Journal of Korean Neurosurgical Society

  • 제46권3호
  • /
  • Pages.232-238
  • /
  • 2009
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Anterior Communicating Artery Aneurysm Related to Visual Symptoms

  • Park, Jung-Hyun (Department of Neurological Surgery, Sanggye Paik Hospital, College of Medicine, Inje University) ;
  • Park, Sang-Keun (Department of Neurological Surgery, Sanggye Paik Hospital, College of Medicine, Inje University) ;
  • Kim, Tae-Hong (Department of Neurological Surgery, Sanggye Paik Hospital, College of Medicine, Inje University) ;
  • Shin, Jun-Jae (Department of Neurological Surgery, Sanggye Paik Hospital, College of Medicine, Inje University) ;
  • Shin, Hyung-Shik (Department of Neurological Surgery, Sanggye Paik Hospital, College of Medicine, Inje University) ;
  • Hwang, Yong-Soon (Department of Neurological Surgery, Sanggye Paik Hospital, College of Medicine, Inje University)
  • 발행 : 2009.09.28
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Intracranial aneurysms are sometimes presented with visual symptoms by their rupture or direct compression of the optic nerve. It is because their prevalent sites are anatomically located close to the optic pathway. Anterior communicating artery is especially located in close proximity to optic nerve. Aneurysm arising in this area can produce visual symptoms according to their direction while the size is small. Clinical importance of visual symptoms presented by aneurysmal optic nerve compression is stressed in this study. Methods : Retrospective analysis of ruptured anterior communicating artery aneurysms compressing optic apparatus were carried out. Total 33 cases were enrolled in this study. Optic nerve compression of the aneurysms was confirmed by the surgical fields. Results : In 33 cases among 351 cases of ruptured anterior communicating artery aneurysms treated surgically, from 1991 to 2000, the dome of aneurysm was compressed in optic pathway. In some cases, aneurysm impacted into the optic nerve that deep hollowness was found when the aneurysm sac was removed during operation. Among 33 cases, 10 cases presented with preoperative visual symptoms, such as visual dimness (5), unilateral visual field defect (2) or unilateral visual loss (3), 20 cases had no visual symptoms. Visual symptoms could not be checked in 3 cases due to the poor mental state. In 6 cases among 20 cases having no visual symptoms, optic nerve was deeply compressed by the dome of aneurysm which was seen in the surgical field. Of 10 patients who had visual symptoms, 8 showed improvement in visual symptoms within 6 months after clipping of aneurysms. In 2 cases, the visual symptoms did not recover. Conclusion : Anterior communicating artery aneurysm can cause visual symptoms by compressing the optic nerve or direct rupture to the optic nerve with focal hematoma formation. We emphasize that cerebral vascular study is highly recommended to detect intracranial aneurysm before its rupture in the case of normal CT findings with visual symptoms and frequent headache.

