1
|
Peterson C, Yu N, Duong HT. Surgical treatment of a giant paraophthalmic aneurysm postfailed flow diversion through endoscopic endonasal approach: Technical nuances and review of the literature. Surg Neurol Int 2024; 15:75. [PMID: 38628543 PMCID: PMC11021103 DOI: 10.25259/sni_939_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/29/2024] [Indexed: 04/19/2024] Open
Abstract
Background Giant internal carotid artery (ICA) aneurysms are usually treated through flow diversion, coiling, or a combination of both. However, certain cases that fail the endovascular treatment pose a technical challenge. Case Description A 68-year-old male presented with gradual visual changes affecting his right eye and was found to have a giant unruptured right paraophthalmic aneurysm. The aneurysm showed growth, and the patient's symptoms worsened despite coiling and flow diversion. Due to the location of this aneurysm and persistent compression of the optic chiasm by the coil mass, his right ICA was sacrificed, and an expanded endoscopic endonasal approach was successfully used to clip the residual aneurysm, remove the coil mass, and thus, decompress the optic chiasm. The patient's visual symptoms improved after that, and post clipping imaging demonstrated adequate occlusion of his right paraophthalmic aneurysm. Conclusion Recognizing the option of an endoscopic endonasal approach for clipping giant internal carotid aneurysms is of great importance. This approach can be safe and technically successful for the treatment of paraophthalmic aneurysms that fail the typical endovascular treatment.
Collapse
Affiliation(s)
- Catherine Peterson
- Department of Neurological Surgery, University of California, Sacramento, United States
| | - Nina Yu
- Department of School of Medicine, University of California, Sacramento, United States
| | - Huy T. Duong
- Department of Neurological Surgery, Kaiser Permanente Sacramento Medical Center, Sacramento, United States
| |
Collapse
|
2
|
Chiaroni PM, Guerra X, Cortese J, Burel J, Courret T, Constant Dit Beaufils P, Agripnidis T, Leonard-Lorant I, Fauché C, Bankole NDA, Forestier G, L'allinec V, Sporns PB, Gueton G, Lorena N, Psychogios MN, Girot JB, Rouchaud A, Janot K, Raynaud N, Pop R, Hak JF, Kerleroux B, Bourcier R, Marnat G, Papagiannaki C, Sourour NA, Clarençon F, Shotar E. Location specific rupture risk of intracranial aneurysms: case of ophthalmic aneurysms. J Neurointerv Surg 2023:jnis-2023-020909. [PMID: 37798103 DOI: 10.1136/jnis-2023-020909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Aneurysm location is a key element in predicting the rupture risk of an intracranial aneurysm. A common impression suggests that pure ophthalmic aneurysms are under-represented in ruptured intracranial aneurysms (RIAs). The purpose of this study was to specifically evaluate the risk of rupture of ophthalmic aneurysms compared with other aneurysm locations. METHODS This multicenter study compared the frequency of ophthalmic aneurysms in a prospective cohort of RIAs admitted to 13 neuroradiology centers between January 2021 and March 2021, with a retrospective cohort of patients with unruptured intracranial aneurysms (UIAs) who underwent cerebral angiography at the same neuroradiology centers during the same time period. RESULTS 604 intracranial aneurysms were included in this study (355 UIAs and 249 RIAs; mean age 57 years (IQR 49-65); women 309/486, 64%). Mean aneurysm size was 6.0 mm (5.3 mm for UIAs, 7.0 mm for RIAs; P<0.0001). Aneurysm shape was irregular for 37% UIAs and 73% RIAs (P<0.0001). Ophthalmic aneurysms frequency was 14.9% of UIAs (second most common aneurysm location) and 1.2% of RIAs (second least common aneurysm location; OR 0.07 (95% CI 0.02 to 0.23), P<0.0001). CONCLUSIONS Ophthalmic aneurysms seem to have a low risk of rupture compared with other intracranial aneurysm locations. This calls for a re-evaluation of the benefit-risk balance when considering preventive treatment for ophthalmic aneurysms.
