Results, outcomes, and follow-up of remnants in the treatment of ophthalmic aneurysms: A 16-year experience of a combined neurosurgical and endovascular team

Daniel H. Fulkerson, Terry C. Horner, Troy D. Payner, Thomas J. Leipzig, John A. Scott, Andrew J. Denardo, Kathleen Redelman, Julius M. Goodman

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Abstract

OBJECTIVE: Ophthalmic aneurysms present unique challenges to a vascular team. This study reviews the 16-year experience of a multidisciplinary neurovascular service in the treatment, complications, outcomes, and follow-up of patients with ophthalmic aneurysms from 1990 to 2005. METHODS: A retrospective analysis of prospectively collected data of 134 patients with 157 ophthalmic aneurysms is presented. Subgroup analysis is performed based on treatment and clinical presentation of the patients. RESULTS: Clinical outcomes are reported using the Glasgow Outcome Scale. A "good" outcome is defined as a Glasgow Outcome Scale score of 4 or 5, and a "poor" outcome is defined as a Glasgow Outcome Scale score of 1 to 3. Outcome was related to patient age (P = 0.0002) and aneurysm size (P = 0.046). Outcomes for patients with ruptured aneurysms were related to hypertension (P<0.0001) and clinical admission grade (P= 0.001). In patients with unruptured aneurysms, a good clinical outcome was noted in 103 (92.7%) of 111 patients at discharge and 83 (94.3%) of 88 patients at the time of the 1-year follow-up evaluation. Complete clipping was attained in 89 (79.5%) of 112 patients with angiographic follow-up. Patients with aneurysm remnants from both coiling and clipping had a low risk of regrowth, and there were no rehem-orrhages. One of 25 patients with angiographic follow-up (average, 4.3 ± 4.1 years) after "complete" clipping showed recurrence of the aneurysm. CONCLUSION: Despite the difficulties presented by ophthalmic aneurysms, these lesions can be successfully managed by a multidisciplinary team. Imaging follow-up of patients is important, as there is a risk of aneurysm regrowth after either coiling or clipping.

Original languageEnglish (US)
Pages (from-to)218-229
Number of pages12
JournalNeurosurgery
Volume64
Issue number2
DOIs
StatePublished - Feb 1 2009

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Keywords

  • Aneurysm
  • Angiogram
  • Complication
  • Endovascular
  • Ophthalmic
  • Remnant

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Fulkerson, D. H., Horner, T. C., Payner, T. D., Leipzig, T. J., Scott, J. A., Denardo, A. J., Redelman, K., & Goodman, J. M. (2009). Results, outcomes, and follow-up of remnants in the treatment of ophthalmic aneurysms: A 16-year experience of a combined neurosurgical and endovascular team. Neurosurgery, 64(2), 218-229. https://doi.org/10.1227/01.NEU.0000337127.73667.80