Ophthalmic Artery Aneurysm Research Articles

Large Ophthalmic Artery Aneurysm Presented as Isolated Basifrontal Hematoma without Subarachnoid Hemorrhage: A Rare Imaging Finding

Large Ophthalmic Artery Aneurysm Presented as Isolated Basifrontal Hematoma without Subarachnoid Hemorrhage: A Rare Imaging Finding

Multiple intra-aneurysmal WEB devices: Case discussions and operative technique

The Woven Endobridge (WEB, Sequent Medical, Aliso Viejo, California) device has emerged as an FDA approved endosaccular flow diverting alternative for patients with complex aneurysm morphology. We describe for the first time, in patients with dual anti platelet therapy (DAPT) non compliance, two cases during which multiple WEB devices were deployed within the aneurysm sac to achieve flow disruption. Two ophthalmic segment internal carotid artery aneurysms are treated by the deployment of an additional WEB device within the sac. We subsequently discuss the techniques utilized to ensure parent vessel patency. We demonstrate that patients with contraindications to endovascular modalities requiring DAPT may be candidates for a multi WEB intra-aneurysmal construct.

Surgical clipping of ophthalmic artery aneurysms: a single center series

Aim The purpose of this study was to summary the characteristics of ophthalmic artery (OphA) aneurysms and to obtain the independent risk factors for poor prognosis of microsurgical clipping treatment for OphA aneurysms. Methods The clinical and microsurgical clipping results of all 63 patients with ophthalmic aneurysm were investigated and reviewed. The OphA aneurysm patient's case records were reviewed including clinical characteristics, image findings, and clinical outcomes. Then, the risk factors of poor prognosis were analyzed retrospectively. Results Monocular blindness persisted in 4 patients (6.35%), 1 patient developed persistent vegetate state (PVS) (1.59%), while 4 patients (6.35%) died. The matching process constructed a cohort consisting of 9 poor outcome (Glasgow Outcome Scale, GOS 1–3) patients (14.3%), and 54 good outcome (GOS 4–5) patients (85.7%). Univariate analysis between the good outcome and poor outcome revealed statistical significance in age > 60 (p = 0.045), size (p = 0.016), and rupture before operation (p = 0.049). Further, multivariate logistic regression analysis identified age > 60 (odds ratio [OR], 5.877; 95% confidence interval [CI], 1.039–33.254; p = 0.045) and aneurysm size > 10mm (OR, 9.417; 95% CI, 1.476–60.072; p = 0.018) as the independent risk factors for poor outcome in microsurgical clipping treatment for OphA aneurysms. Conclusion The significant independent risk factors associated with clipping OphA aneurysms are age (>60) and size (>10mm).

Surgical clipping of a non-ruptured ophthalmic aneurysm through an extradural micropterional keyhole approach.

Clipping continues to be one of the treatment strategies for ophthalmic artery aneurysms not amenable for stenting or coiling, or when long-term treatment durability is a concern. However, crescent development of endovascular techniques demands minimal invasiveness in the transcranial approaches while ensuring satisfactory results. We describe an extradural micropterional keyhole approach (eMKA) to the paraclinoid region and highlight the key anatomical elements of this surgical approach. The eMKA is a minimally invasive approach that provides access to the paraclinoid region using an extradural corridor. Therefore, it is suitable for clipping of ophthalmic artery aneurysms and other paraclinoid aneurysms.

Microsurgical Clipping Techniques and Outcomes for Paraclinoid Internal Carotid Artery Aneurysms.

