title: Indocyanine Green Videoangiography Transoptic Visualization and Clipping Confirmation of an Optic Splitting Ophthalmic Artery Aneurysm.
abstract: OBJECTIVE
  Ophthalmic artery aneurysms with medial and superior projection in exceptionally rare cases can split the optic nerve. Treatment of these aneurysms is challenging, because the aneurysm dome is hidden from the optic nerve, rendering its visualization and clipping confirmation difficult. In addition, optic nerve function should be preserved during surgical maneuvers. Preoperative detection of this growing feature is usually missing.
  
  
  METHODS
  We illustrate the first case of indocyanine green videoangiography (ICG-VA) application in an optic penetrating ophthalmic artery aneurysm treatment. A 57-year-old woman presented with temporal hemianopsia, slight right visual acuity deficit, and new onset of headache. The cerebral angiography detected a right ophthalmic artery aneurysm medially and superiorly projecting. The A1 tract of the ipsilateral anterior cerebral artery was elevated and curved, being suspicious for an under optic aneurysm growth. Surgery was performed. Initially the aneurysm was not visible. ICG-VA permitted the transoptic aneurysm visualization. After optic canal opening, the aneurysm was clipped and transoptic ICG-VA confirmed the aneurysm occlusion. ICG-VA showed also the slight improvement of the optic nerve pial vascularization. Postoperatively, the visual acuity was 10/10 and the hemianopsia did not worsen.
  
  
  CONCLUSIONS
  The elevation and curve of the A1 tract in medially and superiorly projecting ophthalmic aneurysms may be an indirect sign of under optic growth, or optic splitting aneurysms. ICG-VA transoptic aneurysm detection and occlusion confirmation reduces the surgical maneuvers on the optic nerve, contributing to function preservation.
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padua, Italy. Electronic address: orielarustemi@libero.it.
authors.forename: Oriela
authors.initials: O
authors.lastname: Rustemi
authors.affiliation: Department of Neuroradiology, Padua University Hospital, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Cester
authors.affiliation: Department of Neuroradiology, Padua University Hospital, Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Causin
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padua, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Scienza
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padua, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Puppa
mesh_terms: D000783:Aneurysm / Q000473:pathology* / Q000601:surgery*; D000792:Angiography / Q000379:methods; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000473:pathology* / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods; D009900:Optic Nerve / Q000473:pathology*; D059351:Organ Sparing Treatments / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D020535:Video-Assisted Surgery / Q000379:methods*
chemical_list: D007208:Indocyanine Green
keywords: Aneurysm clipping; ICG-VA; Ophthalmic artery; Optic splitting