Challenges in a case of ophthalmic artery aneurysm associate
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Aneurysms account for 0.2-7.9% of all cerebrovascular lesions, with 5% of them being ophthalmic artery aneurysms. These are usually discovered when they are large enough to become symptomatic, with diplopia and headache. Ophthalmic artery aneurysms pose particular challenges to both neurosurgeon and interventional radiologist. Modern embolization techniques proved safe and effective, raising the survival and the quality of life for ophthalmic artery aneurysms patients; thus, it has become the standard of care. We present the case of a 62-year-old woman admitted for transient loss of consciousness, followed by generalized tonic-clonic seizures. Computed tomography (CT) showed a subarachnoid hemorrhage (SAH), clinically graded as Hunt and Hess III. Magnetic resonance imaging (angioMR) and the four-vessel digital subtraction angiography (DSA) identified a ruptured, 8 mm left ophthalmic artery aneurysm. Embolization was the first therapeutic choice. Nevertheless, the attempt had to be aborted due to a combination of a hypoplastic right internal carotid artery (ICA) and an irregular atheromatous plaque on the left ICA, rendering the procedure unduly hazardous. Therefore, microsurgical clipping of an aneurysm became the procedure of choice. Postoperatively, the patient was in good condition, with no visual and neurological deficits.

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