Microsurgical clipping of paraclinoid aneurysms presents unique technical challenges because of the anatomical complexity of the paraclinoid region. To analyze microsurgical clipping techniques, complications, and outcomes associated with paraclinoid aneurysms, with a focus on clip selection and clipping technique according to aneurysm location. From 1997 to 2016, 231 unruptured paraclinoid aneurysms from 216 patients were treated using microsurgical clipping. We retrospectively reviewed patient records to analyze clinical outcomes. A total of 80 aneurysms (34.6%) were treated with simple clipping. Among them, fenestrated clips were used with superior hypophyseal artery (SHA) aneurysms, but curved clips were used with most other aneurysms. A total of 151 aneurysms (65.6%) were treated using multiple clips, including tandem clipping for ophthalmic artery (OphA) aneurysms, tandem angled-fenestrated clipping for SHA and ventral carotid aneurysms, stacked clipping for dorsal carotid aneurysms, and various techniques for clinoidal segment/carotid cave aneurysms. Postoperative angiography was performed in 214 aneurysms (92.6%), and complete obliteration was confirmed in 195 aneurysms (91.1%). Using the modified Rankin Scale (mRS), overall functional outcome was good (mRS 0-2) in 99.6% of patients, although 30 cases (13.0%) showed new postoperative visual deficits. Surgical clipping of paraclinoid aneurysms is an excellent treatment modality with good clinical outcomes and acceptable complication rates, particularly in centers with large experience in the microsurgical management of cerebrovascular disorders. Appropriate clip selection and clipping techniques are required to perform complete and safe clipping.

Bilateral Giant Opthalmic Carotid Artery Aneurysms Presenting as Unilateral Diplopia: A Case Report

Introduction: The etiology of giant aneurysms is multifactorial. It becomes symptomatic in 9/100.000, most frequently in the fifth and sixth decades of the life. Intracavernous carotid artery aneurysms (ICAAs) represent less than 1% of intracranial aneurysms and show a slight female predominance. Case-Report: We report an interesting case of bilateral ICAA in 42-year-old female presented as acute diplopia and emphasize the need of a thorough systemic evaluation in young patients with diplopia and treated with endovascular coil embolization. A 42-year-old woman was admitted to the neurology department suffering from the unilateral diplopia. Neurological examination showed the left sixth cranial nerve palsy and had no further general motor or sensory symptoms. Digital Subtraction Angiogram (DSA) showed bilateral ophthalmic artery aneurysm. The patient was treated with endovascular loose packing coil embolization and Derivo 3.5x30mm flow diverter stent. Conclusion: It should be kept in mind that intracavernous carotid artery aneurysms may be bilateral in patients with unilateral cranial nerve symptoms.

Этапное хирургическое лечение пациента с аневризмами брюшной аорты и внутренней сонной артерии

The presence of associated cerebral aneurysm and abdominal aortic aneurysm is an extremely rare degenerative vascular pathology. The article describes a two-stage treatment of a patient with aneurysms that occur in different types of blood vessels characterized by different hemodynamic conditions. A 56-year-old man suffering from hypertension complained of abdominal pain, headache, and dizziness. The exam-ination revealed multiple aneurysms: in the abdominal and iliac arteries, as well as an ophthalmic artery aneurysm of the internal carotid ar-tery. Surgical interventions were carried out in stages: osteoplastic pterional craniotomy with aneurysm clipping of the right internal carotid artery with vascular ultrasound and endoprosthesis of abdominal aorta and iliac arteries with a stent graft. The patient was discharged in a satisfactory condition. Regression of clinical disease manifestations was found. It was shown that the key point was to create a multidisci-plinary team and determine the stages of surgical treatment when managing such patients.KEYWORDS: abdominal aortic aneurysm, iliac artery aneurysm, cerebral aneurysm, hypertension, degenerative pathology, treatment stages.FOR CITATION: Gilemkhanov A.R., Plechev V.V., Ishmetov V.Sh. et al. Step surgical treatment of a patient with abdominal aortic and internal carotid artery aneurysms. Russian Medical Inquiry. 2020;4(7):463–466. DOI: 10.32364/2587-6821-2020-4-7-463-466.

