Case report: a troublesome ophthalmic artery aneurysm.

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Large unruptured ophthalmic artery aneurysms pose treatment challenges, particularly when causing visual deficits.
• Surgical clipping is traditionally preferred for optic nerve decompression, but endovascular techniques offer alternatives.
• The advent of stents has advanced endovascular treatment but complicated strategy selection.

Observation:

• A 56-year-old woman presented with progressive vision loss due to a 20-mm ophthalmic artery aneurysm.
• Initial endovascular treatment with stent and coils led to aneurysm growth.
• Subsequent interventions, including bypass and internal carotid artery occlusion, were insufficient to control growth.

Findings:

• The ophthalmic artery aneurysm continued to grow despite multiple endovascular and surgical interventions.
• Persistent retrograde flow in the internal carotid artery contributed to aneurysm expansion.
• Final surgical excision was required, resulting in vision improvement in one eye but permanent blindness in the other.

Implications:

• This case underscores the potential for aneurysm growth and treatment complications, even with advanced techniques.
• It highlights the critical need for thorough pre-procedural assessment and tailored treatment strategies for complex ophthalmic artery aneurysms.
• Careful consideration of collateral circulation and potential for retrograde flow is essential in managing these challenging cases.