Department of Neurosurgery, University of Iowa, Iowa City, IA, USA.
Department of Neurology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, USA.
Clin Neurol Neurosurg. 2021 Dec;211:107029. doi: 10.1016/j.clineuro.2021.107029. Epub 2021 Nov 11.
Edema coursing the optic apparatus has traditionally been associated with sellar and para-sellar tumors. However, postoperative aneurysmal volume expansion following endovascular treatment has been reported to induce cranial neuropathies, such as vision loss in rare instances. Here, we present a case report of worsening optic tract edema associated with bilateral visual acuity deficit following treatment of a large left paraophthalmic aneurysm with pipeline-assisted coiling. Rapid resolution of visual deficit was observed following administration of corticosteroids. A 42-year-old female with a 6-month history of worsening left eye vision and sentinel headache presented with left visual field cut and decreased left visual acuity. She was found to have a large paraophthalmic aneurysm which was treated with pipeline-assisted coiling. Within one week post-treatment, the patient presented to the emergency department with worsening right visual complaints. On magnetic resonance imaging, T2 hyperintensities coursing the right posterior optic nerve, optic chiasm, and bilateral optic tracts were noted. Angiography demonstrated an expanding neck remnant. The patient was treated with oral corticosteroids and repeat pipeline stenting. At four week follow up, she demonstrated significant improvement of symptoms and reduced T2 hyperintensities. With the advancement in endovascular technique for the treatment of large aneurysms, more patients are electing endovascular treatment over microsurgical clipping. Given the possibility of continued growth following endovascular treatment, patient counseling regarding risks and side effects is paramount.
视神经周围的水肿传统上与鞍内和鞍旁肿瘤有关。然而，血管内治疗后动脉瘤体积的扩张已被报道会引起颅神经病变，例如在罕见情况下视力丧失。在这里，我们报告了一例与使用Pipeline 辅助弹簧圈栓塞治疗大型左眶周动脉瘤相关的视束水肿加重伴双侧视力减退的病例。皮质类固醇治疗后，视力减退迅速恢复。一名 42 岁女性，左眼视力恶化伴哨兵性头痛 6 个月，表现为左眼视野缺损和左眼视力下降。发现她患有大型眶周动脉瘤，采用 Pipeline 辅助弹簧圈栓塞治疗。治疗后一周内，患者因右眼视力恶化到急诊就诊。磁共振成像显示，右侧视神经、视交叉和双侧视束后 T2 高信号。血管造影显示颈部残端扩张。给予口服皮质类固醇和重复 Pipeline 支架置入术。四周后随访时，她的症状明显改善，T2 高信号减少。随着血管内治疗大型动脉瘤技术的进步，越来越多的患者选择血管内治疗而不是显微手术夹闭。鉴于血管内治疗后可能继续生长，必须对患者进行风险和副作用的咨询。