Off-Label Use of the WEB Device

We present our initial experience with the off-label use of the Woven EndoBridge (WEB) device. We performed a retrospective study from 2 institutions of patients with intracranial aneurysms who underwent treatment with the WEB device alone or in conjunction with stenting and/or coiling in an off-labeled location. Eleven patients with 12 aneurysms were included. Four (30.8%) aneurysms presented ruptured. Off-labeled locations included 3 aneurysms in the posterior communicating artery, 3 in the supraclinoid ophthalmic artery, 2 in the pericallosal artery, 2 in the posterior inferior cerebellar artery, 1 at the vertebrobasilar junction, and 1 in the cavernous internal carotid artery. Mean dome-to-neck ratio was 1.91 ± 0.9. Average duration of the procedure was 63.9 ± 29.6 minutes. Femoral route was used in 61.5%, and radial access in 48.5% of cases. Five procedures (41.7%) were performed under monitored anesthesia care. We had 1.33 attempts per aneurysm. WEB embolization was supplemented with coiling in 2 cases (16.67%) and stenting in 1 case (8.3%). Based on the O'Kelly-Marotta ("OKM") grading scale, we report a rate of 0% for grade 1, 33.3% for grade 2, and 33.3% for grade 3. Postprocedural occlusion was complete in 4 (33.3%) and adequate in 8 (66.6%) patients. No procedure-related deaths or symptomatic complications were reported. The WEB device was successfully deployed in off-labeled locations, including posterior communicating artery, ophthalmic artery, and pericallosal aneurysms. The efficacy of this usage must be evaluated in multicenter prospective studies, but our preliminary results are promising. Correct characterization of the aneurysm size/morphology, as well as awareness of possible adjunct treatments, are crucial for successful intervention.

An Anatomic Feasibility Study for Revascularization of the Ophthalmic Artery, Part I: Intracanalicular Segment

The anatomico-functional complexity of the ophthalmic segment aneurysms is attributable to the presence of critical neurovascular structures in the surgical field. Surgical clipping of the ophthalmic artery (OpA) aneurysms can result in postoperative visual deficit due to the complexity of the aneurysm, vasospasm, or optic nerve manipulation. In this study, we aimed to characterize the feasibility of an intracanalicular OpA (iOpA) revascularization with 2 donor vessels: an intracranial-intracranial (IC-IC) bypass using the anterior temporal artery (ATA) and an extracranial-intracranial (EC-IC) bypass using the superficial temporal artery (STA). We further discuss their potential role in "unclippable" OpA aneurysms. Twenty cadaveric specimens were used to evaluate the operative exposure of the intradural and intracanalicular OpA segments using an extradural-intradural intracanalicular approach. The arterial caliber and length at the anastomotic sites and required donor artery lengths were measured. The feasibility of the bypass using both donors was assessed. The average length of the intradural and intracanalicular segment of the OpA was 9.5 ± 1.6 mm. The mean caliber of the iOpA was 1.5 ± 0.2 mm. The mean ATA length required for an ATA-OpA anastomosis was 26.7 ± 8.9 mm, with a mean caliber of 1.0 ± 0.1 mm. The mean length of STA required for the bypass was 89.9 ± 9.7 mm, with a mean caliber of 1.92 ± 0.4 mm. This study confirms the feasibility of iOpA revascularization using IC-IC and EC-IC bypasses. These techniques could potentially be used for prophylactic or therapeutic neuroprotection from retinal ischemic injury while treating complex OpA aneurysms, infiltrative tumors, or intraoperative arterial injuries.

An Anatomical Feasibility Study for Revascularization of the Ophthalmic Artery. Part II: Intraorbital Segment

Distal ophthalmic artery (OpA) aneurysms are a rare subset of vascular lesions with lack of optimal treatment. The management of these aneurysms may require complete occlusion of the parent vessel, carrying a risk of permanent visual impairment due to individual variations of extracranial collateral flow to the intraorbital ophthalmic artery (iOpA). To test the feasibility of a superficial temporal artery (STA) to iOpA bypass to prevent acute ischemic retinal injury. Two different transorbital corridors (superomedial and posterolateral approaches) for this bypass were evaluated. Each approach was carried out in 10 specimens each (n= 20). The corridors were compared to achieve the optimal exposure of the iOpA until the central retinal artery origin was visualized. An end-to-end anastomosis was performed from STA-to-iOpA. The arterial caliber and length at the anastomotic sites, required donor artery length, and intraorbital surgical area were measured. STA-iOpA bypasses were performed in all specimens. For the posterolateral transorbital approach, the mean caliber of STA was 1.8 ± 0.2 mm, and that of iOpA was 1.7 ± 0.5 mm. The required STA graft length was 78.3 ± 1 mm with lateral iOpA transposition of 8.2 ± 1.1 mm. For the superomedial approach, the average STA length required for an intraorbital bypass was 130.8 ± 14.0 mm. The mean calibers of iOpA and STA were 1.5 ± 0.1 mm and 1.5 ± 0.1 mm, respectively. This study demonstrates the feasibility of a novel revascularization technique of the iOpA using 2 different transorbital approaches. These techniques can be used in the management of intraorbital lesions such as OpA aneurysms, tumoral infiltrations, or intraoperative injuries.

