Spontaneous extrusion of guglielmi detachable coils from anterior communicating artery aneurysm.

Recurrence of coiled aneurysm usually due to coil compaction is a known phenomenon. Extent of recurrence and its relation to re-bleeding is not known. The authors report a case of spontaneous asymptomatic extrusion of guglielmi detachable coils from the dome of a previously ruptured anterior communicating artery aneurysm two years after the initial endovascular obliteration. The initial aneurysm had a suitable neck-aspect ratio for endovascular obliteration with uncomplicated coiling procedure. Extreme degree of coil compaction with subsequent expulsion of the coils from the dome due to water-hammer effect of blood flow is thought to be the main pathogenic mechanism of this rare but worrying complication. Surgical management includes clipping at the neck ensuring complete obliteration of the aneurysm. Postoperative angiogram to confirm its satisfactory obliteration is advised.

Sudden visual loss due to posterior ischemic optic neuropathy following craniotomy for a ruptured intracranial aneurysm.

The authors report a rare case of acute ipsilateral blindness that occurred after a standard fronto-temporal craniotomy for aneurysm in supine position. Posterior ischemic optic neuropathy caused by external pressure on the ipsilateral eye, its differentials and subsequent medico-legal implications are discussed.