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  • Visual Complications Following Stent Assisted Endovascular Embolization of Paraophthalmic and Suprasellar Variant Superior Hypophyseal Ophthalmic Segment ICA Aneurysms: The Duke Cerebrovascular Center

    Final Number:

    Andrew S. Ferrell MD; Mark L. Lessne MD; Michael J. Alexander MD FACS; Pratish Shah MD; Kiarash Golshani MD; Ali R. Zomorodi MD; Tony P. Smith MD; Gavin W. Britz MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Acute and delayed visual deficits following coil embolization of ophthalmic segment ICA aneurysms has been previously described. It is unclear if stent assisted embolization of these aneurysms will result in additional visual complications compared to embolization alone. We retrospectively reviewed the Duke cerebrovascular experience with stent assisted coiling of ophthalmic segment ICA aneurysms to report outcome data and identify the rate of associated visual complications

    Methods: The Duke endovascular database was retrospectively reviewed to identify all ICA aneurysms treated with stent assisted embolization between November 2002 and October 2009. Only aneurysms arising from the ophthalmic segment of the ICA which were paraophthalmic or suprasellar variant superior hypophyseal in origin were included. This would select only for aneurysms that would create potential visual changes related to mass effect on the optic nerve or chiasm respectively, or have potential to disrupt the ophthalmic artery. Chart review was performed to obtain clinical information, immediate incidence and follow-up of aneurysm remnants, and any visual complications.

    Results: Sixty three aneurysms (48 parophthalmic and 15 suprasellar variant superior hypophyseal) were identified in 57 patients. The ophthalmic artery was preserved in all but two cases (3.5%), neither of which resulted in visual deficits. One patient (1.8%) experienced transient acute visual disturbances with two patients (3.5%) having delayed, persistent deficits.

    Conclusions: Stent assisted embolization of ophthalmic segment ICA aneurysms is technically achievable and in our series does not appear to result in increased visual complications compared to coil embolization alone or surgical treatment.

    Patient Care: The results show that placement of the Neuroform stent for assistance with coil embolization of paraophthalmic aneurysms is safe with a low risk of visual complications. This may allow confident use of endovascular therapies for these lesions and avoid morbidity and mortality of open surgical approaches.

    Learning Objectives: To determine whether Neuroform stent placement within the ophthalmic segment of the internal carotid artery for assistance with aneurysm remodeling results in an unacceptable rate of visual complications.

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