Abstract
One case of a large carotid-ophthalmic aneurysm was treated by clipping of the neck and intra aneurysmal injection of cyanoacrylate. A 52-year-old woman noticed progressive visual deterioration in her left eye for six months. On admission, visual examination revealed a left inferior nasal quadrantanopsia and a left atrophic disc. Visual acuity was 0.05 on the left. CT scan confirmed the presence of a suprasellar mass, which angiography proved to be a large left carotid-ophthalmic aneurysm directed superomedially. The aneurysm was explored in September 1983. The neck was clipped with a Heifetz clip during temporary occlusion of the carotid artery in the neck. Post-operative angiograms demonstrated that the clip had slipped. The aneurysm was re-explored. The neck was occluded with a long Sugita clip with the aid of temporary carotid occlusion. As there was still some filling of the aneurysm, a second Scoville clip was applied. The aneurysm was then discolored. After the aspiration of the aneurysm, cyanoacryate was in into the sac during temporary trapping of the carotid artery to secure the obliteration of the aneurysm. Postoperative angiograms revealed successful occlusion of the aneurysm and filling of the residual neck in the cavernous sinus. Visual acuity in the left eye improved to 0.3, although the field deficits persisted. Injection of cyanoacrylate into the aneurysm is an effective procedure in cases where multiple maneuvers fail to keep the aneurysm collapsed. However, the disadvantage of this method is undesirable embolization through the neck. Therefore, the injection of cyanoacrylate should be carried out during temporary trapping of the carotid artery and/or clipping of the neck of the aneurysm.
