PDF(Pubmed)
Abstract：
BACKGROUND: Visual impairment due to delayed optic neuropathy is a rare complication of the endovascular treatment of paraclinoid aneurysms. An inflammatory response induced in the treated aneurysm wall is a known mechanism underlying this pathophysiology. The authors describe a case with severe and progressive optic neuropathy leading to neuronal degeneration and severe visual dysfunction.
METHODS: A 42-year-old female with a history of surgical clipping for a paraclinoid aneurysm presented with a recurrence. Although the patient was unaware of any visual dysfunction, a preoperative ophthalmological examination revealed mild inferior quadrantanopia in the left eye. The coil embolization procedure was uneventful; however, the following day, the patient experienced progressive visual impairment, which worsened despite the initiation of steroid therapy. Ophthalmological examination revealed a severe decrease in visual acuity and further deterioration of the visual field. Magnetic resonance imaging showed remarkable swelling and edema of the left optic nerve adjacent to the treated aneurysm. Despite continued steroid therapy, the patient\'s visual function did not recover well due to subsequent optic nerve degeneration.
CONCLUSIONS: Optic neuropathy after endovascular procedures can lead to severe visual dysfunction. Careful management is essential, particularly when treating a symptomatic paraclinoid aneurysm, even if symptoms are only apparent on detailed examination.
METHODS: A 42-year-old female with a history of surgical clipping for a paraclinoid aneurysm presented with a recurrence. Although the patient was unaware of any visual dysfunction, a preoperative ophthalmological examination revealed mild inferior quadrantanopia in the left eye. The coil embolization procedure was uneventful; however, the following day, the patient experienced progressive visual impairment, which worsened despite the initiation of steroid therapy. Ophthalmological examination revealed a severe decrease in visual acuity and further deterioration of the visual field. Magnetic resonance imaging showed remarkable swelling and edema of the left optic nerve adjacent to the treated aneurysm. Despite continued steroid therapy, the patient\'s visual function did not recover well due to subsequent optic nerve degeneration.
CONCLUSIONS: Optic neuropathy after endovascular procedures can lead to severe visual dysfunction. Careful management is essential, particularly when treating a symptomatic paraclinoid aneurysm, even if symptoms are only apparent on detailed examination.
摘要：
背景：迟发性视神经病变引起的视力障碍是一种罕见的手术并发症。在治疗的动脉瘤壁中诱导的炎症反应是这种病理生理学的已知机制。作者描述了一个严重和进行性视神经病变导致神经元变性和严重视觉功能障碍的病例。
方法：一名42岁女性，有手术夹闭手术史，表现为突突旁动脉瘤复发。尽管患者没有意识到任何视觉功能障碍，术前眼科检查显示左眼轻度下正交视。线圈栓塞程序是顺利的;然而，第二天,患者出现进行性视力障碍，尽管开始了类固醇治疗，但情况恶化了。眼科检查显示视力严重下降，视野进一步恶化。磁共振成像显示与治疗动脉瘤相邻的左视神经明显肿胀和水肿。尽管持续的类固醇治疗,由于随后的视神经变性，患者的视功能没有很好地恢复。
结论：腔内手术后的视神经病变可导致严重的视觉功能障碍。谨慎的管理至关重要，特别是在治疗有症状的突突旁动脉瘤时，即使症状仅在详细检查时明显。
方法：一名42岁女性，有手术夹闭手术史，表现为突突旁动脉瘤复发。尽管患者没有意识到任何视觉功能障碍，术前眼科检查显示左眼轻度下正交视。线圈栓塞程序是顺利的;然而，第二天,患者出现进行性视力障碍，尽管开始了类固醇治疗，但情况恶化了。眼科检查显示视力严重下降，视野进一步恶化。磁共振成像显示与治疗动脉瘤相邻的左视神经明显肿胀和水肿。尽管持续的类固醇治疗,由于随后的视神经变性，患者的视功能没有很好地恢复。
结论：腔内手术后的视神经病变可导致严重的视觉功能障碍。谨慎的管理至关重要，特别是在治疗有症状的突突旁动脉瘤时，即使症状仅在详细检查时明显。
