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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Endovascular Approach to Concurrent Anterior Cranial Fossa Dural AVF and Concurrent Flow-Related Ophthalmic Artery
Vikas Chandra Jha1, Rahul Jain1, Vivek Saran Sinha1
1Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India.
Abstract:
Dural arteriovenous fistulas (DAVFs) with concurrent flow-related ophthalmic artery aneurysms, particularly intraorbital aneurysms, are rare. Retrograde cortical blood flow and sinus thrombosis heighten the risk of rupture and optic nerve compression, yet treatment strategies remain poorly defined. This study aims to explore effective management for these complex cases. A 66-year-old hypertensive man presented with an acute severe headache, loss of consciousness, and decreased vision in the left eye. Imaging revealed a left frontal intracranial hemorrhage and an anterior cranial fossa DAVF with a left ophthalmic artery aneurysm. Endovascular embolization via the left ophthalmic artery, using a microcatheter distal to the aneurysm and controlled reflux of glue injection (N-butyl cyanoacrylate and lipiodol), successfully treated the DAVF and ophthalmic artery aneurysm. Visual acuity improved to finger counting at 1 foot, with no residual DAVF at 6 months. This case demonstrates that controlled glue embolization is a viable alternative when microsurgery is not feasible due to complex anatomy.
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