 7 days, associated with vomiting. The SAH was diagnosed with a tiny saccular aneurysm arising from the anterior communicating artery. A left pterional craniotomy and clipping of aneurysm were done. On the 3rd postoperative day, he complained of left-sided complete blindness, and on the 5th postoperative day, his GCS dropped to E4V1M5 with right-sided hemiplegia. MRI brain showed normal optic apparatus with bilateral ACA and left MCA territory infarct. Conclusion: The PION must be kept in the differential diagnosis of post-clipping sudden visual deterioration, especially following anterior communicating artery aneurysm rupture.