Collapse
Affiliation(s)
| | - Xavier Guerra
- Department of Neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
- Sainte Anne Hospital, Paris, France
| | - Jonathan Cortese
- Interventional Neuroradiology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Julien Burel
- Radiology, Rouen University Hospital, Rouen, France
| | - Thomas Courret
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | | | | | - Ian Leonard-Lorant
- Interventional Neuroradiology Department, Strasbourg University Hospital, Strasbourg, France
| | | | | | - Géraud Forestier
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | | | - Peter B Sporns
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gaelle Gueton
- Interventional Neuroradiology Department, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nico Lorena
- Interventional Neuroradiology Department, Saint-Etienne University Hospital, Saint-Etienne, France
| | | | | | - Aymeric Rouchaud
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
- University of Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | - Kevin Janot
- Neuroradiology, University Hospital of Tours, Tours, France
| | | | - Raoul Pop
- Interventional Neuroradiology Department, Strasbourg University Hospital, Strasbourg, France
| | | | | | - Romain Bourcier
- Diagnostic and Interventional Neuroradiology Department, CHU Nantes, Nantes, France
| | - Gaultier Marnat
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | | | | | - Frédéric Clarençon
- Department of Neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne University, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
- INSERM, CNRS, Vision Institute, Sorbonne University, Paris, France
| |
Collapse
|
3
|
Rodriguez-Calienes A, Borjas-Calderón NF, Vivanco-Suarez J, Zila-Velasque JP, Chavez-Malpartida SS, Terry F, Grados-Espinoza P, Saal-Zapata G. Endovascular Treatment and Microsurgical Clipping for the Management of Paraclinoid Intracranial Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 178:e489-e509. [PMID: 37516140 DOI: 10.1016/j.wneu.2023.07.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE We aimed to compare the efficacy and safety of microsurgical clipping versus endovascular treatment (EVT) for paraclinoid aneurysms. METHODS A systematic search for studies including patients with paraclinoid aneurysms treated with a microsurgical or endovascular technique was conducted in 6 databases from inception to February 2022. Efficacy outcomes included complete angiographic occlusion at last follow-up, favorable functional outcome, and recurrence of the aneurysm. For safety, we assessed a composite of intraoperative and postoperative complications. Data were pooled using a random-effects model. RESULTS A total of 95 studies including 6711 patients, 3029 in the surgical group and 3682 in the EVT group were found. Pooled rates of complete occlusion were 94% (95% CI 91%-96%; I2 = 0%) in the surgical group and 69% (95% CI 63%-74%; I2 = 79%) in the EVT group, respectively. The favorable functional outcome rate was 86% (95% CI 76%-92%; I2 = 72%) with surgical treatment and 95% (95% CI 92%-97%; I2 = 61%) with EVT. The rate of aneurysm recurrence with surgical treatment was 1% (95% CI 0%-4%; I2 = 0%) and 12% (95% CI 9%-16%; I2 = 57%) with EVT. The composite safety outcome rate in the surgical group was 24% (95% CI 18%-30%; I2 = 90%) and 10% (95% CI 8%-13%; I2 = 71%) in the EVT group. CONCLUSIONS Our findings suggest that microsurgical clipping seems to have a higher efficacy than EVT in terms of angiographic occlusion and aneurysm recurrence; however, EVT seems to be safer in terms of intraoperative and postoperative complications. Considering the heterogeneity and low-level evidence of the data available, further prospective randomized studies are warranted to confirm our findings.
Collapse
Affiliation(s)
- Aaron Rodriguez-Calienes
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru.
