Department of Neurosurgery, Third Hospital of People Liberation Army, Baoji, People's Republic of China.
Department of Neurosurgery, Third Hospital of People Liberation Army, Baoji, People's Republic of China.
World Neurosurg. 2019 Jun;126:296-300. doi: 10.1016/j.wneu.2019.03.076. Epub 2019 Mar 18.
Complications after coiling of large, giant, and thrombosed aneurysms because of increased mass effect on surrounding structures have been widely reported. A case of bilateral blindness after incomplete coil embolization of a small anterior cerebral artery aneurysm is rare. We review the potential mechanisms, clinical progression, and proper treatment needs.
A 50-year-old man was urgently admitted with subarachnoid hemorrhage. Digital subtraction angiography (DSA) showed a ruptured aneurysm of the A1 segment, anterior cerebral artery. An endovascular coil occlusion was performed without an additional device. The visual acuity of patient slowly decreased from the 13th day after endovascular intervention. His visual acuity improved after steroid therapy but then deteriorated again. DSA showed an enlarged aneurysm, and an urgent craniotomy was performed for optic nerve decompression. The patient finally became bilaterally blind, although hyperbaric oxygen, neurotrophy drugs, and other supporting treatment was given.
Incomplete aneurysm coiling may result in bilateral blindness, even at a small anterior cerebral artery. Early DSA, steroid therapy, and secondary craniotomy for nerve decompression should be considered promptly for improving clinical outcome before nerve atrophy, although sometimes single steroid therapy is effective.
由于对周围结构的占位效应增加，大型、巨型和血栓形成的动脉瘤在进行线圈栓塞后会出现广泛报道的并发症。然而，小脑前动脉动脉瘤不完全线圈栓塞后出现双侧失明的情况较为罕见。我们回顾了这种情况的潜在机制、临床进展和适当的治疗需求。
一名 50 岁男性因蛛网膜下腔出血而被紧急收治入院。数字减影血管造影（DSA）显示 A1 段、大脑前动脉的动脉瘤破裂。进行了血管内线圈栓塞术，但未使用其他设备。患者在血管内介入治疗后的第 13 天，视力逐渐下降。尽管使用类固醇治疗后视力有所改善，但随后再次恶化。DSA 显示动脉瘤增大，紧急行视神经减压开颅术。尽管给予高压氧、神经营养药物等支持治疗，但患者最终仍双侧失明。
不完全的动脉瘤线圈栓塞可能导致双侧失明，即使是在较小的大脑前动脉。对于这种情况，应尽早考虑进行 DSA、类固醇治疗和二次神经减压开颅术，以改善临床预后，避免神经萎缩，尽管有时单一的类固醇治疗也是有效的。
