title: Influence of surgical or endovascular treatment on visual symptoms caused by intracranial aneurysms: single-center series and systematic review.
abstract: OBJECTIVE
  Intracranial aneurysms of the anterior circulation might become symptomatic by causing visual deficits. The influence of treatment modality on improvement is still unclear. The objective of this study was to analyze the recovery of visual deficits caused by the mass effect of intracranial aneurysms after surgical clipping or endovascular treatment.
  
  
  METHODS
  Between June 1999 and December 2009, 20 patients with unruptured intracranial aneurysms causing visual dysfunction due to compression of the optical nerve were treated at the authors' institution. Visual deficits were recorded at admission and at follow-up. To evaluate a larger number of patients, MEDLINE was searched for published studies involving visual disturbance caused by an aneurysm. A multivariate analysis was performed to find independent predictors for favorable visual outcome.
  
  
  RESULTS
  Nine (75%) of 12 patients treated surgically achieved improvement of visual symptoms, compared with 3 (38%) of 8 patients treated endovascularly. A literature review, including the current series, revealed a total of 165 patients with UIAs causing visual dysfunction. Surgical treatment was associated with a significantly higher rate of visual improvement (p = 0.002) compared with endovascular treatment. According to the multivariate analysis, surgical clipping was the only variable significantly associated with improvement of visual outcome (p = 0.02).
  
  
  CONCLUSIONS
  Aneurysm-related visual dysfunction developed from direct mechanical compression may improve after surgical clipping and endovascular coiling. However, based on the present series combined with pooled analysis of data from the literature, the only factor significantly associated with improvement of visual dysfunction was surgical clipping.
authors.affiliation: Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. patrick.schuss@med.uni-frankfurt.de
authors.forename: Patrick
authors.initials: P
authors.lastname: Schuss
authors.forename: Erdem
authors.initials: E
authors.lastname: Güresir
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000601:surgery / Q000628:therapy*