Cortical blindness, transient and otherwise, associated with detachable coil embolization of intracranial aneurysms
Cortical blindness, transient and otherwise, associated with detachable coil embolization of intracranial aneurysms
复制标题
DOI：
10.3174/ajnr.a0858
复制
发表时间：
2008-03-01
影响因子：
3.5
通讯作者：
Berenstein, A.
中科院分区：
文献类型：
--
作者：
Niimi, Y.;Kupersmith, M. J.;Berenstein, A.
背景与目的：皮质性视力丧失是一种罕见的脑血管造影并发症，没有明确的病理生理学。鉴于用于治疗脑动脉瘤的血管内手术的快速增加，我们探索了这种并发症的患病率，以及我们是否可以增加对这种疾病的理解。材料和方法：我们对1996年至2006年I血管内外科使用相同造影剂和可拆卸线圈治疗后循环动脉瘤的所有手术进行了回顾性分析。所有患者在每次手术前后都由包括神经眼科医生在内的团队进行评估。结果：在137例动脉内治疗后循环动脉瘤的手术中，我们发现了4例脑视力丧失并发症。在同一时期，治疗了500个脑前循环动脉瘤，没有出现这种并发症。2例单侧视野丧失，2例双侧视野丧失。3例完全恢复，4例基本正常。造影剂的用量和手术时间在所有患者中是相似的。这4例患者没有确定发生手术相关枕部功能障碍的特定危险因素，所有4例患者都进行了血管造影，1例患者进行了重复卷曲，无并发症。结论：血管内线圈治疗后循环动脉瘤的脑视力下降率为2.9%，高于单纯血管造影术。我们的患者在皮质类固醇和静脉水化治疗后恢复良好。认识到这个问题的自限性可能会防止不必要的干预。
BACKGROUND AND PURPOSE: Cortical visual loss is a rare complication of cerebral angiography without a definitive pathophysiology. Given the rapid increase in endovascular procedures used to treat cerebral aneurysms, we explored the prevalence of this complication and whether we could add to the understanding of this disorder.MATERIALS AND METHODS: We performed a retrospective review of all procedures performed with the same contrast agent and detachable coils for treatment of posterior circulation aneurysms by I endovascular surgery service from 1996 to 2006. All patients were evaluated before and after each procedure by a team that included a neuro-ophthalmologist.RESULTS: Of 137 intra-arterial treatment procedures performed for posterior circulation aneurysms, we identified 4 patients with cerebral vision loss complications. During the same time period, > 500 aneurysms of the anterior cerebral circulation were treated without this complication. The visual field loss was unilateral in 2 and bilateral in 2 patients. Recovery was complete in 3 and almost normal in the fourth patient. The amount of contrast used and the duration of the procedure were similar among all patients. The 4 patients had no identified specific risk factors for developing procedure-associated occipital dysfunction, all 4 had undergone prior angiography, and 1 patient had undergone repeat coiling, without complication.CONCLUSION: The 2.9% prevalence of cerebral visual loss with endovascular coil treatment of posterior circulation aneurysms is higher than that for angiography alone. Our patients recovered well with corticosteroid and intravenous hydration treatment. Recognizing the self-limiting nature of this problem might prevent an unneeded intervention.