Management of Opthalmic Aneurysm

Background: Aim of the study was to evaluate outcomes of the extraintradural approach, to analyze complications and to assess the role of endovascular techniques and microsurgery from our experience and literature. Methods: Between 1999 and 2010 we treated 601 aneurysms, there were 58 (9.64%) caroticopthalmic aneurysms. We used surgical clipping in 37 cases and in 21 cases we performed coiling. The mean age was 51.4 years in the surgical group and 51.5 years in the endovascular group. The range of size of surgically treated aneurysms has been 2 to 25 mm, and only 2 to 15 mm for the endovascular group. Results: Morbidity mortality of the series was 12.9% for surgically managed patients and 14.2% for endovasculary treated patients (not significantly different). No patient had a new visual deficit in both treatment lines. Conclusion: Direct clipping of the aneurysm utilizing advanced surgical techniques is our preferred treatment approach. We achieved complete occlusion and long-term exclusion of the aneurysms from circulation with acceptable morbidity mortality rate of 12.9%. Another advantage of surgical methods is immediate decompression of optic nerve and visual pathway. Careful and anchoraged surgical indication is necessary for elderly and medical risk patients. We prefer endovascular techniques only for high medical risk patients with small aneurysms and narrow neck. We find coiling unsatisfactory for large aneurysms with wide necks.