Neurointervention.  2022 Mar;17(1):18-27. 10.5469/neuroint.2020.00185.

Comparison of Visual Outcomes of Ophthalmic Artery Aneurysms Treated with Microsurgical Clipping and Endovascular Coiling

• Lu G
• Chung J
• Park JC
• Ahn JS
• Kwun BD
• Lee DH

• KMID: 2526622
• DOI: http://doi.org/10.5469/neuroint.2020.00185

Abstract

Purpose
Post-treatment visual deficit is a major concern associated with both microsurgical clipping and endovascular coiling for the treatment of ophthalmic artery (OphA) aneurysms of the internal carotid artery. We aimed to compare the safety and effectiveness of the 2 modalities.
Materials and Methods
We retrospectively reviewed and compared the baseline characteristics and postoperative visual and angiographic outcomes of OphA aneurysms treated by clipping or coiling between January 2010 and August 2018 at our hospital. In addition, the balloon occlusion test was performed to evaluate the safety of OphA occlusion.
Results
This study included 56 aneurysms treated by clipping and 82 aneurysms treated by coiling. Both the immediate and follow-up rates of incomplete aneurysm occlusion were comparable between the 2 groups (21.4% vs. 22.0%; 24.4% vs. 23.6%). The incidence of post-treatment visual deficits was higher in the clipping group than in the coiling group (16.1% vs. 2.4%; P=0.010). We observed total ipsilateral OphA occlusion in 6 patients and near occlusion in 3 patients during endovascular coiling; however, only 1 patient with near OphA occlusion showed a post-treatment visual field defect.
Conclusion
OphA aneurysms treated by endovascular coiling exhibited an aneurysm occlusion rate similar to that of microsurgical clipping with fewer post-treatment visual deficits. The total occlusion of OphA with adequate collaterals did not cause post-treatment visual deficits.

Keyword

Aneurysms; Balloon occlusion test; Clipping; Coiling; Ophthalmic artery; Vision, ocular

Reference

1. Kumon Y, Sakaki S, Kohno K, Ohta S, Ohue S, Oka Y. Asymptomatic, unruptured carotid-ophthalmic artery aneurysms: angiographical differentiation of each type, operative results, and indications. Surg Neurol. 1997; 48:465–472.

2. Kamide T, Tabani H, Safaee MM, Burkhardt JK, Lawton MT. Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms. J Neurosurg. 2018; 129:1511–1521.

3. Yu JW, Shim YS, Lee JW, Kim DJ, Kim BM, Lim YC, et al. Vision outcomes of endovascular treatment for unruptured ophthalmic artery aneurysms. World Neurosurg. 2018; 116:e1223–e1229.

4. Park H, Nakagawa I, Yokoyama S, Wada T, Motoyama Y, Kichikawa K, et al. Central retinal artery thromboembolism without ophthalmic artery occlusion during stent-assisted coil embolization of ophthalmic artery aneurysm. World Neurosurg. 2019; 121:77–82.

5. Elkordy AM, Sato K, Inoue Y, Mano Y, Matsumoto Y, Takahashi A, et al. Central retinal artery occlusion after the endovascular treatment of unruptured ophthalmic artery aneurysm: a case report and a literature review. NMC Case Rep J. 2016; 3:71–74.

6. Castillo B Jr, De Alba F, Thornton J, DeBrun G, Pulido J. Retinal artery occlusion following coil embolization of carotid-ophthalmic aneurysms. Arch Ophthalmol. 2000; 118:851–852.

7. Turner RD, Byrne JV, Kelly ME, Mitsos AP, Gonugunta V, Lalloo S, et al. Delayed visual deficits and monocular blindness after endovascular treatment of large and giant paraophthalmic aneurysms. Neurosurgery. 2008; 63:469–474. discussion 474-475.

8. Kim B, Jeon P, Kim K, Yang N, Kim S, Kim H, et al. Endovascular treatment of unruptured ophthalmic artery aneurysms: clinical usefulness of the balloon occlusion test in predicting vision outcomes after coil embolization. J Neurointerv Surg. 2016; 8:696–701.

9. Ahn JH, Cho YD, Kang HS, Kim JE, Cho WS, Jung SC, et al. Endovascular treatment of ophthalmic artery aneurysms: assessing balloon test occlusion and preservation of vision in coil embolization. AJNR Am J Neuroradiol. 2014; 35:2146–2152.

10. Horiuchi T, Yamamoto Y, Suzuki Y, Kobayashi M, Ichinose S, Hongo K. Clipping surgery for paraclinoid carotid aneurysm. Acta Neurochir Suppl. 2016; 123:27–32.

11. Matsukawa H, Tanikawa R, Kamiyama H, Tsuboi T, Noda K, Ota N, et al. Risk factors for visual impairments in patients with unruptured intradural paraclinoid aneurysms treated by neck clipping without bypass surgery. World Neurosurg. 2016; 91:183–189.

12. Adeeb N, Griessenauer CJ, Foreman PM, Moore JM, Motiei-Langroudi R, Chua MH, et al. Comparison of stent-assisted coil embolization and the pipeline embolization device for endovascular treatment of ophthalmic segment aneurysms: a multicenter cohort study. World Neurosurg. 2017; 105:206–212.

13. Date I, Asari S, Ohmoto T. Cerebral aneurysms causing visual symptoms: their features and surgical outcome. Clin Neurol Neurosurg. 1998; 100:259–267.

14. Heran NS, Song JK, Kupersmith MJ, Niimi Y, Namba K, Langer DJ, et al. Large ophthalmic segment aneurysms with anterior optic pathway compression: assessment of anatomical and visual outcomes after endosaccular coil therapy. J Neurosurg. 2007; 106:968–975.

15. Tawk RG, Villalobos HJ, Levy EI, Hopkins LN. Surgical decompression and coil removal for the recovery of vision after coiling and proximal occlusion of a clinoidal segment aneurysm: technical case report. Neurosurgery. 2006; 58:E1217. discussion E1217.

16. Nanda A, Javalkar V. Microneurosurgical management of ophthalmic segment of the internal carotid artery aneurysms: single-surgeon operative experience from Louisiana State University, Shreveport. Neurosurgery. 2011; 68:355–370. discussion 370-371.

17. Shimizu K, Imamura H, Mineharu Y, Adachi H, Sakai C, Sakai N. Endovascular treatment of unruptured paraclinoid aneurysms: single-center experience with 400 cases and literature review. AJNR Am J Neuroradiol. 2016; 37:679–685.

18. Sattur MG, Welz ME, Bendok BR, Miller JW. Balloon occlusion testing to assess retinal collateral and predict visual outcomes in the management of a fusiform intraorbital ophthalmic artery aneurysm: technical note and literature review. Oper Neurosurg (Hagerstown). 2019; 16:60–66.

19. Di Maria F, Pistocchi S, Clarençon F, Bartolini B, Blanc R, Biondi A, et al. Flow diversion versus standard endovascular techniques for the treatment of unruptured carotid-ophthalmic aneurysms. AJNR Am J Neuroradiol. 2015; 36:2325–2330.