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“Successful” coiling of a giant ophthalmic aneurysm resulting in blindness: case report and critical review

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA

    Ramsey Ashour, Jeremiah Johnson & Mohammad Ali Aziz-Sultan

  2. Department of Neurosurgery, University of Kansas School of Medicine, Kansas, USA

    Koji Ebersole

Authors
  1. Ramsey Ashour
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  2. Jeremiah Johnson
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  3. Koji Ebersole
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  4. Mohammad Ali Aziz-Sultan
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Corresponding author

Correspondence to Ramsey Ashour.

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Comments

Gerasimos Baltsavias, Zurich, Switzerland

I cannot agree more with the authors’ conclusion.

However, important questions remain. What was the indication for a flow-diverter in this case? How should somebody act in a future similar case? If flow-diverter would be technically successful, should we go for it?

These are the crucial and difficult-to-answer questions beyond any easy and ex post facto wisdom. It is interesting that the decision for flow-diverter as first choice was not actually analyzed in the discussion as much as all other therapeutic options.

As it is stated by the authors, the choice was based on the preference to preserve the ICA, on a feeling that its application could be achieved with minimal risk, plus the fact that it “represents a new frontier.”

None of the above nor all the above together, support such a decision well enough. I would say the opposite.

In my knowledge so far, flow-diverters have not shown any superiority in terms of safety and predictability of the immediate result or in terms of effectiveness and long-term outcome, in comparison with parent artery occlusion in patients with adequate collaterals.

Aki Laakso, Helsinki, Finland

Giant intracranial aneurysms are dangerous lesions with poor prognosis, if left untreated. In addition to high risk of rupture and death, they often predispose the patient to thromboembolic complications and neurologic defects caused by mass effect. Their treatment is also often a formidable undertaking. In our center, the treatment of a giant aneurysm with a mass effect causing a significant neurological deficit (a visual deficit in this case) is primarily surgical one—either with or without a concomitant bypass, depending on the case—and aims at decompression of surrounding neural structures, if possible. Endovascular treatment for these aneurysms would be reserved only for obviously inoperable cases. The case described by the authors is an unfortunate reminder that, despite advances in endovascular treatment, open microneurosurgery still has, and should have, a significant role in the treatment of many aneurysms.

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Ashour, R., Johnson, J., Ebersole, K. et al. “Successful” coiling of a giant ophthalmic aneurysm resulting in blindness: case report and critical review. Neurosurg Rev 36, 661–665 (2013). https://doi.org/10.1007/s10143-013-0472-z

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  • DOI: https://doi.org/10.1007/s10143-013-0472-z

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