title: Surgical decompression and coil removal for the recovery of vision after coiling and proximal occlusion of a clinoidal segment aneurysm: technical case report.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: 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.
authors.forename: Rabih G
authors.initials: RG
authors.lastname: Tawk
authors.forename: Hunaldo J
authors.initials: HJ
authors.lastname: Villalobos
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
mesh_terms: D002340:Carotid Artery Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D003399:Craniotomy; D019299:Decompression, Surgical; D020878:Device Removal; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009900:Optic Nerve / Q000601:surgery; D020127:Recovery of Function; D016879:Salvage Therapy; D014786:Vision Disorders / Q000209:etiology* / Q000503:physiopathology; D014785:Vision, Ocular