Large ophthalmic segment aneurysms with anterior optic pathway compression: Assessment of anatomical and visual outcomes after endosaccular coil therapy

Navraj S. Heran, Joon K. Song, Mark J. Kupersmith, Yasunari Niimi, Katsunari Namba, David J. Langer, Alejandro Berenstein

Research output: Contribution to journalReview articlepeer-review

81 Scopus citations

Abstract

Object. The optimal therapy for ophthalmic segment aneurysms with anterior optic pathway compression (AOPC) is undecided. Surgical results have been described, but the results of endovascular coil therapy have not been well documented. Methods. The authors retrospectively reviewed data obtained in all patients who harbored unruptured ophthalmic segment aneurysms with AOPC who underwent endovascular coil therapy at their institution. They analyzed baseline and outcome visual function, aneurysm features, extent of aneurysm closure, internal carotid artery (ICA) occlusion, additional interventions, and neurological outcome. In 17 patients (16 women), age 38 to 83 years, there were 28 affected eyes. All aneurysms were greater than 10 mm in diameter. In the initial procedures 16 of 17 patients received endosaccular coils and the ICA was preserved; in one patient the aneurysm was trapped and the ICA occluded. Patients then underwent follow up for a mean of 2.90 years (range 1 month-11.2 years) after the last procedure. One patient died of subarachnoid hemorrhage (SAH) 1 month postoperatively and thus no follow-up data were available for this case. Vision worsened in six patients, stabilized in four, and improved in six. Twelve patients underwent 13 subsequent procedures, including endovascular ICA occlusion in seven, repeated coil therapy in five, and optic nerve decompression in one; vision improved in 83% of these cases after ICA occlusion. A second patient died of SAH 5 months after repeated coil treatment. At the final follow up, vision had improved in eight patients (50%), stabilized in four (25%), and worsened in four (25%). In 16 patients with follow-up studies, aneurysm closure was complete in eight (50%) and incomplete in eight (50%). Conclusions. The authors found that in patients with ophthalmic segment aneurysms causing chronic AOPC, endosaccular platinum coil therapy, with ICA preservation, may not benefit vision and that additional procedures may be needed. Evaluation of their results suggests that endovascular trapping of the aneurysm and sacrifice of the ICA appear to result in good visual, clinical, and anatomical outcomes.

Original languageEnglish
Pages (from-to)968-975
Number of pages8
JournalJournal of Neurosurgery
Volume106
Issue number6
DOIs
StatePublished - Jun 2007
Externally publishedYes

Keywords

  • Carotid artery occlusion
  • Detachable coil
  • Endovascular therapy
  • Ophthalmic segment aneurysm
  • Optic nerve compression

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