The Ophthalmic Arterial Complex in Angiographic Diagnosis

Peripheral ophthalmic artery aneurysm

Generally speaking, the term "ophthalmic aneurysms" refers to carotid-ophthalmic aneurysms, which arise from the internal carotid artery (ICA) wall at or around the origin of the ophthalmic artery (OA). In contrast, aneurysms arising from the OA stem or its branches, separate from the ICA are called peripheral OA aneurysms (POAAs). POAAs are a rare entity, which clinical features and natural course are not fully understood. A comprehensive literature review of reported aneurysms involving each segment of the OA was undertaken. The demographics, aetiology, clinical manifestations and treatment of reported POAAs are discussed. Of 35 retrieved cases, ten involved the intracranial segment, two were fusiform aneurysms in the optic canal, 17 arose from the intraorbital segment, and 6 involved either the lacrimal or the anterior ethmoidal branches. In 34 cases, clinical details were available; 18 patients experienced moderate to severe visual impairment including blindness, while seven patients had improvement in visual acuity as a result of surgical treatment. The present clinical review reveals that aneurysms of the OA stem and lacrimal branch are potentially threatening to visual acuity, while intracranial segment and anterior ethmoidal aneurysms can rupture and cause subarachnoid or intraparenchymal haemorrhage. Surgical intervention is mandatory in symptomatic cases to prevent visual deterioration or treat aneurismal rupture; alternatively, for small incidental POAAs "watchful waiting" may be indicated.

Ruptured aneurysm of the ophthalmic artery trunk demonstrated by three-dimensional rotational angiography: case report

OBJECTIVE AND IMPORTANCE

Aneurysms arising from the ophthalmic artery are extremely rare, compared with carotid-ophthalmic aneurysms arising from the wall of the internal carotid artery. We present a very unusual type of aneurysm arising from the ophthalmic artery itself.

CLINICAL PRESENTATION

A 54-year-old man presented with a sudden onset of headache and was transferred to a local hospital. Computed tomography demonstrated subarachnoid hemorrhage around the left anterior clinoid process, but digital subtraction angiography failed to localize the source of the hemorrhage. The patient was referred to our hospital for further evaluation and treatment. Conventional cerebral angiography did not reveal the source of the hemorrhage, but three-dimensional rotational angiography clearly demonstrated an aneurysm arising from the ophthalmic artery trunk, apart from the internal carotid artery.

INTERVENTION

The patient underwent microsurgical clipping of the aneurysm via a left pterional craniotomy. The aneurysm originated from the bifurcation of the ophthalmic artery and a perforating artery to the optic nerve. The aneurysm was successfully obliterated, and the postoperative course was uneventful.

CONCLUSION

This report is the first to describe a case of a ruptured aneurysm arising from the ophthalmic artery trunk. We discuss the clinical significance of an aneurysm at this site, as well as the role of three-dimensional rotational angiography in determining the source of subarachnoid hemorrhage.

Peripheral ophthalmic artery aneurysm

✓ The authors report on two patients with peripheral ophthalmic artery (OphA) aneurysms and demonstrate the mechanism by which these lesions are formed by using OphA color Doppler flow velocimetry imaging. During formation of these two aneurysms, the hemodynamic stress on the OphA was quite significant.

Case report: saccular aneurysm of the intraorbital ophthalmic artery

A saccular aneurysm of the intraorbital portion of the ophthalmic artery is extremely rare. We report this entity in a 54-year-old man who also had a dural arteriovenous malformation (AVM) at the base of the anterior cranial fossa. The aneurysmal formation at this unusual site may be explained by a haemodynamic stress that derived from the presence of the dural AVM.

Intraorbital ophthalmic artery aneurysm: case report

A rare case is presented of a nonruptured aneurysm of the intraorbital ophthalmic artery in which successful resection of the aneurysm resulted in improvement of preoperative progressive signs caused by the mass effect of the aneurysm. The surgical management of this rare entity is discussed with special attention given to the collateral circulation of the ophthalmic artery from the external carotid artery.

A new look at the blood supply of the retro-ocular space. Three-dimensional analysis of the arterial pattern of the posterior ciliary artery

A study of the arterial architecture of the orbit, especially the ophthalmic artery and the course of the posterior ciliary artery in the retroocular space, was carried out in 198 cadavers by three-dimensional arteriographic analysis. The posterior ciliary arteries were classified into three types: lateral posterior ciliary, medial posterior ciliary, and accessory posterior ciliary arteries. Both the lateral and medial posterior ciliary arteries reach the eyeball in three ways: (1) they run antero-inferiorly in a winding course to the posterior margin of the eyeball, then shift upward vertically at a 60-90 degree angle and reach the eyeball, where they divide into several ciliary branches (69%); (2) after a similar course, others branch to the eyeball from the superior side (29.3%); or (3) they reach the eyeball in an almost straight course along the optic nerve (1.7%). The fundamental characteristics of these three types of posterior ciliary artery pattern also exist in subhuman primates.

Tumours aneurysms

Intracranial aneurysms commonly present with subarachnoid hemorrhage. Rarely, they may attain a large size and manifest exclusively as intracranial space-taking lesions. We have collected a series of 48 cases of large aneurysms; 47 of them have been previously unpublished. To our knowledge, this is the largest series on this subject.

Intraorbital aneurysm of the ophthalmic artery

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