Misra Basant K, Khandhar Alay V, Pradhan Reema
J Neurosurg Case Lessons. 2022 Dec 12;4(24). doi: 10.3171/CASE22352.
The best treatment option for giant intracranial aneurysms (GIAs) is still debated. The authors report a case of a giant thrombosed cavernous carotid artery (CCA) aneurysm for which two sessions of flow diverter (FD) placement failed, leading to bilateral blindness.
A 66-year-old man presented to an outside center with a history of rapid-onset right-sided retro-orbital pain, visual deterioration, and restricted eye movements associated with headache, vomiting, and diminished sensations on the right side of the face. He was diagnosed with an unruptured thrombosed giant CCA aneurysm and was treated twice with unsuccessful FDs. At follow-up, he developed blindness in both eyes. After 1.5 years, he presented to the authors' institution with headache, vomiting, and epistaxis, for which he underwent high-flow external carotid artery-M2 segment of the middle cerebral artery bypass grafting using the radial artery as a conduit and ligation of the internal carotid artery in the neck without any added neurological deficits.
This dreadful complication of bilateral blindness after being treated with repeated unsuccessful FDs has not been reported in the literature. It could have been avoided if microsurgery had been the primary modality of treatment.
巨大颅内动脉瘤（GIA）的最佳治疗方案仍存在争议。作者报告了一例巨大血栓形成的海绵窦段颈内动脉（CCA）动脉瘤病例，该病例进行了两次血流导向装置（FD）置入均失败，导致双侧失明。
一名66岁男性因快速发作的右侧眶后疼痛、视力恶化、眼球运动受限伴头痛、呕吐及右侧面部感觉减退的病史就诊于外院。他被诊断为未破裂的血栓形成的巨大CCA动脉瘤，并接受了两次FD治疗，但均未成功。随访时，他出现了双眼失明。1.5年后，他因头痛、呕吐和鼻出血就诊于作者所在机构，为此他接受了以桡动脉为血管桥的高流量颈外动脉-大脑中动脉M2段搭桥术，并结扎了颈部的颈内动脉，术后未出现任何新增神经功能缺损。
文献中尚未报道重复FD治疗失败后出现双侧失明这种可怕并发症的情况。如果将显微手术作为主要治疗方式，本可避免这种情况发生。
