Rabih G Tawk1, Hunaldo J Villalobos, Elad I Levy, L Nelson Hopkins. 1. Department of Neurosurgery, Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
Abstract
OBJECTIVE: We present the case of a patient with continued deterioration of vision after endovascular treatment of an unruptured clinoidal segment aneurysm. In conjunction with a review of the literature, the findings in this case highlight the need for further refinements in our understanding of pathophysiological changes induced by coiling of cerebral aneurysms, especially those in aneurysms producing signs and symptoms relating to mass effect. CLINICAL PRESENTATION: The patient is a 45-year-old man who presented with progressive vision loss. Imaging studies revealed a large, clinoidal segment aneurysm. The patient continued to experience progressive vision loss despite treatment with endovascular coiling, proximal occlusion, and high-dose steroid medication. INTERVENTION: The patient underwent a craniotomy for decompression of the optic nerve and for salvage of vision. Clipping of the distal vessel was performed, and the coil mass was removed. The patient experienced marked improvement of central vision after the surgical procedure. CONCLUSION: Although endovascular treatment of aneurysms protects most patients from aneurysm rupture, this case illustrates the fact that coiling, followed by proximal occlusion, might fail to alleviate symptoms related to mass effect. Our experience in this case suggests that early surgical decompression may be indicated for patients presenting with progressive visual deterioration.
OBJECTIVE: We present the case of a patient with continued deterioration of vision after endovascular treatment of an unruptured clinoidal segment aneurysm. In conjunction with a review of the literature, the findings in this case highlight the need for further refinements in our understanding of pathophysiological changes induced by coiling of cerebral aneurysms, especially those in aneurysms producing signs and symptoms relating to mass effect. CLINICAL PRESENTATION: The patient is a 45-year-old man who presented with progressive vision loss. Imaging studies revealed a large, clinoidal segment aneurysm. The patient continued to experience progressive vision loss despite treatment with endovascular coiling, proximal occlusion, and high-dose steroid medication. INTERVENTION: The patient underwent a craniotomy for decompression of the optic nerve and for salvage of vision. Clipping of the distal vessel was performed, and the coil mass was removed. The patient experienced marked improvement of central vision after the surgical procedure. CONCLUSION: Although endovascular treatment of aneurysms protects most patients from aneurysm rupture, this case illustrates the fact that coiling, followed by proximal occlusion, might fail to alleviate symptoms related to mass effect. Our experience in this case suggests that early surgical decompression may be indicated for patients presenting with progressive visual deterioration.
Authors: G W Schmidt; S F Oster; K C Golnik; L M Tumialán; V Biousse; R Turbin; C J Prestigiacomo; N R Miller Journal: AJNR Am J Neuroradiol Date: 2007 Nov-Dec Impact factor: 3.825
Authors: Albedy Moreira Bastos; Anderson Raiol Rodrigues; Maria Izabel Tentes Côrtes; Eliza Maria da Costa Brito Lacerda; Mônica Gomes Lima; Cláudio Eduardo Corrêa Teixeira; Luiz Carlos de Lima Silveira Journal: Front Neurol Date: 2017-09-21 Impact factor: 4.003