title: Neuro-ophthalmic presentation and surgical results of unruptured intracranial aneurysms—prospective Helsinki experience of 142 patients.
abstract: OBJECTIVE
  To assess prospectively neuro-ophthalmic findings associated with unruptured intracranial aneurysms and treatment morbidity and to identify factors predicting these findings.
  
  
  METHODS
  Patients admitted to Helsinki University Central Hospital and treated surgically or endovascularly during 2011 underwent a neuro-ophthalmic examination, including formal visual field testing, before operation, at discharge, and 2-4 months and ≥6 months postoperatively. Univariate and multivariate analysis was used to identify factors predicting eye movement disorders.
  
  
  RESULTS
  Study participants included 142 patients with 184 treated aneurysms: 7 (5%) had a third, fourth, or sixth nerve palsy or skew deviation preoperatively, and 16 (11%) had a third, fourth, or sixth nerve palsy or skew deviation postoperatively; the frequency was 8 (6%) at the last follow-up evaluation. Other findings included compressive optic neuropathy (n = 4), ischemic optic neuropathy (n = 1), Weber syndrome (n = 3), Benedikt syndrome (n = 1), and Wallenberg syndrome (n = 1). Of the 140 survivors at 6 months, 7 (5%) presented with visual field defects resulting from the aneurysm or its treatment. In the best bivariate model, factors independently predicting postoperative eye movement disorders were aneurysm location in the posterior circulation with an odds ratio of 142.02 (95% confidence interval = 20.13-1002.22) and aneurysm size (odds ratio = 1.28 for each 1-mm increase in diameter, 95% confidence interval = 1.12-1.47).
  
  
  CONCLUSIONS
  Management of unruptured intracranial aneurysms is fairly safe from a neuro-ophthalmic perspective, with some treatment-related morbidity being transient and minor. Although rare, an irreversible deficit is possible and should be taken into account when considering preventive treatment.
authors.affiliation: Department of Ophthalmology, Division of Neuro-Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: Elina.Koskela@hus.fi.
authors.forename: Elina
authors.initials: E
authors.lastname: Koskela
authors.affiliation: Department of Ophthalmology, Division of Neuro-Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Setälä
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Riku
authors.initials: R
authors.lastname: Kivisaari
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Aki
authors.initials: A
authors.lastname: Laakso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D015835:Ocular Motility Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D011446:Prospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D014787:Vision Tests; D058609:Visual Field Tests; D055815:Young Adult
keywords: Fourth nerve palsy; Intracranial aneurysm; Sixth nerve palsy; Third nerve palsy; Visual field defect; Weber syndrome