Microneurosurgical Management of Ophthalmic Segment of the Internal Carotid Artery Aneurysms: Single-Surgeon Operative Experience From Louisiana State University, Shreveport

BACKGROUND: Surgical clipping of ophthalmic segment aneurysms is more technically challenging than other anterior circulation aneurysms. OBJECTIVE: To analyze whether surgical clipping is an effective treatment for ophthalmic segment aneurysms with good clinical outcomes and acceptable complication rates. METHODS: From 1994 to 2009, a total of 86 aneurysms of the ophthalmic segment of the internal carotid artery were surgically clipped in 80 patients. We retrospectively reviewed the records of these patients to analyze the clinical outcome. RESULTS: Of the 86 aneurysms, 68 (79%) were large or giant. Cranial base modification was required in 28 operations. Drilling of the anterior clinoid process was performed in 49 operations. The mean follow-up was 27.38 months. Of the 80 patients, 76 were assessable for clinical outcome. At the last follow-up, 5 patients had a Glasgow Outcome Scale (GOS) score of 1, 4 had a GOS score of 3, 10 had a GOS score of 4, and 57 had a GOS score of 5. Thus, the clinical outcome was good (GOS scores of 5 and 4) in the majority (88%) of patients. Of the 15 patients who presented with visual problems before surgery, 77% showed improvement after surgical clipping. The overall visual morbidity rate was 2.5%. Outcome assessment indicated that infarcts (P = .000), hydrocephalus (P = .001), and poor grade (P = .000) were significant negative predictors of outcome. CONCLUSION: Surgical clipping is an effective treatment for ophthalmic segment of the internal carotid artery aneurysms with excellent or good clinical outcome. Infarcts, hydrocephalus, and poor grade were significant negative predictors of outcome. Surgical clipping may facilitate improvement in vision by decompression of the visual apparatus.