Two-Stage Revascularization and Clip Reconstruction of a Giant Ophthalmic Artery Aneurysm: 3-Dimensional Operative Video.

Ophthalmic segment aneurysms (OSAs) are technically challenging lesions with a wide-neck morphology and proximity to the optic nerve. Revascularization and aneurysm trapping are occasionally needed to manage unclippable OSAs. Microsurgical treatment requires anterior clinoidectomy, optic strut drilling, and proximal/distal dural ring dissection for adequate exposure. This video demonstrates a two-stage revascularization and clip reconstruction of an OSA. A 62-yr-old woman was presented, with acute-onset expressive aphasia, right hemineglect, and hemiparesis. Neuroimaging revealed a partially thrombosed giant OSA measuring 2.5×2.3 cm2. Patient consent was obtained for bypassing, trapping, and decompressing the aneurysm. A pterional craniotomy was performed and an external carotid artery - radial artery graft - middle cerebral artery bypass was performed. The aneurysm was proximally occluded with a permanent clip on the clinoidal internal carotid artery (ICA). Adherence of the distal supraclinoid ICA to the aneurysm wall did not allow for aneurysm trapping. On postoperative day 8, the patient experienced acute mental status decline due to a frontal intraparenchymal hemorrhage. The aneurysm was trapped in a second surgery to occlude persistent retrograde aneurysm filling. The aneurysm sac was circumferentially dissected with temporary parent artery trapping. The OSA was opened and thrombectomized using an ultrasonic aspirator followed by trapping clip application. Postoperatively, the patient gradually returned to neurological baseline with minimal expressive aphasia. Although OSAs are preferentially treated with flow diversion, giant OSAs with significant mass effect may necessitate microsurgical clipping or trapping with decompressive thrombectomy. This case demonstrates that proximal clip occlusion may not be sufficient for aneurysm thrombosis and rupture prevention. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Diverse Use of the WEB Device: A Technical Note on WEB Stenting and WEB Coiling of Complex Aneurysms

Abstract INTRODUCTION The Woven EndoBridge (WEB) device has recently emerged as an alternative to embolize complex intracranial aneurysms (IAs). However, there are limitations to the WEB device such as inability to secure acutely ruptured and wide-neck IAs. METHODS We conducted a retrospective analysis of our prospectively collected database of patients with IAs who underwent treatment with WEB device in conjunction with stenting and/or coiling, or WEB device placement in challenging locations. RESULTS A total of 7 patients/IAs were included. Average age was 59.3 ± 7.8 yr. All patients were women, and 2 presented with SAH. Two patients were treated with simultaneous stenting and WEB placement. One patient had a previous stent through which the WEB was placed. One patient underwent coiling, WEB and stent placement simultaneously. Another patient had a post-coiling recurring aneurysm which was treated with WEB placement. One patient was treated with WEB and coiling. One patient had an ophthalmic artery aneurysm with an acute angle treated with WEB alone. Two patients developed an asymptomatic decrease in flow in the parent vessel, which was successfully restored with the initiation of Tirofiban. One patient developed a herniation of the WEB device through the stent, requiring salvage with an expandable balloon that crushed the WEB against the stent and pushed it back to the aneurysm. No permanent complications or clinical deficits were reported after the endovascular procedures. The occlusion score was as follows: 4/7 cases (57.1%) achieved 100% occlusion, 2/7 cases (28.6%) had neck remnants, and 1 case (14.3%) had an aneurysmal remnant. One patient with severe SAH (Hunt & Hess grade IV) died due to no improvement in neurological exam and withdrawal of care. CONCLUSION WEB can be safely used in adjunct to coiling and/or stenting, or as a wire-navigation tool. Accurate sizing before deployment is critical.

Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms.