키워드

참고문헌

  1. Arseni C, Ghitescu M, Cristescu A, Mihaila G : Intrasellar aneurysms simulating hypophyseal tumors. Eur Neurol 3 : 321-329, 1970 https://doi.org/10.1159/000113996
  2. Chan JW, Hoyt WF, Ellis WG, Gress D : Pathogenesis of acute monocular blindness from leaking anterior communicating artery aneurysms; report of six cases. Neurology 48 : 680-683, 1997 https://doi.org/10.1212/WNL.48.3.680
  3. Chong CT, Chin KJ, Yip LW, Singh K : Case series : monocular visual loss associated with subarachnoid hemorrhage secondary to ruptured intracranial aneurysms. Can J Anaesth 53 : 684-689, 2006 https://doi.org/10.1007/BF03021627
  4. Claes C, Milea D, Bodaghi B, Tran TH, LeHoang P, Blanc R : Acute retrobulbar optic neuropathy due to rupture of anterior communication artery aneurysm. Acta Ophthalmol Scand 84 : 145-146, 2006 https://doi.org/10.1111/j.1600-0420.2005.00545.x
  5. Craenen G, Brown SM, Freedman KA, Windisch TR, Corona J : Rapid, painless unilateral vision loss in an 37-year-old healthy woman. Surv Ophthalmol 49 : 343-348, 2004 https://doi.org/10.1016/j.survophthal.2004.02.012
  6. Cullen JF, Haining WM, Crombie AL : Cerebral aneurysms presenting with visual field defects. Br J Ophthalmol 50 : 251-256, 1966 https://doi.org/10.1136/bjo.50.5.251
  7. Date I, Asari S, Ohmoto T : Cerebral aneurysms causing visual symptoms; their features and surgical outcome. Clin Neurol Neurosurg 100 : 259-267, 1998 https://doi.org/10.1016/S0303-8467(98)00047-X
  8. Debrun GM, Aletich VA, Kehrli P, Misra M, Ausman JI, Charbel F : Selection of cerebral aneurysm for treatment using Guglielmi detachable coils : the preliminary university of Illinois at Chicago experience. Neurosurgery 43 : 1281-1295; discussion 1296-1297, 1998 https://doi.org/10.1097/00006123-199812000-00011
  9. Ferguson GG, Drake CG : Carotid-ophthalmic aneurysms : visual abnormalities in 32 patients and the results of treatment. Surg Neurol 16 : 1-8, 1981 https://doi.org/10.1016/S0090-3019(81)80049-3
  10. Halbach VV, Higashida RT, Dowd CF, Barnwell SL, Fraser KW, Smith TP, et al. : The efficacy of endovasccular aneurysm occlusion in alleviating neurological deficits produced by mass effect. J Neurosurg 80 : 659-666, 1994 https://doi.org/10.3171/jns.1994.80.4.0659
  11. Hara N, Mukuno K, Ohtaka H, Shimizu K : Ischemic optic neuropathy associated with subarachnoid hemorrhage after rupture of anterior communicating artery aneurysm. Ophthalmologica 217 : 79-84, 2003 https://doi.org/10.1159/000068247
  12. H$\o$jer-Pedersen E, Haase J : Giant anterior communicating aneurysm with bitemporal hemianopsia; case report. Neurosurgery 8 : 703-706, 1981 https://doi.org/10.1227/00006123-198106000-00012
  13. Kassell NF, Sasaki T, Colohan AR, Nazar G : Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 16 : 562-572, 1985 https://doi.org/10.1161/01.STR.16.4.562
  14. Koo SK, Song YJ, Huh JT : Surgically Treated Anterior Communicating Artery Aneurysm. J Korean Neurosurg Soc 37 : 405-409, 2005
  15. Kupersmith MJ, Siegel IM, Carr RE : Reduced contrast sensitivity in compressive lesions of the anterior visual pathway. Neurology 31 : 550-554, 1981 https://doi.org/10.1212/WNL.31.5.550
  16. Lee Ag, Brazis PW, Miller NR : Posterior ischemic optic neuropathy associated with migrane. Headache 36 : 506-510, 1996 https://doi.org/10.1046/j.1526-4610.1996.3608506.x
  17. Malisch TW, Guglielmi G, Vinuela F, Duckwiler G, Gobin YP, Martin NA, et al. : Unruptured aneurysms presenting with mass effect symptoms; response to endosaccular treatment with Guglielmi detachable coils. Part I. Symptoms of cranial nerve dysfunction. J Nurosurg 89 : 956-961, 1998 https://doi.org/10.3171/jns.1998.89.6.0956
  18. McCarron MO, Alberts MJ, McCarron P : A systematic review of Terson’s syndrome; frequency and prognosis after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 75 : 491-493, 2004 https://doi.org/10.1136/jnnp.2003.016816
  19. Nishino A, Sakurai Y, Arai H, Nishimura S, Suzuki S, Uenohara H : Clinical manifestations, character of aneurysms, and surgical results for unruptured cerebral aneurysms presenting with ophthalmic symptoms. Acta Neurochir Suppl 82 : 47-49, 2002
  20. Nonaka T, Haraguchi K, Baba T, Koyanagi I, Houkin K : Clinical manifestations and surgical results for paraclinoid cerebral aneurysms presenting with visual symptoms. Surg Neurol 67 : 612-619; discussion 619, 2007 https://doi.org/10.1016/j.surneu.2006.08.074
  21. Norwood EG, Kline LB, Chandra-Sekar B, Harsh GR 3rd : Aneurysmal compression of the anterior visual pathways. Neurology 36 ; 1035-1041, 1986 https://doi.org/10.1212/WNL.36.8.1035
  22. Peiris JB, Ross Russell RW : Giant aneurysms of the carotid system presenting as visual field defect. J Neurol Neurosurg Psychiatry 43 : 1053-1064, 1980 https://doi.org/10.1136/jnnp.43.12.1053
  23. Pfausler B, Belcl R, Metzler R, Mohsenipour I, Schmutzhard E : Terson’s syndrome in spontaneous subarachnoid hemorrhage a prospective study in 60 consecutive patients. J Neurosurg 85 : 392- 394, 1996 https://doi.org/10.3171/jns.1996.85.3.0392
  24. Pico F, Biousse V, Chapot R, Bousser MG : [Aneurysm of the anterior cerebral artery disclosed by unique hemianoptic scotoma.] Rev Neurol (Paris) 158 : 347-350, 2002
  25. Portney GL, Roth AM : Optic cupping caused by an intracranial aneurysm. Am J Ophthalmol 84 : 98-103, 1977 https://doi.org/10.1016/0002-9394(77)90332-4
  26. Raymond LA, Tew J : Large suprasellar aneurysms imitating pituitary tumor. J Neurol Neurosurg Psychiatry 41 : 83-87, 1978 https://doi.org/10.1136/jnnp.41.1.83
  27. Resnick SJ, Rabinstein AA : Neurological picture. Terson’s syndrome in subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry 77 : 287, 2006 https://doi.org/10.1136/jnnp.2005.077628
  28. Ruben S, Afshar F : Visual failure following subarachnoid hemorrhage from rupture of an anterior communication artery aneurysm. J Neurol Neurosurg Psychiatry 54 : 1017-1018, 1991 https://doi.org/10.1136/jnnp.54.11.1017
  29. Sadda SR, Nee M, Miller NR, Biousse V, Newman NJ, Kouzis A : Clinical spectrum of posterior ischemic optic neuropathy. Am J Ophthalmol 132 : 743-750, 2001 https://doi.org/10.1016/S0002-9394(01)01199-0
  30. Thygesen J, Rosen$\o$rn J : Transient bilateral blindness in relation to subarachnoid haemorrhage caused by spastic ischemic changes in retina and optic nerve. Acta Ophthalmol (Copenh) 60 : 325-331, 1982 https://doi.org/10.1111/j.1755-3768.1982.tb08388.x

