Isolated Progressive Visual Loss after Coiling of Paraclinoid Aneurysms
G.W. Schmidta,
S.F. Ostera,
K.C. Golnikb,
L.M. Tumialánc,
V. Bioussed,e,
R. Turbinf,
C.J. Prestigiacomog and
N.R. Millera
a Neuro-Ophthalmology Unit, The Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Md
b Department of Neuro-Ophthalmology, Cincinnati Eye Institute, University of Cincinnati, Cincinnati, Ohio
c Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga
d Department of Neurology, Emory University School of Medicine, Atlanta, Ga
e Department of Ophthalmology, Emory University School of Medicine, Atlanta, Ga
f Department of Neuro-Ophthalmology and Orbital Surgery, New Jersey Medical School, Newark, NJ
g Department of Neurological Surgery and Radiology, New Jersey Medical School, Newark, NJ
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Fig 1. Case 4. A 52-year-old woman with progressive visual loss in the left eye beginning 5 days following coiling of a left paraclinoid aneurysm. A, Preoperative MR imaging: T2-weighted axial image shows an aneurysm arising from the paraclinoid portion of the left ICA. B, Preoperative MR imaging: T1-weighted axial image following administration of gadolinium shows marked enhancement of the aneurysm. C, Preoperative MR imaging: T1-weighted coronal image following administration of gadolinium shows marked enhancement of the aneurysm. D, Five days after coiling: T2-weighted axial MR image shows a heterogeneous signal intensity from within the aneurysm, consistent with coil packing. E, Five days after coiling: T1-weighted axial MR image following administration of gadolinium shows that most of the aneurysm no longer enhances; however, there is generalized irregular enhancement surrounding it. F, Five days after coiling: T1-weighted coronal MR image following administration of gadolinium shows a thin layer of irregular enhancement either in the wall of the aneurysm or in adjacent tissue. G, Six months after coiling: T2-weighted axial MR image shows that the aneurysm is slightly larger (1–2 mm) than before coiling. H, Six months after coiling: T1-weighted axial MR image following administration of gadolinium shows areas of persistent slight enhancement around the margin of the coiled aneurysm. I, Six months after coiling: T1-weighted coronal MR image following administration of gadolinium shows a thin margin of irregular enhancement around the coiled aneurysm.
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Fig 2. Case 5. A 53-year-old man with progressive visual loss in the left eye beginning 24 hours following coiling of a left paraclinoid aneurysm. T1-weighted axial (A) and coronal (B) MR images show irregular enhancement, suggesting recanalization of the aneurysm as well as mildly diminished flow within the left cavernous and supraclinoid ICA, thought to be related to mass effect from the partially occluded aneurysm.
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Fig 3. Case 8. A 71-year-old woman with progressive visual loss in the right eye beginning 2 weeks following coiling of a right paraclinoid aneurysm. A, Conventional angiogram following endovascular embolization demonstrates compaction of coils at the anterior portion of the aneurysm. B, Automated static perimetry 8 weeks postcoiling reveals a field defect in the right eye and a minimal superior temporal defect in the left eye. C, Eleven weeks after coiling, the visual field (automated static perimetry) of the right eye shows minimal worsening and there is now a more significant superior temporal defect in the visual field of the left eye. D, Thirty-nine weeks after coiling, the visual field (automated static perimetry) of the right eye shows improvement and there is minimal change in the superior temporal defect in the visual field of the left eye. E, Automated static perimetry 54 weeks after the coiling procedure reveals an improved superior and inferior arcuate scotoma on the right side. The left eye reveals a subtle superotemporal defect.
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