Die Aneurysmen der A. ophthalmica

Zusammenfassung

Eigentliche Aneurysmen der A. ophthalmica sind äußerst selten und erzeugen durch Blutung und Kompression massive Leitungsstörungen des N. opticus. Häufiger sind die sog. Carotis-ophthalmica-Aneurysmen, welche an der medialen oder supramedialen Wand der Carotis interna distal vom Abgang der A. ophthalmica sich entwickeln und den Sehnerven, das Chiasma oder sogar den Tractus opticus in Mitleidenschaft ziehen können. Darstellung der Symptomatologie und der modernen mikrochirurgischen Therapie anhand von 33 Fällen mit insgesamt 40 Aneurysmen.

Summary

True saccular aneurysms of the ophthalmic artery, either intraorbital or intracranial, are extremely rare. They manifest themselves by a unilateral progressive decrease in vision, visual field defects and occasionally unilateral papilledema or optic atrophy. They seldom rupture, producing acute hemorrhage with proptosis and sudden blindness. Carotid-ophthalmic aneurysms, originating from the superior or superomedial surface of the internal carotid artery at or near the origin of the ophthalmic artery, often show initial subarachnoid hemorrhage. This paper describes 33 patients with 40 aneurysms. Multiple additional aneurysms in other locations are a striking feature. Even though carotid-ophthalmic aneurysms affect the optic nerve and the chiasm in particular, only one-fifth of the cases presented preoperatively with visual signs and symptoms: unilateral loss of vision, unilateral optic atrophy. One case with initial bitemporal hemianopia was erroneously diagnosed before surgery as pituitary adenoma and treated with radiotherapy. One patient suffered from acute bleeding into one optic nerve with subsequent blindness and temporal hemianopia on the contralateral side. Four-vessel angiography is mandatory for diagnosis and surgical management. The direct surgical approach via frontotemporal-sphenoidal craniotomy, using microsurgical techniques, is the modern method of choice for treatment of carotid-ophthalmic aneurysms and in experienced hands has a very low rate of morbidity and mortality. Surgical decompression of the optic nerve and chiasm by direct clipping and dissection of the aneurysm resulted in a considerable improvement in visual acuity on the side of the lesion, though less frequently in a change in visual field defects.