Microsurgical treatment of ophthalmic artery aneurysm, a case series of 55 patients with long-term follow-up.
Aneurysm microsurgery
Brain aneurysm
Clip ligation
Lateral supra orbital craniotomy
Ophthalmic artery aneurysm
Paraclinoidal artery aneurysm
Journal
BMC surgery
ISSN: 1471-2482
Titre abrégé: BMC Surg
Pays: England
ID NLM: 100968567
Informations de publication
Date de publication:
07 May 2024
07 May 2024
Historique:
received:
27
03
2023
accepted:
18
04
2024
medline:
8
5
2024
pubmed:
8
5
2024
entrez:
7
5
2024
Statut:
epublish
Résumé
Ophthalmic artery aneurysm (OAA) can be secured in endovascular or microsurgical approaches. Still there are controversies in technique selection and their long term outcomes. All the patients with OAA were treated microsurgically and followed. Demographic data, neurological status, physical examination findings, angiographic data, operation details, and intraoperative and postoperative events were recorded and analyzed. P < 0.05 was considered significant. Among 55 patients, 38 were females (69.1%). Median preoperative glasgow coma scale (GCS), Fisher Grade, and Hunt and Hess(HH) scores were 15, 1 and 1, respectively. The most common neurologic manifestation was visual problems (n = 15). The most common anatomical projection was medial (43.6%) oriented lesions. 85.5% of them only had 1 ophthalmic aneurysm while multiple aneurysms were reported in 14.6%. In 52 patients temporary clip was used. in 21 patients (38.2%) intraoperative aneurysm rupture occurred. Larger aneurysm size and preoperative hydrocephalus were associated with higher rates of aneurysm rupture (P = 0.003 and 0.031). 28.5% of the patients with visual problems had clinical improvement in the postoperative period. The mean follow-up period was 5 years. Follow-up angiography showed a 100% obliteration rate with a 0.0% recurrence rate. Median values for follow-up glasgow outcome scale and modified Rankin scale were 5 and 0, respectively. favorable neurological outcomes were associated with better primary GCS and HH scores. OAA microsurgery is an effective and safe procedure with significant improvement in both visual and neurological status. Low recurrence rate and excellent clinical recovery are the most important advantages of microsurgery in OAA treatment.
Sections du résumé
BACKGROUND
BACKGROUND
Ophthalmic artery aneurysm (OAA) can be secured in endovascular or microsurgical approaches. Still there are controversies in technique selection and their long term outcomes.
METHODS
METHODS
All the patients with OAA were treated microsurgically and followed. Demographic data, neurological status, physical examination findings, angiographic data, operation details, and intraoperative and postoperative events were recorded and analyzed. P < 0.05 was considered significant.
RESULTS
RESULTS
Among 55 patients, 38 were females (69.1%). Median preoperative glasgow coma scale (GCS), Fisher Grade, and Hunt and Hess(HH) scores were 15, 1 and 1, respectively. The most common neurologic manifestation was visual problems (n = 15). The most common anatomical projection was medial (43.6%) oriented lesions. 85.5% of them only had 1 ophthalmic aneurysm while multiple aneurysms were reported in 14.6%. In 52 patients temporary clip was used. in 21 patients (38.2%) intraoperative aneurysm rupture occurred. Larger aneurysm size and preoperative hydrocephalus were associated with higher rates of aneurysm rupture (P = 0.003 and 0.031). 28.5% of the patients with visual problems had clinical improvement in the postoperative period. The mean follow-up period was 5 years. Follow-up angiography showed a 100% obliteration rate with a 0.0% recurrence rate. Median values for follow-up glasgow outcome scale and modified Rankin scale were 5 and 0, respectively. favorable neurological outcomes were associated with better primary GCS and HH scores.
CONCLUSION
CONCLUSIONS
OAA microsurgery is an effective and safe procedure with significant improvement in both visual and neurological status. Low recurrence rate and excellent clinical recovery are the most important advantages of microsurgery in OAA treatment.
Identifiants
pubmed: 38714953
doi: 10.1186/s12893-024-02419-x
pii: 10.1186/s12893-024-02419-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
139Informations de copyright
© 2024. The Author(s).
Références
Dinca EB, Brehar F, Giovani A, Ciurea AV. Challenges in a case of ophthalmic artery aneurysm associated with abnormal internal carotid arteries. Asian J Neurosurg. 2017;12(1):106–8.
doi: 10.4103/1793-5482.144160
pubmed: 28413549
pmcid: 5379780
Durst CR, Starke RM, Clopton D, Hixson HR, Schmitt PJ, Gingras JM, et al. Endovascular treatment of ophthalmic artery aneurysms: ophthalmic artery patency following flow diversion versus coil embolization. J NeuroInterventional Surg. 2016;8(9):919.
doi: 10.1136/neurintsurg-2015-011887
Krisht AF, Hsu SPC. Paraclinoid aneurysms: part IV—Medial aneurysms. Contemp Neurosurg. 2019;41(18).
Kutty RK, Kumar A, Yamada Y, Kawase T, Tanaka R, Miyatani K, et al. Visual outcomes after surgery for paraclinoid aneurysms: a Fujita experience. Asian J Neurosurg. 2020;15(2):363–9.
doi: 10.4103/ajns.AJNS_39_20
pubmed: 32656133
pmcid: 7335145
Hernesniemi J, Ishii K, Niemelä M, Smrcka M, Kivipelto L, Fujiki M, et al. editors. Lateral supraorbital approach as an alternative to the classical pterional approach. New trends of surgery for stroke and its Perioperative Management. 2005;Vienna: Springer Vienna.
Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES Jr., et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006;59(1):21–7. discussion – 7.
pubmed: 16823296
Lindvall P, Runnerstam M, Birgander R, Koskinen LO. The Fisher grading correlated to outcome in patients with subarachnoid haemorrhage. Br J Neurosurg. 2009;23(2):188–92.
doi: 10.1080/02688690802710668
pubmed: 19306176
Bhogal P, Aguilar Pérez M, Sauder G, Bäzner H, Ganslandt O, Henkes H. Management of paraophthalmic aneurysms: review of endovascular treatment strategies. Ophthalmologe. 2018;115(2):114–22.
doi: 10.1007/s00347-017-0497-8
pubmed: 28439656
Heran NS, Song JK, Kupersmith MJ, Niimi Y, Namba K, Langer DJ, et al. Large ophthalmic segment aneurysms with anterior optic pathway compression: assessment of anatomical and visual outcomes after endosaccular coil therapy. J Neurosurg. 2007;106(6):968–75.
doi: 10.3171/jns.2007.106.6.968
pubmed: 17564166
Adeeb N, Griessenauer CJ, Foreman PM, Moore JM, Motiei-Langroudi R, Chua MH, et al. Comparison of stent-assisted coil embolization and the pipeline embolization device for endovascular treatment of ophthalmic segment aneurysms: a multicenter cohort study. World Neurosurg. 2017;105:206–12.
doi: 10.1016/j.wneu.2017.05.104
pubmed: 28559080
Wang Y, Yu J. Endovascular treatment of aneurysms of the paraophthalmic segment of the internal carotid artery: current status. Front Neurol. 2022;13.
Iihara K, Murao K, Sakai N, Shindo A, Sakai H, Higashi T, et al. Unruptured paraclinoid aneurysms: a management strategy. J Neurosurg. 2003;99(2):241–7.
doi: 10.3171/jns.2003.99.2.0241
pubmed: 12924695
Falk Delgado A, Andersson T, Falk Delgado A. Ruptured carotid-ophthalmic aneurysm treatment: a non-inferiority meta-analysis comparing endovascular coiling and surgical clipping. Br J Neurosurg. 2017;31(3):345–9.
doi: 10.1080/02688697.2017.1297371
pubmed: 28637115
Xu BN, Sun ZH, Romani R, Jiang JL, Wu C, Zhou DB, et al. Microsurgical management of large and giant paraclinoid aneurysms. World Neurosurg. 2010;73(3):137–46. discussion e17, e19.
doi: 10.1016/j.surneu.2009.07.042
pubmed: 20860951
Puffer RC, Kallmes DF, Cloft HJ, Lanzino G. Patency of the ophthalmic artery after flow diversion treatment of paraclinoid aneurysms. J Neurosurg. 2012;116(4):892–6.
doi: 10.3171/2011.11.JNS111612
pubmed: 22224787
Otani N, Toyooka T, Mori K. Surgery of Paraclinoid Aneurysm. In: July J, Wahjoepramono EJ, editors. Neurovascular surgery: Surgical approaches for Neurovascular diseases. Singapore: Springer Singapore; 2019. pp. 105–15.
doi: 10.1007/978-981-10-8950-3_13
Ansari A, Kalyan S, Sae-Ngow T, Yamada Y, Tanaka R, Kawase T, et al. Review of avoidance of complications in cerebral aneurysm surgery: the Fujita experience. Asian J Neurosurg. 2019;14(3):686–92.
doi: 10.4103/ajns.AJNS_131_17
pubmed: 31497085
pmcid: 6703062
Radoi M, Vakilnejad R, Stefan S, Stefanescu F. Microsurgical clipping of paraclinoid aneurysms: a single centre experience. Romanian Neurosurg. 2020;34(1):31–40.
doi: 10.33962/roneuro-2020-005
Kamide T, Tabani H, Safaee MM, Burkhardt J-K, Lawton MT. Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms. J Neurosurg JNS. 2018;129(6):1511–21.
doi: 10.3171/2017.7.JNS17673
Bsat S, Halaoui A, Sunna T, Alomari S, El Houshiemy M, Darwish H. CSF leak post-anterior clinoidectomy: case report and technical nuances. Interdisciplinary Neurosurg. 2020;20:100696.
doi: 10.1016/j.inat.2020.100696
Jha V, Behari S, Jaiswal AK, Bhaisora KS, Shende YP, Phadke RV. The focus on aneurysm principle: classification and surgical principles of management of concurrent arterial aneurysm with arteriovenous malformation causing intracranial hemorrhage. Asian J Neurosurg. 2016;11(3):240–54.
doi: 10.4103/1793-5482.145340
pubmed: 27366251
pmcid: 4849293
Flores BC, Klinger DR, Kl R, Sl B, Welch BG, White JA, et al. Management of intracranial aneurysms associated with arteriovenous malformations. Neurosurgical Focus FOC. 2014;37(3):E11.
doi: 10.3171/2014.6.FOCUS14165
Rammos SK, Gardenghi B, Bortolotti C, Cloft HJ, Lanzino G. Aneurysms Associated with Brain Arteriovenous malformations. AJNR Am J Neuroradiol. 2016;37(11):1966–71.
doi: 10.3174/ajnr.A4869
pubmed: 27339951
pmcid: 7963791