Unexpected angiographic and visual findings after clipping of a carotid-ophthalmic aneurysm

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.