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Patency of the ophthalmic artery after flow diversion treatment of paraclinoid aneurysms

Clinical article

Ross C. Puffer, David F. Kallmes, Harry J. Cloft, and Giuseppe Lanzino

Object

In this study the authors determined the patency rate of the ophthalmic artery (OphA) after placement of 1 or more flow diversion devices across the arterial inlet for treatment of proximal internal carotid artery (ICA) aneurysms, and correlated possible risk factors for OphA occlusion.

Methods

Nineteen consecutive patients were identified (mean age 53.9 years, range 23–74 years, all female) who were treated for 20 ICA aneurysms. In all patients a Pipeline Embolization Device (PED) was placed across the ostium of the OphA while treating the target aneurysm. Flow through the OphA after PED placement was determined by immediate angiography as well as follow-up angiograms (mean 8.7 months), compared with the baseline study. Potential risk factors for OphA occlusion, including age, immediate angiographic flow through the ophthalmic branch, status of flow within the aneurysm after placement of PEDs, whether the ophthalmic branch originated from the aneurysm dome, and number of PEDs placed across the ophthalmic branch inlet were correlated with patency rate.

Results

Patients were treated with 1–3 PEDs (3 aneurysms treated with placement of 1 PED, 12 with 2 PEDs, and 5 with 3 PEDs). In 17 (85%) of 20 treated aneurysms, no changes in the OphA flow were noted immediately after placement of the device. Two (10%) of 20 patients had delayed antegrade filling immediately following PED placement and 1 patient (5%) had retrograde flow from collaterals to the OphA immediately after placement of the device. One patient (5%) experienced delayed asymptomatic ICA occlusion; this patient was excluded from analysis at follow-up. At follow-up the OphA remained patent with normal antegrade flow in 13 (68%) of 19 patients, patent but with slow antegrade flow in 2 patients (11%), and was occluded in 4 patients (21%). No visual changes or clinical symptoms developed in patients with OphA flow compromise. The mean number of PEDs in the patients with occluded OphAs or change in flow at angiographic follow-up was 2.4 (SEM 0.2) compared with 1.9 (SEM 0.18) in the patients with no change in OphA flow (p = 0.09). There was no significant difference between the patients with occluded OphAs compared with nonoccluded branches based on patient age, immediate angiographic flow through the ophthalmic branch, status of flow through the aneurysm after placement of PEDs, whether the ophthalmic branch originated from the aneurysm dome, or number of PEDs placed across the ophthalmic branch inlet.

Conclusions

Approximately one-quarter of OphAs will undergo proximal thrombosis when covered with flow diversion devices. Even though these events were well-tolerated clinically, our findings suggest that coverage of branch arteries that have adequate collateral circulation may lead to spontaneous occlusion of those branches.

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New variant of persistent primitive olfactory artery associated with a ruptured aneurysm

Case report

Nobutaka Horie, Minoru Morikawa, Shuji Fukuda, Kentaro Hayashi, Kazuhiko Suyama, and Izumi Nagata

and 2 ( Fig. 3 ). F ig . 3. Drawings of 3 types of PPOA: Type 1, PPOA involving the ACA (A) ; Type 2, PPOA without involving the ACA (B) ; and Type 3, PPOA partially involving the ACA (C) . AchoA = anterior choroidal artery; MCA = middle cerebral artery; OphA = ophthalmic artery; PcomA = posterior communicating artery. Second, this case has an associated ruptured aneurysm at the A 1 portion of the ACA. The incidence of aneurysms has been reported to be high in the PPOA. 1–3 , 8 , 10 , 13 , 14 The pathogenesis of associated aneurysms is not fully

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Aneurysmal subarachnoid hemorrhage in young adults: a comparison between patients in the third and fourth decades of life

Tetsuyoshi Horiuchi, Yuichiro Tanaka, Kazuhiro Hongo, and Shigeaki Kobayashi

 AChA 1 5  OphA 0 3  others 1 4 ACA  ACoA 5 38  others 0 8 MCA  bifurcation 6 22  others 1 1 * AChA = anterior choroidal artery; ACoA = anterior communicating artery; OphA = ophthalmic artery; PCoA = posterior communicating artery. Discussion Epidemiological Considerations The occurrence of aneurysmal SAH among young adults in the third or fourth decade of life is rare. 6, 8 The incidence was 5.3% (131 of 2493 patients) in this study. It is

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The learning curve for cavernous sinus surgery illustrated by symptomatic intracavernous aneurysm clipping through a pretemporal transcavernous approach

Chih-Hsiang Liao, Chun-Fu Lin, Jui-To Wang, Wei-Hsin Wang, Shao-Ching Chen, and Sanford P. C. Hsu

, & open Dorello’s canal ant = anterior; OphA = ophthalmic artery; pst = posterior. FIG. 2. Level 1: a basic Dolenc extradural approach. It involves opening the anterior third of the lateral wall and the anterior half of the roof of the CS. Incision of the lateral aspect of the DDR and the falciform ligament should be done as well. After completing all the surgical steps required in level 1, we can achieve 1) proximal control of the clinoid ICA, 2) decompression and mobilization of the optic nerve, and 3) clear visualization of the ophthalmic artery