| | - Nagheli Fernanda Borjas-Calderón
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru; Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru; Abdulrauf University of Neurosurgery, Simi Valley, California, USA
| | - Juan Vivanco-Suarez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - J Pierre Zila-Velasque
- Universidad Nacional Daniel Alcides Carrión, Facultad de Medicina Humana, Pasco, Peru; Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Sandra S Chavez-Malpartida
- Universidad Nacional Mayor de San Marcos, Lima, Peru; Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
| | - Fernando Terry
- Department of Neurosurgery, Clínica Internacional, Lima, Peru
| | - Pamela Grados-Espinoza
- Universidad Nacional Daniel Alcides Carrión, Facultad de Medicina Humana, Pasco, Peru; Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Giancarlo Saal-Zapata
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Peru; Departament of Neurosurgery, Clinica Angloamericana, Lima, Peru
| |
Collapse
|
4
|
Kaiser DPO, Cuberi A, Linn J, Gawlitza M. Flow diversion for compressive unruptured internal carotid artery aneurysms with neuro-ophthalmological symptoms: a systematic review and meta-analysis. J Neurointerv Surg 2023; 15:892-897. [PMID: 35918130 PMCID: PMC10447391 DOI: 10.1136/jnis-2022-019249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/20/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Data on the safety and efficacy of flow diverters (FD) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms (NOS) are scarce and comprise mainly small case series. METHODS We performed a search of three databases and included series with ≥10 patients, with unruptured aneurysms of the ICA and NOS, treated with FD. Random-effects analysis of treatment results and safety was performed. RESULTS A total of 22 studies reporting on 594 patients were included. Pooled proportions of NOS recovery, improvement, transient and permanent worsening were: 47.4% (95% CI 35.0% to 60.1%); 74.5% (95% CI 67.9% to 80.2%); 7.1% (95% CI 3.3% to 14.7%); and 4.9% (95% CI 3.2% to 7.4%), respectively. Rates of complete recovery and improvement in patients with isolated visual symptoms were 30.6% (95% CI 12.5% to 57.7%) and 56.6% (95% CI 42.3% to 69.9%). Isolated oculomotor symptoms recovered completely in 47.8% (95% CI 29.9% to 66.3%) and improved in 78% (95% CI 69.2% to 84.9%). Morbidity occurred in 5% (95% CI 2.8% to 9%) and mortality in 3.9% (95% CI 2% to 7.5%) of patients. An increased likelihood of symptom improvement was observed when treatment was performed early (<1 month) after symptom onset (OR=11.22, 95% CI 3.9% to 32.5%). CONCLUSION Flow diversion promotes recovery or improvement of compressive symptoms in a large proportion of patients but is associated with significant rates of morbidity and mortality. Transient and permanent NOS worsening is not uncommon. Early treatment is of utmost importance, as it increases the likelihood of symptom improvement more than 10-fold.
Collapse
Affiliation(s)
- Daniel P O Kaiser
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
- EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany
| | - Ani Cuberi
- Department of Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jennifer Linn
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Matthias Gawlitza
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
- EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany
| |
Collapse
|
5
|
Partial medial clinoidectomy with optic canal roof drilling for clipping of ophthalmic artery aneurysms: how I do it. Acta Neurochir (Wien) 2022; 164:2893-2898. [PMID: 36104634 DOI: 10.1007/s00701-022-05352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clipping of ophthalmic artery (OA) aneurysms present one of the treatment strategies for long-term disease management. Existing surgical techniques primarily require extra/intradural removal of the anterior clinoid process, carrying a higher risk of infection, damage to surrounding structures or technical complications. METHODS We present the technique of minimally invasive partial medial clinoidectomy with the unroofing of the optic canal for surgical clipping of OA aneurysms, and besides its pros and cons, we also discuss proper technical indications. CONCLUSION The partial medial clinoidectomy improves manoeuvrability around the paraclinoid region, provides better protection for adjacent structures and renders excellent treatment outcome.