OBJECTIVEWhile most paraclinoid aneurysms can be clipped with excellent results, new postoperative visual deficits are a concern. New technology, including flow diverters, has increased the popularity of endovascular therapy. However, endovascular treatment of paraclinoid aneurysms is not without procedural risks, is associated with higher rates of incomplete aneurysm occlusion and recurrence, and may not address optic nerve compression symptoms that surgical debulking can. The increasing endovascular management of paraclinoid aneurysms should be justified by comparisons to surgical benchmarks. The authors, therefore, undertook this study to define patient, visual, and aneurysm outcomes in the most common type of paraclinoid aneurysm: ophthalmic artery (OphA) aneurysms.METHODSResults from microsurgical clipping of 208 OphA aneurysms in 198 patients were retrospectively reviewed. Patient demographics, aneurysm morphology (size, calcification, etc.), clinical characteristics, and patient outcomes were recorded and analyzed.RESULTSDespite 20% of these aneurysms being large or giant in size, complete aneurysm occlusion was accomplished in 91% of 208 cases, with OphA patency preserved in 99.5%. The aneurysm recurrence rate was 3.1% and the retreatment rate was 0%. Good outcomes (modified Rankin Scale score 0-2) were observed in 96.2% of patients overall and in all 156 patients with unruptured aneurysms. New visual field defects (hemianopsia or quadrantanopsia) were observed in 8 patients (3.8%), decreased visual acuity in 5 (2.4%), and monocular blindness in 9 (4.3%). Vision improved in 9 (52.9%) of the 17 patients with preoperative visual deficits.CONCLUSIONSThe most important risk associated with clipping OphA aneurysms is a new visual deficit. Meticulous microsurgical technique is necessary during anterior clinoidectomy, aneurysm dissection, and clip application to optimize visual outcomes, and aggressive medical management postoperatively might potentially decrease the incidence of delayed visual deficits. As the results of endovascular therapy and specifically flow diverters become known, they warrant comparison with these surgical benchmarks to determine best practices.

Management of recurrent intracranial aneurysms after coil embolization: a novel classification scheme based on angiography.

Recurrent aneurysms after coil embolization remain a challenging issue. The goal of the present study was to report the authors' experience with recurrent aneurysms after coil embolization and to discuss the radiographic classification scheme and recommended management strategy. Aneurysm treatments from a single institution over a 6-year period were retrospectively reviewed. Ninety-seven aneurysms that recurred after initial coiling were managed during the study period. Recurrent aneurysms were classified into the following 5 types based on their angiographic characteristics: I, pure recanalization inside the aneurysm sac; II, pure coil compaction without aneurysm growth; III, new aneurysm neck formed without coil compaction; IV, new aneurysm neck formed with coil compaction; and V, newly formed aneurysm neck and sac. Aneurysm recurrences resulted in rehemorrhages in 6 cases (6.2%) of type III-V aneurysms, but in none of type I-II aneurysms. There was a significantly higher proportion of ophthalmic artery aneurysms and complex internal carotid artery aneurysms presenting as types I and II than presented as the other 3 types (63.3% vs 16.4%, p < 0.001). In contrast, for posterior communicating artery aneurysms and anterior communicating artery aneurysms, a higher proportion of type III-V aneurysms was observed than for the other 2 types, but without a significant difference in the multivariate model (56.7% vs 23.3%). In addition, giant (> 25 mm) aneurysms were more common among type I and II lesions than among type III and IV aneurysms (36.7% vs 9.0%, p = 0.001), which exhibited a higher proportion of small (< 10 mm) lesions (65.7% vs 13.3%, p < 0.001). A single reembolization procedure was sufficient to occlude 80.0% of type I recurrences and 83.3% of type II recurrences from coil compaction but only 65.6% of type III-V recurrences from aneurysm regrowth. Aneurysm size and location represent the determining factors of the angiographic recurrence types. Type I and II recurrences were safely treated by reembolization, whereas type III-V recurrences may be best managed surgically when technically feasible.

Anterior Clinoidectomy and Microsurgical Clipping of a Giant Thrombotic Recurrent Ophthalmic Artery Aneurysm Previously Wrapped and Stent Coiled: 2-Dimensional Operative Video.

Anterior Clinoidectomy and Microsurgical Clipping of a Giant Thrombotic Recurrent Ophthalmic Artery Aneurysm Previously Wrapped and Stent Coiled: 2-Dimensional Operative Video.

