title: Open and endovascular treatment of unruptured carotid-ophthalmic aneurysms: clinical and radiographic outcomes.
abstract: BACKGROUND
  Aneurysms of the carotid-ophthalmic artery present unique challenges to cerebrovascular neurosurgeons given their proximity to vital anatomic structures.
  
  
  OBJECTIVE
  To report our experience with a combined-modality treatment of unruptured carotid-ophthalmic aneurysms over a 12-year period.
  
  
  METHODS
  A retrospective review of 161 patients who underwent open, endovascular, or combined treatment of 170 aneurysms from January 1997 to July 2009 was conducted. Medical records, operative reports, office notes, and follow-up angiograms were reviewed to obtain data on patient demographics, angiographic results, and clinical outcomes.
  
  
  RESULTS
  One hundred forty-seven aneurysms were treated via endovascular techniques; 17 aneurysms (10%) were treated with microsurgical clip ligation; and 6 aneurysms (3.5%) were treated with a combined approach. Of the aneurysms treated via an endovascular approach alone, 81.6% of aneurysms had evidence of ≥ 95% occlusion on initial angiogram. There was a 1.4% rate of major complications associated with the initial procedure. Twenty-six of these aneurysms (18.9%) required further intervention on the basis of early angiographic results. Major complications occurred after 6 of 23 open microsurgical procedures (26.1%), including 2 instances of permanent visual loss. Nine clipped patients had long-term angiographic follow-up; none required further intervention.
  
  
  CONCLUSIONS
  Endovascular treatment of carotid-ophthalmic aneurysms with modern endovascular techniques can be performed safely and efficaciously in the elective setting.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. ymurayama@jikei.ac.jp
authors.forename: Sanjay
authors.initials: S
authors.lastname: Yadla
authors.forename: Peter G
authors.initials: PG
authors.lastname: Campbell
authors.forename: Bartosz
authors.initials: B
authors.lastname: Grobelny
authors.forename: Jack
authors.initials: J
authors.lastname: Jallo
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Jabbour
mesh_terms: D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome