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Case Report
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| Split optic nerve penetrated by a carotid-ophthalmic aneurysm another instance of a rare presentation: A case report |
| Caleb E Feliciano1, Duke Samson2 |
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1Department of Surgery-Section of Neurourgery, University of Puerto Rico-Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067.
2Department of Neurosurgery, University of Texas-Southwestern at Dallas 2353 Harry Hines Blvd, Dallas, TX 75390-8855. |
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doi:10.5348/ijcri-2012-07-149-CR-10
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Address correspondence to: Caleb E. Feliciano, MD Department of Surgery-Section of Neurourgery University of Puerto Rico-Medical Sciences Campus, PO Box - 365067 San Juan, PR 00936-5067 USA Phone: 787-765-8276 Fax: 787-765-8276 Email: caleb.feliciano@upr.edu |
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| How to cite this article: |
| Feliciano CE, Samson D. Split optic nerve penetrated by a carotid-ophthalmic aneurysm another instance of a rare presentation: A case report. International Journal of Case Reports and Images 2012;3(7):39–44. |
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Abstract
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Introduction:
Penetration of the optic nerve by aneurysms of the paraclinoid carotid artery is rare. We present the seventh aneurysm-related split optic nerve case reported in the literature, review the pathophysiologic mechanisms and discuss the technical aspects for successful clip ligation and complication avoidance.
Case Report: A 64-year-old male with history of hypertension, chronic obstructive pulmonary disease and polycystic kidneys presented with headache and dizziness. Magnetic resonance imaging and angiographic work-up confirmed the presence of a right-sided partially thrombosed carotid-ophthalmic aneurysm. There was no evidence of significant visual dysfunction. A right pterional craniotomy with frontal extension was performed. The aneurysm dome was noted to extend subfrontally after passing through a split optic nerve. Aneurysm neck was clipped using a combination of standard ophthalmic and fenestrated clips. During immediate post-operative period the patient had worsening of visual acuity, yet showed progressive visual improvement on clinical follow-up. Conclusion: The pathophysiologic mechanisms for aneurysm development range from congenital to mechanical/hemodynamic. Our patient's clinical presentation suggests a slowly growing lesion that may have penetrated through a weak spot in the overlying optic nerve. This may have been caused by either congenital fenestration of the optic nerve, persistent vestigial artery or an old unrecognized hemorrhage. Optic nerve penetration by carotid-ophthalmic aneurysms occurs rarely, yet is being increasingly reported and recognized. Knowledge of this potential configuration can help avoid inadvertent damage and improve results by novel application of fenestrated and standard clips. | |
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Key Words:
Carotid-ophthalmic aneurysm, Optic nerve fenestration, Paraclinoid aneurysm, Split optic nerve, Surgical technique
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Author Contributions:
Caleb E Feliciano - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Duke Samson - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
Authors declare no conflict of interest. |
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Copyright:
© Caleb E Feliciano et al. 2012; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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