Pituitary neoplasms associated with intracranial aneurysm: A report of 4 cases and literature review

Objective To summarize the imaging findings, treatment and prognosis of pituitary adenoma associated with intracranial aneurysm. Methods From July 2014 to June 2017, 4 patients (3 females and 1 male) with pituitary macroadenoma associated with intracranial aneurysm were admitted to Neurosurgery Department of the Second Affiliated Hospital of Zhejiang University School of Medicine. Among them, 1 patient had bilateral ophthalmic artery aneurysms and 2 cases had right ophthalmic artery aneurysms. All those 3 cases underwent endovascular treatment of intracranial aneurysms followed by transsphenoidal surgery for pituitary adenomas. The other 1 patient with anterior communicating artery aneurysm underwent successful clipping of aneurysm after removal of pituitary adenoma. Results Of the 4 patients with pituitary adenoma and intracranial aneurysm, 3 underwent endovascular embolization of the aneurysm followed by endoscopic transsphenoidal pituitary adenoma resection. MRI showed no recurrence after resection. Digital subtraction angiography (DSA) was performed and revealed that the aneurysm had no recurrence and a good prognosis. One patient with anterior communicating artery aneurysm, although undergoing aneurysm clipping and pituitary adenoma resection, eventually gave up treatment due to pulmonary infection, resulting in a poor prognosis. Conclusions For patients with pituitary adenoma with high risk factors, it is recommended to perform magnetic resonance angiography (MRA) and/or DSA before surgery. MRI T1 and T2 weighted sequences showing flow shadow is an important factor for pituitary adenoma with intracranial aneurysms. For patients with pituitary adenomas with intracranial aneurysms, one or two stages of surgery should be performed according to the presence or absence of aneurysm, and a relatively good prognosis can be obtained. Key words: Pituitary neoplasms; Intracranial aneurysm; Diagnosis; Treatment; Prognosis

Vision Outcomes of Endovascular Treatment for Unruptured Ophthalmic Artery Aneurysms

The purpose of this study was to report the authors' experience with endovascular treatment (EVT) of ophthalmic artery (OA) aneurysms and to investigate risk factors for visual complications of EVT for unruptured OA aneurysms. Fifty-four patients with unruptured OA aneurysms subjected to EVT were recruited for this study from March 2010 to December 2017. The clinical and angiographic outcomes of all 54 patients were investigated and analyzed retrospectively. Of the 54 patients included in this study, 5 patients (9.3%) had visual complications, including asymptomatic unintended OA occlusion in 2 patients (3.7%) and symptomatic complications in 3 patients (5.6%); 2 patients (3.7%) had transient visual complications, and 1 (1.9%) had a permanent complication. No subacute or delayed visual complications occurred during the 20.8-month follow-up period. OA incorporation by the aneurysm (odds ratio [OR], 3.471; 95% confidence interval [CI], 1.115-9.184; P= 0.038) and intentional OA occlusion (OR, 1.820; 95% CI, 1.248-6.221; P= 0.044) were independent risk factors for visual complications in a multivariate logistic regression analysis. The visual complication rate was 9.3% when performing EVT for unruptured OA aneurysms. OA aneurysms with OA incorporation by the aneurysm might be at higher risk of visual complications when performing EVT. Intentional OA occlusion should be performed with caution, even though a patient may have favorable collaterals during balloon test occlusion.

Pituitary Dysfunction from an Unruptured Ophthalmic Internal Carotid Artery Aneurysm with Improved 2-year Follow-up Results: A Case Report.

Internal carotid artery (ICA) supraclinoid segment aneurysms extending into the sellar region and leading to pituitary dysfunction are a rare occurrence. To date, long-term follow up of pituitary function 2 years post-treatment has never been reported. Herein, we present a case of pituitary dysfunction due to an unruptured ophthalmic segment internal carotid artery aneurysm and report improved 2-year follow-up results. A 76-year-old male presented with disturbed consciousness due to hyponatremia, which was caused by hypoadrenocorticism resulting from pituitary dysfunction complicated by hypogonadism and hypothyroidism. Computed tomography angiography revealed an intracranial aneurysm of the ophthalmic segment of the right ICA with an intrasellar extension. Thus, digital subtraction angiography and coil embolization were performed, followed by hormone replacement therapy. A 2-year follow-up revealed a partial improvement in the pituitary function, including complete restoration of thyroid-stimulating hormone level and other thyroid hormones levels, and partial restoration of testosterone levels, followed by discontinuation of thyroid hormone replacement therapy. However, the mechanisms of such pituitary dysfunction and the effects of various treatments, including clipping and coiling, on different hormones of pituitary function recovery remain unclear. A long-term follow-up of >2 years may elucidate the pituitary function recovery post-treatment and provide a medication adjustment for hormone replacement therapy.

