Aneurysms of the ophthalmic (C6) segment of the internal carotid artery: treatment options and strategies based on a clinical series.
OBJECTIVE
Treatment of ophthalmic segment aneurysms is technically demanding and still associated with a relatively high morbidity and mortality. The refinements of surgical techniques combined with the development of indirect methods of treatment have greatly improved the outcome in treating these lesions. We present our clinical experience and discuss treatment strategies.


METHODS
Seventy-eight consecutive patients with 88 ophthalmic segment aneurysms were admitted to our service from January 1997 to June 2003. Forty-three patients presented with unruptured aneurysms and 35 presented with subarachnoid hemorrhage (SAH). Management strategies included surgical clipping alone in 53 patients, clipping and hemicraniectomy in 2, coiling in 17, external carotid artery-middle cerebral artery (ECA/MCA) by-pass in 2, and coil occlusion of the internal carotid artery in 2. Two patients underwent no treatment.


RESULTS
In the group of 41 treated patients with unruptured aneurysms, 40 (97.6%) had good outcomes (GOS 1-2) and 1 patient had poor (GOS 3) outcome at discharge. Procedure-related morbidity was 15.7% (8/51 procedures), and permanent morbidity was 9.75% (4/41 patients). In the 35 patients who presented with SAH, mortality was 14.3% (5 patients); at discharge, 21 patients (60%) had good (GOS 1-2) and 9 (25.7%) poor (GOS 3) outcomes. The overall outcome was good (GOS 1-2) in 63 patients (80.8%) and poor (GOS 3-4) in 10 patients (12.8%). Overall mortality was 6.4% (5 patients all with SAH).


CONCLUSIONS
Direct obliteration of the aneurysm utilizing advanced surgical techniques is our preferred treatment approach, whenever possible. In case of unclippable large or giant aneurysms, the surgical or endovascular occlusion of the proximal internal carotid artery with or without an extracranial-intracranial by-pass is an option. A highly skilled team including a cerebrovascular and an endovascular surgeon is essential to achieve good outcomes in treating these lesions.
Beretta
F
F
Department of Neurosurgery, University of Cincinnati College of Medicine, Ohio 45267, USA. berettafederica@yahoo.com
Andaluz
N
N
Zuccarello
M
M
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000503:physiopathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013525:Surgical Instruments / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data