title: Recovery of Visual and Ophthalmologic Symptoms After Treating Large or Giant Internal Carotid Artery Aneurysm by High-Flow Bypass with Cervical Ligation.
abstract: OBJECTIVE
  Large or giant internal carotid artery (ICA) aneurysms often cause visual deficits and cranial nerve palsy. The aim of this study was to investigate the efficacy of ligation of the ICA with high-flow bypass.
  
  
  METHODS
  We retrospectively analyzed the findings from patients with visual deficit and ophthalmologic symptoms due to ICA aneurysms. In addition, we analyzed the recovery factors associated with the visual deficit and ophthalmologic symptoms postoperatively, focusing on the type of cranial nerve palsy, aneurysm size, location, and the time to treatment from first symptoms.
  
  
  RESULTS
  We identified 38 patients (35 women, 3 men) with a mean age at surgery of 63.6 years (range, 24-81 years) with visual and ophthalmologic symptoms due to large or giant internal carotid aneurysm. Aneurysms ranged in size from 15-50 mm (mean, 25.2 mm). Visual disturbance (7 cases, 18%) and ophthalmoplegia (31 cases, 82%) were the only preoperative cranial nerve palsies. Aneurysms were completely thrombosed in 94.7% of cases (36/38). Visual disturbance improved in 28.5% of cases (2/7), and ophthalmoplegia improved in 87.1% of cases (27/31). Time to therapy from developing a visual disturbance was longer than time to therapy from developing ophthalmoplegia (P = 0.001). Time to therapy was significantly associated with recovery from cranial nerve palsy (P < 0.0001). The recovery of visual disturbance was worse than that of ophthalmoplegia (P = 0.001).
  
  
  CONCLUSIONS
  Early treatment is recommended when the visual and ophthalmologic symptoms are present because treatment delay is a risk factor for nonimprovement of symptoms.
authors: Department of Neurosurgery, Chiba Hokusoh Hospital, Chiba, Japan. Electronic address: s00-078@nms.ac.jp.
authors: Fumihiro
authors: F
authors: Matano
authors: Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
authors: Yasuo
authors: Y
authors: Murai
authors: Department of Neurosurgery, Chiba Hokusoh Hospital, Chiba, Japan.
authors: Takayuki
authors: T
authors: Mizunari
authors: Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
authors: Tomonori
authors: T
authors: Tamaki
authors: Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
authors: Kojiro
authors: K
authors: Tateyama
authors: Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
authors: Kenta
authors: K
authors: Koketsu
authors: Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan.
authors: Rokuya
authors: R
authors: Tanikawa
authors: Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan.
authors: Hiroyasu
authors: H
authors: Kamiyama
authors: Department of Neurosurgery, Chiba Hokusoh Hospital, Chiba, Japan.
authors: Shiro
authors: S
authors: Kobayashi
authors: Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
authors: Akio
authors: A
authors: Morita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D000072226:Computed Tomography Angiography / Q000379:methods; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014786:Vision Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*
keywords: High-flow bypass; Large aneurysm; Oculomotor nerve palsy; Ophthalmoplegia; Visual disturbance