Details

Autor(en) / Beteiligte

• Castillo, Jose A.
• Soufi, Khadija
• Allen, Stephanie
• Rivet, Dennis J.
• Opalak, Charles F.

Titel

Successful Treatment of Optic Nerve Splitting secondary to an Internal Carotid Artery Ophthalmic Segment Aneurysm: case report and literature review

Ist Teil von

• Interdisciplinary neurosurgery : Advanced techniques and case management, 2023-09, Vol.33, p.101776, Article 101776

Ort / Verlag

Elsevier B.V

Erscheinungsjahr

2023

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• •Internal carotid artery (ICA) ophthalmic segment aneurysms are aneurysms of the anterior circulation that are in close proximity to the optic nerve that infrequently have substantial mass effect on or into the nerve and may even “split” the optic nerve.•Four out of the five previously reported cases of optic nerve splitting aneurysms presented symptomatically, though interestingly, only 2 of these were with visual symptoms. They presented either with slow-onset visual disturbances or with abrupt headaches following rupture.•Ophthalmic segment aneurysm including those splitting the optic nerve can be successfully treated with flow diversion over surgical clipping with good long-term success. Ophthalmic segment aneurysms that divide the optic nerve are exceedingly rare. We present a unique case of asymptomatic optic nerve splitting secondary into internal carotid artery ophthalmic segment aneurysm that was successfully treated with flow diversion. Case Description: A 58-year-old female presented to an outside hospital with an intermittent “rubbing sound” in her right ear. Imaging was remarkable for a left anterior skull base meningioma and a left internal carotid artery ophthalmic segment aneurysm. Humphrey visual field testing confirmed lack of scotoma or visual deficit. Intraoperatively, during craniotomy for resection of the meningioma, the aneurysm dome was noted to be splitting the optic nerve with a thin layer covering the dome. Given that the patient was asymptomatic and had intact visual function, it was decided that flow diversion would be safer option than clipping to avoid any optic nerve manipulation. On follow up, the patient remained free of visual impairment with an occluded aneurysm. This case presentation of a unique, asymptomatic ophthalmic segment aneurysm with splitting of the optic nerve, demonstrates successful treatment with flow diversion. It is notable both for the asymptomatic presentation and for highlighting the successful treatment of this kind of aneurysm with flow diversion.