Collapse
|
6
|
Kaiser DPO, Boulouis G, Soize S, Maus V, Fischer S, Lobsien D, Klisch J, Styczen H, Deuschl C, Abdullayev N, Kabbasch C, Jamous A, Behme D, Janot K, Bellanger G, Cognard C, Pierot L, Gawlitza M. Flow Diversion for ICA Aneurysms with Compressive Neuro-Ophthalmologic Symptoms: Predictors of Morbidity, Mortality, and Incomplete Aneurysm Occlusion. AJNR Am J Neuroradiol 2022; 43:998-1003. [PMID: 35738674 DOI: 10.3174/ajnr.a7550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/12/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Flow diversion is an effective treatment for aneurysms of the ICA with compression-related neuro-ophthalmologic symptoms, especially when treatment is initiated early after symptom onset and aneurysm occlusion is complete. However, non-negligible complication rates have been reported. Our aim was to identify risk factors for morbidity/mortality and incomplete aneurysm occlusion. MATERIALS AND METHODS We performed a secondary analysis of a previous publication, which included all patients treated with flow diversion for an unruptured aneurysm of the ICA with compression-related symptoms. RESULTS Fifty-four patients with 54 aneurysms (48 women, 88.9%; mean age, 59.2 [SD, 15.9] years; range, 21-86 years) treated with flow diversion were included. We observed morbidity and mortality rates of 7.4% and 3.7%. Increasing age (OR per decade, 3.2; 95% CI, 1.23-8.49; P = .02) and dual-antiplatelet therapy with ticagrelor (OR, 13.9; 95% CI, 1.16-165.97; P = .04) were significantly associated with morbidity/mortality. After a median follow-up of 13.3 [SD, 10.5] months, the rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 74%, 14%, and 12%. Incomplete occlusion at follow-up was less frequently observed in aneurysms treated with additional coil embolization (OR, 0.1; 95% CI, 0.01-0.86; P = .04). CONCLUSIONS Although a promising treatment for compressive ICA aneurysms, flow diversion carries a relevant risk for complications and incomplete aneurysm occlusion. Our results may help identify patients in which flow diversion may not be the ideal treatment method. Additional coil embolization increased the likelihood of complete aneurysm occlusion at follow-up.
Collapse
Affiliation(s)
- D P O Kaiser
- From the Institute of Neuroradiology (D.P.O.K., M.G.), University Hospital Carl Gustav Carus, Dresden, Germany.,Else Kröner-Fresenius Center for Digital Health (D.P.O.K., M.G.), Technical University Dresden, Dresden, Germany
| | - G Boulouis
- Department of Neuroradiology (G. Boulouis, K.J.), Regional and University Hospital Center Tours, Tours, France
| | - S Soize
- Department of Neuroradiology (S.S., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire Reims, Reims, France
| | - V Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine (V.M., S.F.), University Hospital Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - S Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine (V.M., S.F.), University Hospital Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - D Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology (D.L., J.K.), Helios General Hospital Erfurt, Erfurt, Germany
| | - J Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology (D.L., J.K.), Helios General Hospital Erfurt, Erfurt, Germany
| | - H Styczen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology (H.S., C.D.), University Hospital Essen, Essen, Germany
| | - C Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology (H.S., C.D.), University Hospital Essen, Essen, Germany
| | - N Abdullayev
- Department of Diagnostic and Interventional Radiology (N.A., C.K.), University Hospital Cologne, Cologne, Germany
| | - C Kabbasch
- Department of Diagnostic and Interventional Radiology (N.A., C.K.), University Hospital Cologne, Cologne, Germany
| | - A Jamous
- Institute of Diagnostic and Interventional Neuroradiology (A.J., D.B.), Universitätsmedizin Göttingen, Göttingen, Germany
| | - D Behme
- Institute of Diagnostic and Interventional Neuroradiology (A.J., D.B.), Universitätsmedizin Göttingen, Göttingen, Germany.,Department of Neuroradiology (D.B.), University Hospital Magdeburg, Magdeburg, Germany
| | - K Janot
- Department of Neuroradiology (G. Boulouis, K.J.), Regional and University Hospital Center Tours, Tours, France
| | - G Bellanger
- Diagnostic and Therapeutic Neuroradiology (G. Bellanger, C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - C Cognard
- Diagnostic and Therapeutic Neuroradiology (G. Bellanger, C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - L Pierot
- Department of Neuroradiology (S.S., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire Reims, Reims, France
| | - M Gawlitza
- From the Institute of Neuroradiology (D.P.O.K., M.G.), University Hospital Carl Gustav Carus, Dresden, Germany .,Else Kröner-Fresenius Center for Digital Health (D.P.O.K., M.G.), Technical University Dresden, Dresden, Germany
| | | |
Collapse
|