Penetration of the optic nerve by an internal carotid artery-ophthalmic artery aneurysm: case report and literature review.
OBJECTIVE
Although it is well known that large or giant internal carotid artery-ophthalmic artery aneurysms can cause visual deficits, penetration and schism of the optic nerve by an aneurysm are very rare.


METHODS
A 48-year-old man presented with an acute onset of right visual deterioration after an episode of severe headache. Magnetic resonance imaging demonstrated penetration of the right optic nerve by an intracranial aneurysm. Cerebral angiography revealed an internal carotid artery-ophthalmic artery aneurysm of 12 x 7 mm. The aneurysm was directed superomedially and appeared to have a "waist" within the penetration.


METHODS
Intraoperatively, we observed that part of the aneurysm wall was visible through the optic nerve fibers at the junction with the optic chiasm.


CONCLUSIONS
Although there was no direct evidence of subarachnoid hemorrhage on imaging scans or with operative exploration, we think that the patient must have experienced sentinel hemorrhaging, leading to visual deterioration. We describe the case in detail and review the world literature.
D000783:Aneurysm / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery; D009900:Optic Nerve / Q000473:pathology*