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ophthalmic_artery_aneurysm

Ophthalmic artery aneurysm

J.Sales-Llopis

Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain

Intracranial aneurysm of the ophtalmic artery

Epidemiology

The incidence of ophthalmic artery aneurysms is somewhere between 0.5% and 11% of all intracranial aneurysms 1) 2).

There was a marked female predominance (7:1) and high incidence of multiple intracranial aneurysms (45%) within this population 3).

Types

The three subtypes are the superiorly pointing aneurysms originating at the ophthalmic artery (i.e., ophthalmic artery [OA] aneurysms), the medially pointing aneurysms originating from the superior hypophyseal trunk, and aneurysms originating from a perforator-free part of the ICA, the so-called atypical or blister ICA aneurysms 4).

see Giant Ophthalmic Artery Aneurysm

Clinical Features

Most commonly, ophthalmic artery aneurysms present with progressive visual disturbance or exophthalmos, although they may be asymptomatic.

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. 5).

Treatment

Unruptured large OA aneurysms frequently present with gradual loss of vision. The goal of their treatment is then twofold: to exclude the aneurysm from the circulation and to preserve or restore visual function. Treatment of OA aneurysms can be surgical or endovascular, depending on the mode of presentation, aneurysm geometrics and size, as well as the patient́ s medical condition 6).

Surgery on OA aneurysms is technically demanding because these aneurysms are often large and may extend into the cavernous sinus 7) 8) 9) 10) 11) 12).

When direct operation is performed for a carotid-ophthalmic artery aneurysm, care must be taken to avoid optic nerve injury caused by the retraction and/or the heat of the drill 13).


Contralateral approach

Disadvantages of a contralateral approach (CA) are deep and narrow surgical corridors and inconsistent ability to achieve proximal control of the supraclinoid internal carotid artery (ICA). However, a CA remains as microsurgical option for selected internal carotid artery-ophthalmic segment (ICA-opht) aneurysms.

Its feasibility depends on specific anatomic parameters related to the aneurysm itself and to the prechiasmatic distance, interoptic distance, and relationship of the ICA with the anterior clinoid process 14).

In selected patients, transient cardiac arrest induced by adenosine during a contralateral approach allows a brief flow arrest and softening of the aneurysm for a safer exposure and clipping 15).

Endovascular treatment

Ophthalmic artery aneurysms may be adequately and safely treated with either the Pipeline Embolization Device (PED) or coil embolization. However, treatment with the PED carries a higher risk of impeding flow to the ophthalmic artery, although this did not result in clinical sequelae in a study 16).

Videos

Treatment of ophthalmic artery aneurysm w/ endovasc. balloon-assisted carotid occlusion

Case reports

Peschillo S, Biraschi F, Diana F, Colonnese C, Marenco M, Delfini R. Aneurysms of the Intracranial Segment of the Ophthalmic Artery Trunk: Case Report and Systematic Literature Review. J Neurol Surg A Cent Eur Neurosurg. 2017 Jul 25. doi: 10.1055/s-0037-1604268. [Epub ahead of print] PubMed PMID: 28743134 17).

1) , 3) , 5)
Day A L. Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg. 1990;72(5):677–691.
2)
Yasargil M G, Gasser J C, Hodosh R M, Rankin T V. Carotid-ophthalmic aneurysms: direct microsurgical approach. Surg Neurol. 1977;8(3):155–165.
4)
Meling T R, Sorteberg A, Bakke S J, Slettebø H, Hernesniemi J, Sorteberg W. Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. J Neurosurg. 2008;108(4):662–671
6)
Debrun G M Aletich V A Kehrli P Misra M Ausman J I Charbel F Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience Neurosurgery 19984361281–1295.1295; discussion 1296–1297
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Hosobuchi Y. Direct surgical treatment of giant intracranial aneurysms. J Neurosurg. 1979;51(6):743–756.
8)
Sundt T M Jr, Piepgras D G. Surgical approach to giant intracranial aneurysms. Operative experience with 80 cases. J Neurosurg. 1979;51(6):731–742.
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Almeida G M, Shibata M K, Bianco E. Carotid-ophthalmic aneurysms. Surg Neurol. 1976;5(1):41–45.
10)
Kattner K A, Bailes J, Fukushima T. Direct surgical management of large bulbous and giant aneurysms involving the paraclinoid segment of the internal carotid artery: report of 29 cases. Surg Neurol. 1998;49(5):471–480.
11)
Nutik S L. Ventral paraclinoid carotid aneurysms. J Neurosurg. 1988;69(3):340–344.
12)
Nutik S. Carotid paraclinoid aneurysms with intradural origin and intracavernous location. J Neurosurg. 1978;48(4):526–533
13)
Kumon Y, Sakaki S, Kohno K, Ohta S, Ohue S, Oka Y. Asymptomatic, unruptured carotid-ophthalmic artery aneurysms: angiographical differentiation of each type, operative results, and indications. Surg Neurol. 1997 Nov;48(5):465-72. PubMed PMID: 9352810.
14)
Andrade-Barazarte H, Kivelev J, Goehre F, Jahromi BR, Hijazy F, Moliz N, Gauthier A, Kivisaari R, Lehto H, Hernesniemi JA. Contralateral Approach to Internal Carotid Artery Ophthalmic Segment Aneurysms: Angiographic Analysis and Surgical Results for 30 Patients. Neurosurgery. 2015 Mar 23. [Epub ahead of print] PubMed PMID: 25812068.
15)
Andrade-Barazarte H, Luostarinen T, Goehre F, Kivelev J, Jahromi BR, Ludtka C, Lehto H, Raj R, Ibrahim TF, Niemela M, Jääskeläinen JE, Hernesniemi JA. Transient cardiac arrest induced by adenosine: A tool for contralateral clipping of internal carotid artery-ophthalmic segment aneurysms. World Neurosurg. 2015 Sep 1. pii: S1878-8750(15)01054-2. doi: 10.1016/j.wneu.2015.08.038. [Epub ahead of print] PubMed PMID: 26341426.
16)
Durst CR, Starke RM, Clopton D, Hixson HR, Schmitt PJ, Gingras JM, Ding D, Liu KC, Crowley RW, Jensen ME, Evans AJ, Gaughen J. Endovascular treatment of ophthalmic artery aneurysms: ophthalmic artery patency following flow diversion versus coil embolization. J Neurointerv Surg. 2015 Sep 9. pii: neurintsurg-2015-011887. doi: 10.1136/neurintsurg-2015-011887. [Epub ahead of print] PubMed PMID: 26354944.
17)
Peschillo S, Biraschi F, Diana F, Colonnese C, Marenco M, Delfini R. Aneurysms of the Intracranial Segment of the Ophthalmic Artery Trunk: Case Report and Systematic Literature Review. J Neurol Surg A Cent Eur Neurosurg. 2017 Jul 25. doi: 10.1055/s-0037-1604268. [Epub ahead of print] PubMed PMID: 28743134.
ophthalmic_artery_aneurysm.txt · Last modified: 2017/07/26 14:59 by administrador