Okuyama Tomohiro, Kurisu Kota, Osanai Toshiya, Ito Masaki, Sugiyama Taku, Uchino Haruto, Fujimura Miki
J Neurosurg Case Lessons. 2024 May 13;7(20). doi: 10.3171/CASE24143.
Visual impairment due to delayed optic neuropathy is a rare complication of the endovascular treatment of paraclinoid aneurysms. An inflammatory response induced in the treated aneurysm wall is a known mechanism underlying this pathophysiology. The authors describe a case with severe and progressive optic neuropathy leading to neuronal degeneration and severe visual dysfunction.
A 42-year-old female with a history of surgical clipping for a paraclinoid aneurysm presented with a recurrence. Although the patient was unaware of any visual dysfunction, a preoperative ophthalmological examination revealed mild inferior quadrantanopia in the left eye. The coil embolization procedure was uneventful; however, the following day, the patient experienced progressive visual impairment, which worsened despite the initiation of steroid therapy. Ophthalmological examination revealed a severe decrease in visual acuity and further deterioration of the visual field. Magnetic resonance imaging showed remarkable swelling and edema of the left optic nerve adjacent to the treated aneurysm. Despite continued steroid therapy, the patient's visual function did not recover well due to subsequent optic nerve degeneration.
Optic neuropathy after endovascular procedures can lead to severe visual dysfunction. Careful management is essential, particularly when treating a symptomatic paraclinoid aneurysm, even if symptoms are only apparent on detailed examination.
由于延迟性视神经病变导致的视力损害是蝶骨旁动脉瘤血管内治疗的一种罕见并发症。治疗的动脉瘤壁中诱导的炎症反应是这种病理生理学的已知潜在机制。作者描述了一例严重且进行性视神经病变导致神经元变性和严重视觉功能障碍的病例。
一名有蝶骨旁动脉瘤手术夹闭史的42岁女性出现复发。尽管患者未意识到任何视觉功能障碍，但术前眼科检查发现左眼有轻度下象限盲。弹簧圈栓塞手术顺利；然而，第二天，患者出现进行性视力损害，尽管开始使用类固醇治疗，病情仍恶化。眼科检查显示视力严重下降，视野进一步恶化。磁共振成像显示治疗的动脉瘤附近的左侧视神经明显肿胀和水肿。尽管继续使用类固醇治疗，但由于随后的视神经变性，患者的视觉功能恢复不佳。
血管内手术后的视神经病变可导致严重的视觉功能障碍。仔细的管理至关重要，尤其是在治疗有症状的蝶骨旁动脉瘤时，即使症状仅在详细检查时才明显。
