Endovascular treatment of giant aneurysms which cause visual loss.
BACKGROUND
Progressive visual loss that results when a giant cerebral aneurysm compresses the anterior visual pathway requires treatment. When surgical clipping is not safely feasible, percutaneous methods of embolization of the aneurysm can be visual or life saving.


METHODS
Endovascular techniques were used to treat 19 of 26 consecutive inoperable giant aneurysms in patients with visual loss, which included optic neuropathy (monocular in 13 patients and bilateral in 8) and optic tract dysfunction in five patients. Embolization of the aneurysm was performed with detachable balloons in 12 patients and with Guglielmi detachable electrocoils in 7.


RESULTS
After treatment, vision improved in 7 patients, was unchanged in 11, and worsened in 1. Neurologic complications with balloons were temporary in four patients and severe and permanent in three. In contrast, only one temporary complication occurred with Guglielmi detachable electrocoils. The treatment results are contrasted with the outcome in the seven patients who refused intervention: three hemorrhaged (1 death); monocular blindness with dementia developed in two; a complete homonymous hemianopia and dementia developed in one; and one became bilaterally blind.


CONCLUSIONS
Inoperable symptomatic giant aneurysms can be successfully treated with endovascular treatment.
Vargas
M E
ME
Department of Ophthalmology, New York University Medical Center, New York.
Kupersmith
M J
MJ
Setton
A
A
Nelson
K
K
Berenstein
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002404:Catheterization; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014786:Vision Disorders / Q000209:etiology*; D058609:Visual Field Tests; D014794:Visual Fields