1997 Volume 25 Issue 5 Pages 352-358
Recovery of visual function after the operation of large carotid-ophthalmic aneurysms is not always satisfactory, although a“combined epi- and subdural approach”(Dolenc's approach) has recently been applied for such operations. This report tries to point out a strategy to secure the visual activity with this operation.
We summarize 5 cases. All aneurysms were large enough to compress the optic nerves, causing severe visual disturbance before operation. Two aneurysms had intramural thrombosis or marked calcification. In these cases, visual function subsequently became worse, even if the case was taken to minimize the intraoperative damage to the optic nerves. In the other 3 patients, visual symptoms improved immediately after the operation. A direct neck clipping was performed in cases where intramural thrombosis or marked calcification was not present in the aneurysm. In other cases removal of thrombus was performed after temporary occlusion of the internal carotid artery.
Although the size of aneurysms did not affect the result of postoperative visual functions, the presence of intramural thrombosis or marked calcification in aneurysms caused worsening of visual symptoms. For these aneurysms an indirect operation such as trapping of the carotid artery with or without EC-IC bypass would be a better option.
