Blindness Caused by Wrapping of the ICA Aneurysm

The incidence of blindness after aneurysm surgery is very rare. We experienced a case of unilateral blindness after internal carotid artery(ICA) aneurysm wrapping. A 43-year-old male immediately developed ipsilateral ocular pain and visual loss in his left eye after the treatment of a lateral ICA aneurysm by wrapping with muscle pieces. He had also multiple aneurysms, which were multilobulated anterior communicating artery (A-com), middle cerebral artery(MCA) and posterior communicating artery (P-com) aneurysms. Coilings were done for a part of A-com artery aneurysm and P-com artery aneurysm on admission. The remaining A-com artery aneurysm was clipped and ICA aneurysm was wrapped with temporal muscle piece. A retrobulbar optic neuropathy might have resulted from either direct injury or damage to small dural vessels of the posterior optic nerve. Actually, the optico-carotid space was tight and the optic nerve was compressed by swollen muscle piece. Despite releasing of compression of the optic nerve on second day, his visual loss was irreversible.

Ring Clips for ICA Aneurysm Protruding Inferiorly: Report of Five Cases

The development of more appropriate shapes of aneurysm clips will hopefully enable excellent clipping of most types of difficult aneurysms. The clipping of internal carotid artery(ICA) aneurysms protruding inferiorly is relatively difficult and has the high risk of premature rupture during operation using conventional clips. We report five cases of ICA aneurysms protruding inferiorly in the operative field. All aneurysms were successfully clipped with ring clips without difficulty. Our results suggest that the ring clips rather than conventional clips were appropriate in the ICA aneurysm protruding inferiorly in the operative field.