Surgical clipping of ophthalmic artery aneurysms

British Journal of Neurosurgery, 35:2, 157-160

The purpose of this study was to summary the characteristics of ophthalmic artery (OphA) aneurysms and to obtain the independent risk factors for poor prognosis of microsurgical clipping treatment for OphA aneurysms.

Methods: The clinical and microsurgical clipping results of all 63 patients with ophthalmic aneurysm were investigated and reviewed. The OphA aneurysm patient’s case records were reviewed including clinical characteristics, image findings, and clinical outcomes. Then, the risk factors of poor prognosis were analyzed retrospectively.

Results: Monocular blindness persisted in 4 patients (6.35%), 1 patient developed persistent vegetate state (PVS) (1.59%), while 4 patients (6.35%) died. The matching process constructed a cohort consisting of 9 poor outcome (Glasgow Outcome Scale, GOS 1–3) patients (14.3%), and 54 good outcome (GOS 4–5) patients (85.7%). Univariate analysis between the good outcome and poor outcome revealed statistical significance in age > 60 (p¼0.045), size (p¼0.016), and rupture before operation (p¼0.049). Further, multivariate logistic regression analysis identified age > 60 (odds ratio [OR], 5.877; 95% confidence interval [CI], 1.039–33.254; p¼0.045) and aneurysm size > 10mm (OR, 9.417; 95% CI, 1.476–60.072; p¼0.018) as the independent risk factors for poor outcome in microsurgical clipping treatment for OphA aneurysms.

Conclusion: The significant independent risk factors associated with clipping OphA aneurysms are age (>60) and size (>10mm).

 

Microsurgical clipping of ophthalmic artery aneurysms

J Neurosurg 129:1511–1521, 2018

While most paraclinoid aneurysms can be clipped with excellent results, new postoperative visual deficits are a concern. New technology, including flow diverters, has increased the popularity of endovascular therapy. However, endovascular treatment of paraclinoid aneurysms is not without procedural risks, is associated with higher rates of incomplete aneurysm occlusion and recurrence, and may not address optic nerve compression symptoms that surgical debulking can. The increasing endovascular management of paraclinoid aneurysms should be justified by comparisons to surgical benchmarks. The authors, therefore, undertook this study to define patient, visual, and aneurysm outcomes in the most common type of paraclinoid aneurysm: ophthalmic artery (OphA) aneurysms.

METHODS Results from microsurgical clipping of 208 OphA aneurysms in 198 patients were retrospectively reviewed. Patient demographics, aneurysm morphology (size, calcification, etc.), clinical characteristics, and patient outcomes were recorded and analyzed.

RESULTS Despite 20% of these aneurysms being large or giant in size, complete aneurysm occlusion was accomplished in 91% of 208 cases, with OphA patency preserved in 99.5%. The aneurysm recurrence rate was 3.1% and the retreatment rate was 0%. Good outcomes (modified Rankin Scale score 0–2) were observed in 96.2% of patients overall and in all 156 patients with unruptured aneurysms. New visual field defects (hemianopsia or quadrantanopsia) were observed in 8 patients (3.8%), decreased visual acuity in 5 (2.4%), and monocular blindness in 9 (4.3%). Vision improved in 9 (52.9%) of the 17 patients with preoperative visual deficits.

CONCLUSIONS The most important risk associated with clipping OphA aneurysms is a new visual deficit. Meticulous microsurgical technique is necessary during anterior clinoidectomy, aneurysm dissection, and clip application to optimize visual outcomes, and aggressive medical management postoperatively might potentially decrease the incidence of delayed visual deficits. As the results of endovascular therapy and specifically flow diverters become known, they warrant comparison with these surgical benchmarks to determine best practices.