title: Asymptomatic, unruptured carotid-ophthalmic artery aneurysms: angiographical differentiation of each type, operative results, and indications.
abstract: BACKGROUND
  Some types of carotid-ophthalmic artery aneurysms are still difficult to clip successfully because their exposure requires opening the cavernous sinus and/or retracting the optic nerve. It is useful to know the complications and to determine the type of aneurysm preoperatively for the management of carotid-ophthalmic artery aneurysms.
  
  
  METHODS
  The operative results in 15 patients with asymptomatic unruptured carotid-ophthalmic artery aneurysms were surveyed. The aneurysms were small in all the patients, and they underwent direct operation. Four patients presented with other ruptured aneurysms, four with other diseases (infarction, trauma, or pituitary adenoma), and seven were evaluated with magnetic resonance angiography for symptoms such as vertigo or headache. Among them, five had carotid cave aneurysms and one had paraclinoid aneurysm.
  
  
  RESULTS
  Neck clipping was performed in 13 patients. Postoperatively, ipsilateral visual loss was encountered in one patient, and ipsilateral visual field defect was encountered in three patients. The visual field defect was lower nasal quadrant hemianopsia in two patients and lower hemianopsia in one patient. The cause of this complication was suspected to be retraction and/or the heat of the drill near the optic nerve. It seemed to be possible to distinguish the carotid cave or the paraclinoid aneurysm from the other carotid-ophthalmic aneurysms using carotid angiography preoperatively.
  
  
  CONCLUSIONS
  When direct operation is performed for a carotid-ophthalmic artery aneurysm, care must be taken to avoid optic nerve injury caused by the retraction and/or the heat of the drill.
authors.affiliation: Department of Neurological Surgery, Ehime University School of Medicine, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kumon
authors.forename: S
authors.initials: S
authors.lastname: Sakaki
authors.forename: K
authors.initials: K
authors.lastname: Kohno
authors.forename: S
authors.initials: S
authors.lastname: Ohta
authors.forename: S
authors.initials: S
authors.lastname: Ohue
authors.forename: Y
authors.initials: Y
authors.lastname: Oka
mesh_terms: D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D000792:Angiography; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications; D016896:Treatment Outcome