피인용 문헌

  1. Anterior communicating artery aneurysm presenting as monocular blindness vol.25, pp.5, 2011, https://doi.org/10.3109/02688697.2010.544782
  2. Influence of surgical or endovascular treatment on visual symptoms caused by intracranial aneurysms: single-center series and systematic review : Clinical article vol.115, pp.4, 2009, https://doi.org/10.3171/2011.5.jns101983
  3. Acute Retrobulbar Optic Neuropathy as the Sole Manifestation of Subarachnoid Haemorrhage from a Ruptured Anterior Communicating Artery Aneurysm vol.37, pp.4, 2013, https://doi.org/10.3109/01658107.2013.809366
  4. Vision Outcomes and Major Complications after Endovascular Coil Embolization of Ophthalmic Segment Aneurysms vol.35, pp.11, 2014, https://doi.org/10.3174/ajnr.a4032
  5. A Large Ruptured Anterior Communicating Artery Aneurysm Presenting with Bitemporal Hemianopsia vol.58, pp.3, 2009, https://doi.org/10.3340/jkns.2015.58.3.291
  6. Aneurysmal Subarachnoid Hemorrhage vol.27, pp.3, 2009, https://doi.org/10.1097/ana.0000000000000130
  7. High resolution MRI in treatment decision of anterior communicating artery aneurysm accompanied by visual symptoms: Endovascular treatment or surgical clipping? A report of two cases and literature re vol.22, pp.3, 2009, https://doi.org/10.1177/1591019915623559
  8. The fate of cranial neuropathy after flow diversion for carotid aneurysms vol.124, pp.4, 2009, https://doi.org/10.3171/2015.4.jns142790
  9. Anterior Communicating Artery Aneurysm With Refractory Central Vomiting: A Case Report vol.3, pp.3, 2009, https://doi.org/10.5812/archneurosci.36577
  10. Evidence of Asymptomatic Visual Losses after Surgical Repair of Cerebral Aneurysm vol.8, pp.None, 2009, https://doi.org/10.3389/fneur.2017.00487
  11. An Unruptured Anterior Communicating Artery Aneurysm Presenting with Left Homonymous Hemianopsia: A Case Report vol.19, pp.2, 2009, https://doi.org/10.7461/jcen.2017.19.2.92
  12. Junctional Chiasmatic Syndrome Due to Large Anterior Communicating Artery Aneurysm vol.8, pp.3, 2009, https://doi.org/10.4103/jnrp.jnrp_512_16
  13. Optic neuropathy after anterior communicating artery aneurysm clipping: 3 cases and techniques to address a correctable pitfall vol.128, pp.6, 2018, https://doi.org/10.3171/2017.2.jns162654
  14. Optic neuropathy after anterior communicating artery aneurysm clipping: 3 cases and techniques to address a correctable pitfall vol.128, pp.6, 2018, https://doi.org/10.3171/2017.2.jns162654
  15. Isolated abducens nerve palsy associated with subarachnoid hemorrhage: a localizing sign of ruptured posterior inferior cerebellar artery aneurysms vol.128, pp.6, 2009, https://doi.org/10.3171/2017.2.jns162951
  16. Isolated abducens nerve palsy associated with subarachnoid hemorrhage: a localizing sign of ruptured posterior inferior cerebellar artery aneurysms vol.128, pp.6, 2009, https://doi.org/10.3171/2017.2.jns162951
  17. Prognostic Factors Influencing Outcome in Unruptured Anterior Communicating Artery Aneurysm after Microsurgical Clipping vol.14, pp.1, 2009, https://doi.org/10.4103/ajns.ajns_198_18
  18. Improved visual acuity after microsurgical clipping of a symptomatic anterior cerebral artery aneurysm: case report vol.33, pp.3, 2019, https://doi.org/10.1080/02688697.2017.1332337
  19. Microsurgical Clip Suspension to Prevent Optic Neuropathy Following Ligation of Anterior Communicating Artery Aneurysm: A Technical Report and Surgical Video vol.11, pp.12, 2019, https://doi.org/10.7759/cureus.6354
  20. Recovery of Visual Loss Following Internal Trapping of Anterior Cerebral Artery (A1 Segment) for Partially Thrombosed Large Anterior Communicating Artery Aneurysm: A Case Report vol.8, pp.1, 2009, https://doi.org/10.2176/nmccrj.cr.2021-0248