Furst Taylor, Mattingly Thomas K, Williams Zoë R, Schartz Derrek, Bender Matthew T
Department of Neurological Surgery, University of Rochester Medical Center, NY, Rochester, United States.
Department of Ophthalmology, University of Rochester Medical Center, NY, Rochester, United States.
Front Ophthalmol (Lausanne). 2022 Sep 30;2:940479. doi: 10.3389/fopht.2022.940479. eCollection 2022.
Cerebral aneurysms located along the internal carotid artery at the origin of the ophthalmic artery can be treated through open surgery or endovascular technique. The former affords more certainty of aneurysm obliteration, while the latter poses less risk to vision. Flow diversion is an increasingly accepted treatment for side-wall carotid aneurysms, although location at the branch point of the ophthalmic artery is known to moderate occlusion outcomes.
We present a case of a middle-aged female patient with a morphologically irregular 4-mm ophthalmic artery aneurysm (OphA) and a smaller superior hypophyseal artery (SHA) aneurysm whose successful and uncomplicated obliteration by flow diversion with adjunctive coiling was predicted a balloon test occlusion (BTO). BTO was employed prior to stent placement to confirm a) ophthalmic artery distal collateralization with external carotid artery (ECA) branches and b) preserved arterial flow in the retina visualized fundoscopy. At 1 year following angiography, the patient had no postoperative deficits and benefitted from complete occlusion of the OphA and SHA.
OphAs constitute a complex surgical disease that is historically associated with high visual morbidity. We present a novel advanced endovascular technique of BTO followed by flow diversion with adjunctive coiling that successfully obliterated an OphA while preserving vision.
位于眼动脉起始处颈内动脉的脑动脉瘤可通过开放手术或血管内技术进行治疗。前者能更确切地闭塞动脉瘤，而后者对视力的风险较小。血流导向术是一种越来越被认可的治疗侧壁颈动脉瘤的方法，尽管已知位于眼动脉分支点处会影响闭塞效果。
我们报告一例中年女性患者，患有形态不规则的4毫米眼动脉动脉瘤（OphA）和较小的垂体上动脉（SHA）动脉瘤。通过球囊试验闭塞（BTO）预测，采用血流导向术辅助弹簧圈栓塞可成功且无并发症地闭塞动脉瘤。在置入支架前进行BTO，以确认：a）眼动脉与颈外动脉（ECA）分支的远端侧支循环；b）通过眼底镜检查可见视网膜动脉血流得以保留。血管造影术后1年，患者无术后功能缺损，且因OphA和SHA完全闭塞而获益。
OphA是一种复杂的外科疾病，历来与高视力致残率相关。我们介绍了一种新型的先进血管内技术，即先进行BTO，然后采用血流导向术辅助弹簧圈栓塞，成功闭塞了OphA并保留了视力。