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Clip ligation for ruptured intracranial aneurysm in a child with Loeys-Dietz syndrome: case report

Steven B. Carr, Greg Imbarrato, Robert E. Breeze, and C. Corbett Wilkinson

Paraclinoid Zenteno et al., 2014 46 F No ICA Endovascular No data No Vertebral artery ACoA = anterior communicating artery; OphA = ophthalmic artery; pt = patient. Although our patient did not have evidence of significant perioperative vasospasm, it should be noted that patients with LDS may experience particular vasoreactivity requiring treatment. Two patients in the literature were treated for vasospasm: Hughes et al. 4 reported intraoperative vasospasm requiring topical papaverine on an unruptured aneurysm, and Kellner et al. 6 reported severe postendovascular

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Evaluation of olfactory nerve function after aneurysmal subarachnoid hemorrhage and clip occlusion

Joost de Vries, Tomas Menovsky, and Koen Ingels

yes 2 no no 2 42, F ACoA yes 1 no no 3 35, M ACoA yes 1 no no 4 43, F rt MCA no 3 yes no 5 64, F ACoA yes 3 no yes 6 46, F PerA no 3 yes no 7 42, F ACoA yes 2 no no 8 38, M ACoA yes 1 no no 9 46, M ACoA yes 2 no no 10 66, F ACoA yes 2 no no 11 47, F lt OphA no 2 no no 12 55, M ACoA yes 1 no no 13 41, F ACoA yes 2 no no * MCA = middle cerebral artery; OphA = ophthalmic

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Risk of cerebral vasopasm after subarachnoid hemorrhage reduced by statin therapy: a multivariate analysis of an institutional experience

Matthew J. McGirt, Robert Blessing, Michael J. Alexander, Shahid M. Nimjee, Graeme F. Woodworth, Allan H. Friedman, Carmelo Graffagnino, Daniel T. Laskowitz, and John R. Lynch

cerebral artery; OphA = ophthalmic artery; PCoA = posterior communicating artery; — = not applicable. †Mean ± standard deviation. ‡Statistically significant. §Median ± interquartile range. The presence of statin therapy on admission with SAH was independently associated with an 11-fold reduction in the OR of subsequent vasospasm (OR 0.09, 95% CI 0.01–0.77; Table 2 ). Fisher Grade 3 (OR 2.82, 95% CI 1.50–5.71) and rupture of an ACA or ICA aneurysm (OR 3.77, 95% CI 1.29–10.91) were independently associated with an increased risk of symptomatic vasospasm ( Table 2

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Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Laboratory investigation

David A. Stidd, Joshua Wewel, Ali J. Ghods, Stephan Munich, Anthony Serici, Kiffon M. Keigher, Heike Theessen, Roham Moftakhar, and Demetrius K. Lopes

: Measured neuronavigation errors for the cadaver model * Anatomical Location Measured Error (mm) M 4 branch point 0.0 M 3 –M 4 junction 0.9 M 2 bifurcation 2.2 M 2 branch 0.0 aneurysm dome at M 1 bifurcation 0.0 ICA bifurcation 0.6 ACoA 0.0 PCoA at ICA origin 1.3 BA bifurcation 0.4 OphA origin 1.7 * ACoA = anterior communicating artery; OphA = ophthalmic artery; PCoA = posterior communicating artery. F ig . 2. Surface registration of the cadaver model. The facial surface

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The aspect ratio (dome/neck) of ruptured and unruptured aneurysms

Bryce Weir, Christina Amidei, Gail Kongable, J. Max Findlay, Neal F. Kassell, John Kelly, Lanting Dai, and Theodore G. Karrison

.038 1.06–9.65  PCoA vs cav ICA 5.86 3.41 0.002 1.88–18.3  post circ vs ICA 5.83 3.37 0.002 1.88–18.1 size of aneurysm (mm)  >4 to ≤6 vs ≤4 2.95 0.63 <0.001 1.94–4.47  >6 to ≤8.2 vs ≤4 3.66 0.89 <0.001 2.27–5.90  >8.2 vs ≤4 3.67 0.84 <0.001 2.34–5.75 * ACoA = anterior communicating artery; cav = cavernous; MCA = middle cerebral artery; OphA = ophthalmic artery; post circ = posterior circulation; SE = standard error. Fig. 3. Graphs demonstrating ORs

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Treatment of intracerebral hematomas caused by aneurysm rupture: coil placement followed by clot evacuation

David B. Niemann, Andrew D. Wills, Nicholas F. Maartens, Richard S. C. Kerr, James V. Byrne, and Andrew J. Molyneux

hematoma locations in 27 patients with ICHs * Lesion Location No. of Lesions aneurysm †  MCA 20  ACA 4  ICA 3  CA—OphA 1 hematoma  sylvian fissure 11  temporal lobe 10  frontal lobe 5  parietal lobe 1 * ACA = anterior cerebral artery; CA = carotid artery; OphA = ophthalmic artery. † One patient had two aneurysms. Clinical and Neuroimaging Features The WFNS grades in patients on admission are shown in Table 2 . Twenty-five (92%) of