Lateral Transcanthal-Microsurgical Resection of a Nontraumatic Intraorbital Ophthalmic Artery Aneurysm^[*]

 

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Introduction

Aneurysms of the ophthalmic artery can be localised at any segment: i) intracranial, the most frequent localisation.[12]; ii) intracanalicular, an extremely rare localisation;[3] and iii) intraorbital, also an extremely rare localisation.[13] The association of an antecedent cerebro-cranial trauma with a preceding aneurysm is well known.[16] and rare post-traumatic intraorbital aneurysms have been reported[4] [13] Sporadic intraorbital ophthalmic artery aneurysms with no history of a trauma are extremely rare.[13] These nontraumatic aneurysms are thought to be preceded by an arteriovenous malformation (AVM) and∕or constitutional weakness of the arterial wall.[13] The clinical features are unspecific but similar to both the post-traumatic and the sporadic aneurysms, and show intraindividual variations, ranging from no symptoms (incidental finding) to bleeding-associated pain after rupture of the aneurysm. Symptoms depend on the localisation and the relationship to bony, neural, and muscular structures. Spontaneous or post-traumatic rupture is the most severe peracute complication and results in an acute decrease of bulbar perfusion and ischemia-associated loss of visual function. Other symptoms manifest within several weeks or months, such as progressive central field loss, decreased visual acuity, ptosis, diplopia, and optic atrophy, and are due to the expanding mass of the aneurysm.[13] Treatment depends on clinical presentation and complications such as bleeding, but due to the rarity, little is known about the surgical therapy of intraorbital ophthalmic aneurysms.

We describe an additional patient with an unusual presentation of a large, nontraumatic, ophthalmic aneurysm and perform a review of the literature. Furthermore, we describe a non-osteotomy surgical technique for access to the retro-orbital space via a lateral transcanthal approach. This method has been invented by the senior author of this article (S.H.).[11] and allowed excellent preparation and resection of the aneurysm.

^* This article was originally published online in Central European Neurosurgery on August 11, 2011 (DOI:10.1055/s-0031-1275271)

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