Tanaka Yuko, Nagatsuka Hiroki, Miki Yuma, Tetsuo Yoshiaki, Yabuzaki Hajime, Nakayama Sadayoshi, Matsuda Yoshikazu, Tsumoto Tomoyuki, Terada Tomoaki
Department of Neurosurgery, Showa University Fujigaoka Hospital, Kanagawa, Japan.
Department of Stroke Medicine and Neuroendovascular Therapy, University of Occupational and Environmental Health, Fukuoka, Japan.
Radiol Case Rep. 2022 Mar 3;17(5):1487-1490. doi: 10.1016/j.radcr.2022.01.085. eCollection 2022 May.
The pathogenesis of new visual symptoms after flow diverter stent placement in the ophthalmic artery for internal carotid artery aneurysms remains unclear. We report two cases of patients who developed visual field disturbance and decreased visual acuity following flow diverter placement. The "doughnut sign" was found around the optic nerve on magnetic resonance imaging. The patients had progressive visual field defects and impairment on the side where the flow diverter was placed. Short tau inversion recovery coronal images showed a doughnut-shaped high-signal around the optic nerve on the affected side. Both patients were treated with steroid pulse therapy, and 1 received endovascular therapy. Their symptoms gradually improved, and the "doughnut sign" disappeared. The "doughnut sign" observed around the optic nerve on magnetic resonance imaging may be found alongside visual disturbance symptoms after paraclinoid aneurysm treatment. It is recommended that short tau inversion recovery sequences be performed preoperatively in patients presenting with visual impairment and in whom the possibility of postoperative exacerbation is suspected.
用于治疗颈内动脉动脉瘤的血流导向支架置入术后出现新的视觉症状的发病机制尚不清楚。我们报告了两例患者，他们在血流导向支架置入术后出现了视野障碍和视力下降。磁共振成像显示视神经周围出现“甜甜圈征”。患者在血流导向支架置入侧出现进行性视野缺损和视力损害。短tau反转恢复冠状位图像显示患侧视神经周围呈甜甜圈状高信号。两名患者均接受了类固醇脉冲治疗，其中1例接受了血管内治疗。他们的症状逐渐改善，“甜甜圈征”消失。在磁共振成像上观察到的视神经周围的“甜甜圈征”可能与鞍旁动脉瘤治疗后的视觉障碍症状同时出现。对于有视力损害且怀疑术后可能加重的患者，建议术前进行短tau反转恢复序列检查。
