Journal Information
Vol. 21. Issue 1.
Pages 46-49 (January 2010)
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Vol. 21. Issue 1.
Pages 46-49 (January 2010)
Unexpected angiographic and visual findings after clipping of a carotid-ophthalmic aneurysm
Hallazgos angiograficos y visuales inesperados tras clipage de aneurisma carotido-oftálmico
Visits
1330
L. Mascarenhas
Corresponding author
linomasc@gmail.com

Correspondence: Serviço de Neurocirurgia. Hospital de São Marcos. Apartado 2242. 4701-965 Braga. Portugal.
, C. Alegria
Neurosurgery, São Marcos Hospital. Braga. Portugal
M. Ribeiro*, J. Rocha*
* Neuroradiology, São Marcos Hospital. Braga. Portugal
S. Guimaraes**
** Ophthalmology Services, São Marcos Hospital. Braga. Portugal
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Summary

A 56-year-old woman underwent surgery for a ruptured carotid-ophthalmic artery aneurysm. Intraoperative visual inspection confirmed that the ophthalmic artery was left intact. She had no light perception on the operated side right after surgery. Angiography one week after surgery confirmed exclusion of the aneurysm, no filling of the proximal portion of the ophthalmic artery, and a very faint filling of its distal orbital part. She gradually recovered from this deficit and 9 months after surgery she is capable of counting fingers. At this time angiography displayed filling of all the portions of the ophthalmic artery, absence of recruitment of collateral blood supply, and exclusion of the aneurysm as before. Surgical manipulation seems to either have induced vasospasm or thrombosis of the ophthalmic artery. Regression of vasospasm or secondary recanalization of the thrombus without development of collateral blood supply may account for the gradual improvement of vision. A risk of monocular blindness is associated with the surgical treatment of para-clinoid aneurysms. Nevertheless, when it occurs, a perspective of recovery may exist if certain etiologies are involved.

Key words:
Ophthalmic artery
Aneurysm
Surgery
Angiography
Transitory visual deficit
Resumen

Una mujer de 56 años fue intervenida de un aneurisma carotido-oftálmico roto. La inspección visual intraoperatoria confirmaba que la arteria oftálmica estaba intacta. Tras la cirugía la paciente no percibía luz por dicho ojo y la angiografía una semana después de la cirugía confirmó la exclusión del aneurisma, con falta de relleno de la porción proximal de la arteria oftálmica, y un relleno muy débil de la porción orbitaria distal. La paciente se fue recuperando progresivamente del déficit y 9 meses después de la cirugía es capaz de contar dedos. La angiografía actual demuestra un relleno de todas las porciones de la arteria oftálmica, con ausencia de circulación colateral, y exclusión del aneurisma. La manipulación quirúrgica parece haber inducido vasoespasmo o trombosis de la arteria oftálmica. La regresión del vasoespasmo o la recanalización secundaria del trombo sin desarrollo de circulación colateral pueden justificar la mejoría gradual de la visión. Hay un riesgo de amaurosis unilateral asociado al tratamiento quirúrgico de los aneurismas paraclinoideos, aunque existe posibilidad de mejoría en algunos casos.

Palabras clave:
Arteria oftálmica
Aneurisma
Cirugía
Angiografía
Déficit visual transitorio

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