La Pira Biagia, Brinjikji Waleed, Hunt Christopher, Chen John J, Lanzino Giuseppe
Departments of Neurosurgery (BLP, CH), Radiology (WB, GL), and Neurology (JC), Mayo Clinic, Rochester, Minnesota.
J Neuroophthalmol. 2017 Jun;37(2):154-158. doi: 10.1097/WNO.0000000000000412.
Aneurysmal volume expansion after endovascular treatment is caused by intra-aneurysmal thrombosis in the early postembolization period. Although postembolization mass effect on cranial nerves and other adjacent structures has been previously reported, we are unaware of reports involving the anterior visual pathway. A 66-year-old woman with a 2-week history of blurred vision without headache was found to have a large, unruptured anterior communicating artery aneurysm. One month after endovascular treatment of the aneurysm with coiling and flow diversion, the patient developed decreased vision in her right eye and a left homonymous hemianopia. Magnetic resonance imaging demonstrated compression of the right optic nerve, chiasm, and edema of the right optic tract. The patient was treated with a course of high dose corticosteroids, and over the course of several weeks, her vision improved and the optic tract edema resolved. We alert clinicians to this rare but potentially reversible visual complication of endovascular treatment of intracranial aneurysms.
血管内治疗后动脉瘤体积增大是由栓塞后早期动脉瘤内血栓形成所致。尽管先前已有关于栓塞后肿块对颅神经及其他相邻结构产生影响的报道，但我们尚未发现涉及前视觉通路的相关报道。一名66岁女性，有2周视力模糊病史，无头痛症状，被发现患有一个大型未破裂的前交通动脉瘤。在对该动脉瘤进行血管内栓塞和血流导向治疗1个月后，患者右眼视力下降，出现左侧同向性偏盲。磁共振成像显示右侧视神经、视交叉受压，右侧视束水肿。患者接受了一个疗程的大剂量皮质类固醇治疗，数周后，其视力改善，视束水肿消退。我们提醒临床医生注意这种颅内动脉瘤血管内治疗罕见但可能可逆的视觉并发症。
