title: Return of visual function after bilateral visual loss following flow diversion embolization of a giant ophthalmic aneurysm due to both reduction in mass effect and reduction in aneurysm pulsation.
abstract: Large and giant paraclinoid aneurysms are challenging to treat by either surgical or endovascular means. Visual dysfunction secondary to optic nerve compression and its relationship with aneurysm size, pulsation and thrombosis is poorly understood. We present a patient with a giant paraclinoid aneurysm resulting in bilateral visual loss that worsened following placement of a Pipeline Embolization Device and adjunctive coiling. Visual worsening occurred in conjunction with aneurysm thrombosis, increase in maximal aneurysm diameter and new adjacent edema. Her visual function spontaneously improved in a delayed fashion to better than pre-procedure, in conjunction with reduced aneurysmal mass effect, size and pulsation artifact on MRI. This report documents detailed ophthalmologic and MRI evidence for the role of thrombosis, aneurysm mass effect and aneurysm pulsation as causative etiologies for both cranial nerve dysfunction and delayed resolution following flow diversion treatment of large cerebral aneurysms.
authors.affiliation: Department of Ophthalmology, University of Florida, Gainesville, Florida, USA.
authors.forename: Saharsh
authors.initials: S
authors.lastname: Patel
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Fargen
authors.forename: Keith
authors.initials: K
authors.lastname: Peters
authors.forename: Peter
authors.initials: P
authors.lastname: Krall
authors.forename: Hazem
authors.initials: H
authors.lastname: Samy
authors.forename: Brian L
authors.initials: BL
authors.lastname: Hoh
mesh_terms: D000368:Aged; D000783:Aneurysm / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009880:Ophthalmic Artery; D011673:Pulsatile Flow; D020127:Recovery of Function; D014786:Vision Disorders / Q000209:etiology* / Q000503:physiopathology
keywords: Aneurysm; Flow Diverter; MRI