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Peripheral ophthalmic artery aneurysm

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Abstract

Generally speaking, the term “ophthalmic aneurysms” refers to carotid-ophthalmic aneurysms, which arise from the internal carotid artery (ICA) wall at or around the origin of the ophthalmic artery (OA). In contrast, aneurysms arising from the OA stem or its branches, separate from the ICA are called peripheral OA aneurysms (POAAs). POAAs are a rare entity, which clinical features and natural course are not fully understood. A comprehensive literature review of reported aneurysms involving each segment of the OA was undertaken. The demographics, aetiology, clinical manifestations and treatment of reported POAAs are discussed. Of 35 retrieved cases, ten involved the intracranial segment, two were fusiform aneurysms in the optic canal, 17 arose from the intraorbital segment, and 6 involved either the lacrimal or the anterior ethmoidal branches. In 34 cases, clinical details were available; 18 patients experienced moderate to severe visual impairment including blindness, while seven patients had improvement in visual acuity as a result of surgical treatment. The present clinical review reveals that aneurysms of the OA stem and lacrimal branch are potentially threatening to visual acuity, while intracranial segment and anterior ethmoidal aneurysms can rupture and cause subarachnoid or intraparenchymal haemorrhage. Surgical intervention is mandatory in symptomatic cases to prevent visual deterioration or treat aneurismal rupture; alternatively, for small incidental POAAs “watchful waiting” may be indicated.

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Acknowledgement

The authors thank the libraries of Nanjing University and Jinling Hospital for retrieving the literature.

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Authors and Affiliations

  1. Department of Neurosurgery, Jinling Hospital; Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People’s Republic of China

    Liang Qiao, Handong Wang, Lei Mao, Wei Xie & Qi Wu

  2. Department of Ophthalmology, Jinling Hospital; Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People’s Republic of China

    Suihua Chen

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  1. Liang Qiao
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  2. Handong Wang
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  3. Lei Mao
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  4. Suihua Chen
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Correspondence to Handong Wang.

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Comments

Lotfi Hacein-Bey, Sacramento, USA

In this issue of Neurosurgical Review, Qiao et al. present a comprehensive review of “peripheral ophthalmic artery aneurysms”, which are aneurysms of the ophthalmic artery proper. For a number of anatomical sites like the posterior communicating artery, the anterior-inferior cerebellar artery or the posterior-inferior cerebellar artery, the semantics conventionally used may cause some confusion as to the exact origin of the aneurysm. For instance, “carotid-ophthalmic” aneurysms, which are relatively common, arise from the internal carotid artery at or around the origin of the ophthalmic artery. Indeed, for all these arterial sites, aneurysms which arise past the ostium and spare the parent major artery, therefore called aneurysms proper, are very uncommon.

In this review of peripheral ophthalmic artery aneurysms (POAAs), Qiao et al. identify four distinct segments of the ophthalmic artery, the intracranial, intracanalicular, intraorbital and terminal segments. For each of these segments, the authors provide a comprehensive review of the reported literature, including the various clinical manifestations, a reasonable discussion of the pathophysiology, and the diagnostic workup.

The treatment of these lesions is also discussed in detail in this review. Surgical interruption of the ophthalmic artery at its origin is a very reasonable option for proximal lesions since an abundant anastomotic arterial network exists between the ophthalmic artery and external carotid artery branches. Carotid sacrifice should no longer be considered lightly, in the face of the risks of acute or delayed ischemia, distal embolization, or optic nerve injury. Although new endovascular techniques may allow obliterating the ophthalmic artery with relative ease, one must remain cautious with the choice of embolic agent used, if visual function is to be spared.

Overall, the authors present an interesting and relatively comprehensive review of this rare group of aneurysms.

Ryan Hebert, Ketan R. Bulsara, New Haven, Connecticut, USA

The authors present an interesting and rare cause of vision loss and SAH. Qiao et al. have compiled cases of POAA from intracranial, intracanalicular and intraorbital locations. In compiling these case reports, the authors have given us insight into the potential natural history, presentation and aetiology of POAA. Qiao et al. reiterate the importance of conventional digital subtraction angiography and three-dimensional rotation angiography in the diagnosis of rare causes of SAH. The rarity of these lesions makes it difficult to compile a large patient series, but the authors have done a good job of compiling reported cases and by doing so providing insights into these rare vascular lesions.

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Qiao, L., Wang, H., Mao, L. et al. Peripheral ophthalmic artery aneurysm. Neurosurg Rev 34, 29–38 (2011). https://doi.org/10.1007/s10143-010-0290-5

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