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DOI: 10.1055/s-0034-1384078
Prevention of Visual Function in the Direct Surgery of Paraclinoid Aneurysms
Objective: For paraclinoid aneurysms, especially carotid cave aneurysm, endovascular intervention is recommendable. However, recent publication revealed that its rates of complication and recurrence are relatively high. Direct surgery, which could be useful, might be difficult for the young surgeon because those aneurysms are rare. One of seven cases with paraclinoid aneurysm treated at our department in 2013 deteriorated her vision 2 days after surgery. The problems are evaluated and discussed. Patient: A 54-year-old female patient with right carotid cave aneurysm had received the direct surgery with intradural ACP removal. Aneurysm had completely been closed with curved fenestrate clip. Intraoperative ICG showed disappearance of aneurysm and patency of arteries. Her right vision suddenly deteriorated 2 days later, although her MRI, MRA, and 3D-CTA showed patency of arteries including right opthalmic artery. Results: Operative video revealed that optic nerve had been contracted toward to ICA during dissection of aneurysm and opthalmic artery. It is suggested that this physical contraction could cause the optic nerve injury. Hence, the complete excision of distal dural ring, removal of optic strut and appropriate dissection of falcifalm fold might be important to easily mobilize ICA and prevent injury. Conclusions: Importance of other procedures including dural ring excision should be emphasized as well as ACP removal to complete safe surgery and prevent visual function.