Fusiform intracanalicular ophthalmic artery aneurysm; case report and review of literature

Abstract

A 35-year-old man's vision had progressively deteriorated over a 3-month period. His left visual acuity was 5/20. Enhanced orbital computed tomographic (CT) scans revealed a fusiform dilatation of the ophthalmic artery in the left optic canal. Cerebral Angiography revealed a fusiform aneurysm on the left ophthalmic artery in the optic canal, measuring 6.2 x 4.6 mm in size. Four days after admission, visual acuity dropped to hand-motion. Endovascular treatment was chosen and a microcatheter was guided into the proximal segment of the ophthalmic artery. Using 4 detachable coils, parent artery occlusion was done. Three months after the intervention, the visual acuity in his left eye improved to 20/20. Dramatic recovery of visual acuity is exceptional with an ophthalmic artery trunk aneurysm. When an occlusion of the proximal ophthalmic artery is the only treatment option in such a situation, the endovascular occlusion of the proximal ophthalmic artery is quite feasible in the sense that it does not require any optic nerve manipulation.

Keywords: Detachable coil; Fusiform aneurysm; Intracanalicular portion; Ophthalmic artery trunk aneurysm.

Fig. 1

A : Axial T2-weighted magnetic resonance image demonstrating a signal void in the left optic canal (arrow). B : Magnetic resonance angiography revealing an aneurysm on the left ophthalmic artery trunk. C : Axial enhanced orbital computed tomographic scan showing a fusiform dilatation of the left ophthalmic artery with bony erosion of the ethmoidal wall (arrow). D : Coronal orbital computed tomography illustrating an enlarged left optic canal (arrow).

Fig. 2

A : Cerebral angiography of the left internal carotid artery depicting a fusiform aneurysm of the left ophthalmic artery trunk. Luminal irregularities are noted on proximal segments of left ophthalmic artery. B : The distal tip of a microcatheter is located just proximal to the aneurysm. C : Detached coils are visible on the proximal ophthalmic artery during the procedure. D : After the ophthalmic artery occlusion, the aneurysm is no longer filled and antegrade flow is not observed. E : Late arterial phase of left external carotid angiogram shows retrograde collateral flows which constitute choroidal crescent (arrow heads). Retrograde filling of the intraorbital ophthalmic artery is also noted (arrow).

Fig. 3

Three months after the intervention, cerebral angiography illustrates well-obliterated left ophthalmic artery.