%0 Journal Article
%T Unexpected angiographic and visual findings after clipping of a carotid-ophthalmic aneurysm Hallazgos angiograficos y visuales inesperados tras clipage de aneurisma carotido-oft¨¢lmico
%A L. Mascarenhas
%A M. Ribeiro
%A S. Guimaraes
%A J. Rocha
%J Neurocirug¨ªa
%D 2010
%I Scientific Electronic Library Online
%X A 56-year-old woman underwent surgery for a ruptured carotid-ophthalmic artery aneurysm. Intraoperative visual inspection confirmed that the ophthalmic artery was left intact. She had no light perception on the operated side right after surgery. Angiography one week after surgery confirmed exclusion of the aneurysm, no filling of the proximal portion of the ophthalmic artery, and a very faint filling of its distal orbital part. She gradually recovered from this deficit and 9 months after surgery she is capable of counting fingers. At this time angiography displayed filling of all the portions of the ophthalmic artery, absence of recruitment of collateral blood supply, and exclusion of the aneurysm as before. Surgical manipulation seems to either have induced vasospasm or thrombosis of the ophthalmic artery. Regression of vasospasm or secondary recanalization of the thrombus without development of collateral blood supply may account for the gradual improvement of vision. A risk of monocular blindness is associated with the surgical treatment of para-clinoid aneurysms. Nevertheless, when it occurs, a perspective of recovery may exist if certain etiologies are involved. Una mujer de 56 a os fue intervenida de un aneurisma carotido-oft¨¢lmico roto. La inspecci¨®n visual intraoperatoria confirmaba que la arteria oft¨¢lmica estaba intacta. Tras la cirug¨ªa la paciente no percib¨ªa luz por dicho ojo y la angiograf¨ªa una semana despu¨¦s de la cirug¨ªa confirm¨® la exclusi¨®n del aneurisma, con falta de relleno de la porci¨®n proximal de la arteria oft¨¢lmica, y un relleno muy d¨¦bil de la porci¨®n orbitaria distal. La paciente se fue recuperando progresivamente del d¨¦ficit y 9 meses despu¨¦s de la cirug¨ªa es capaz de contar dedos. La angiograf¨ªa actual demuestra un relleno de todas las porciones de la arteria oft¨¢lmica, con ausencia de circulaci¨®n colateral, y exclusi¨®n del aneurisma. La manipulaci¨®n quir¨²rgica parece haber inducido vasoespasmo o trombosis de la arteria oft¨¢lmica. La regresi¨®n del vasoespasmo o la recanalizaci¨®n secundaria del trombo sin desarrollo de circulaci¨®n colateral pueden justificar la mejor¨ªa gradual de la visi¨®n. Hay un riesgo de amaurosis unilateral asociado al tratamiento quir¨²rgico de los aneurismas paraclinoideos, aunque existe posibilidad de mejor¨ªa en algunos casos.
%K Arteria oft¨¢lmica
%K Aneurisma
%K Cirug¨ªa
%K Angiograf¨ªa
%K D¨¦ficit visual transitorio
%K Ophthalmic artery
%K Aneurysm
%K Surgery
%K Angiography
%K Transitory visual deficit
%U http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-14732010000100006