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Case report
Return of visual function after bilateral visual loss following flow diversion embolization of a giant ophthalmic aneurysm due to both reduction in mass effect and reduction in aneurysm pulsation
  1. Saharsh Patel1,
  2. Kyle M Fargen2,
  3. Keith Peters3,
  4. Peter Krall1,
  5. Hazem Samy1,
  6. Brian L Hoh2
  1. 1Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
  2. 2Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
  3. 3Department of Radiology, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Kyle Michael Fargen, Department of Neurosurgery, University of Florida, Box 100265, Gainesville, Florida 32610, USA; kyle.fargen{at}neurosurgery.ufl.edu

Abstract

Large and giant paraclinoid aneurysms are challenging to treat by either surgical or endovascular means. Visual dysfunction secondary to optic nerve compression and its relationship with aneurysm size, pulsation and thrombosis is poorly understood. We present a patient with a giant paraclinoid aneurysm resulting in bilateral visual loss that worsened following placement of a Pipeline Embolization Device and adjunctive coiling. Visual worsening occurred in conjunction with aneurysm thrombosis, increase in maximal aneurysm diameter and new adjacent edema. Her visual function spontaneously improved in a delayed fashion to better than pre-procedure, in conjunction with reduced aneurysmal mass effect, size and pulsation artifact on MRI. This report documents detailed ophthalmologic and MRI evidence for the role of thrombosis, aneurysm mass effect and aneurysm pulsation as causative etiologies for both cranial nerve dysfunction and delayed resolution following flow diversion treatment of large cerebral aneurysms.

  • Aneurysm
  • MRI
  • Flow Diverter
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