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.
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.
Department of Ophthalmology, University of Florida, Gainesville, Florida, USA.
Saharsh
S
Patel
Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
Kyle M
KM
Fargen
Department of Radiology, University of Florida, Gainesville, Florida, USA.
Keith
K
Peters
Department of Ophthalmology, University of Florida, Gainesville, Florida, USA.
Peter
P
Krall
Department of Ophthalmology, University of Florida, Gainesville, Florida, USA.
Hazem
H
Samy
Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
Brian L
BL
Hoh
D000368:Aged; D000783:Aneurysm / Q000473:pathology / Q000628:therapy*; D001766:Blindness / Q000209:etiology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009880:Ophthalmic Artery / Q000473:pathology*; D020127:Recovery of Function / Q000502:physiology*
Aneurysm; Flow Diverter; MRI