title: Direct Surgery of Previously Coiled Large Internal Carotid Ophthalmic Aneurysm for the Purpose of Optic Nerve Decompression.
abstract: BackgroundProgressive visual loss after coil embolization of a large internal carotid ophthalmic aneurysm has been widely reported. It is generally accepted that the primary strategy for this complication should be conservative, including steroid therapy; however, it is not well known as to what approach to take when the conservative therapy is not effective.Case PresentationWe report a case of a 55-year-old female presenting with progressive visual loss after the coiling of a ruptured large internal carotid ophthalmic aneurysm. As the conservative therapy had not been effective, we performed neck clipping of the aneurysm with optic canal unroofing, anterior clinoidectomy, and partial removal of the embolized coils for the purpose of optic nerve decompression. After the surgery, the visual symptom was improved markedly.ConclusionsIt is suggested that direct surgery for the purpose of optic nerve decompression may be one of the options when conservative therapy is not effective for progressive visual disturbance after coil embolization.
authors.affiliation: Department of Neurosurgery, Kansai Rosai Hospital, Hyogo, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Kawabata
authors.affiliation: Department of Neurosurgery, Kansai Rosai Hospital, Hyogo, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Toyota
authors.affiliation: Department of Neurosurgery, Kansai Rosai Hospital, Hyogo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kumagai
authors.affiliation: Department of Neurosurgery, Kansai Rosai Hospital, Hyogo, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Neurosurgery, Kansai Rosai Hospital, Hyogo, Japan.
authors.forename: Kanji
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Neurosurgery, Kansai Rosai Hospital, Hyogo, Japan.
authors.forename: Takuyu
authors.initials: T
authors.lastname: Taki
keywords: clipping; coiled aneurysm; mass effect; nerve decompression