Endoscopic Endonasal Clipping of Anterior Circulation Aneurysm: Surgical Techniques and Results

Endoscopic endonasal clipping of intracranial aneurysms may use microsurgical techniques as an alternative to the transcranial approach. Here we report a series of patients who underwent microsurgical clipping of anterior circulation aneurysms via an endoscopic endonasal approach (EEA). This retrospective chart review included all the patients who underwent standard binostril EEA for aneurysm clipping. Surgical outcomes and complications are noted. The rationality and limitations of this procedure are discussed. Seven patients with 12 aneurysms of the anterior circulation underwent EEA for clipping. These 12 aneurysms consisted of 5 anterior communicating artery (AComA) aneurysms, 4 paraclinoid aneurysms, 1 ophthalmic artery aneurysm, and 2 aneurysm located in the cavernous segment of internal carotid artery (ICA). Nine of the 12 aneurysms were successfully clipped. One giant paraclinoid aneurysm could not be clipped during operation and was coiled in second endovascular stage. The 2 aneurysms located in the cavernous segment of ICA were not clipped intentionally in a single-stage procedure, after weighing the surgical benefit against the difficulty of surgical exposure and feasibility. The proximal control of ICA was achieved in all cases. There was no death, no cerebrospinal fluid leak, or other complications. All patients recovered completely. EEA can provide direct access for microsurgical clipping of strictly selected anterior circulation aneurysms. All the principles of cerebrovascular surgery must be followed. These procedures require a long learning curve. Only teams with adequate experience in microvascular and endoscopic skull base surgeries should attempt this approach for treating aneurysms.

Abstract WP80: Microsurgical Clipping of Ophthalmic Artery Aneurysms:Surgical Results and Visual Outcomes With 208 Aneurysms

Background: While most paraclinoid aneurysms can be clipped with excellent results, new visual deficits postoperatively are a concern. Meanwhile, new technology like flow diverters has increased the popularity of endovascular therapy. However, endovascular treatment of paraclinoid aneurysms is not without procedural risks, is associated with higher rates of incomplete aneurysm occlusion and recurrence, and may not address optic nerve compression symptoms that surgical debulking can. Objective: The increasingly endovascular management of paraclinoid aneurysms should be justified by comparisons to surgical benchmarks. Therefore, we aimed to define patient, visual, and aneurysm outcomes in the most common paraclinoid aneurysm: ophthalmic artery (OphA) aneurysms. Methods: Results from microsurgical clipping of 208 OphA aneurysms in 198 patients were retrospectively reviewed. Patient demographics, aneurysm morphology (size, calcification, etc), clinical characteristics and patient outcomes were recorded and analyzed. Results: Despite 20% of these aneurysms being large or giant in size, complete aneurysm occlusion was accomplished in 91% of aneurysms, with patency of OphA preserved in 99.5%. Aneurysm recurrence rate was 3.1% and retreatment rate was 0%. Good outcomes (modified Rankin Scale score: 0-2) were observed in 96.2% of patients overall, and in all 156 patients with unruptured aneurysms. New visual field defects (hemianopsia or quadrantanopsia) were observed in 3.8% (8 patients), decreased visual acuity in 2.4% (5 patients), and monocular blindness in 4.3% (9 patients). Vision improved in 9 of 17 patients (52.9%) with preoperative deficits. Conclusion: The most important risk associated with clipping OphA aneurysms is a new visual deficit. Meticulous microsurgical technique is necessary during anterior clinoidectomy, aneurysm dissection, and clip application to optimize visual outcomes. As the results of endovascular therapy and specifically flow diverters become known, they warrant comparison with these surgical benchmarks to determine best practices.