Optical chiasmatic compression after endovascular treatment of carotid-ophthalmic aneurysm

Carotid ophthalmic aneurysms present with visual failures, such as visual loss or diplopia. Surgical treatment of these aneurysms is burdened by high morbidity. In the last few years endovascular treatment has offered a valid alternative for the treatment of ruptured and unruptured aneurysms in this site. Although the endovascular approach is a valid option for the treatment of cerebral aneurysms, in few cases this approach cannot solve symptoms related to the mass effect. This is mostly true for carotid-ophthalmic aneurysms, that are often responsible for visual disturbances. We reviewed 4 cases of very large cerebral aneurysms associated with visual loss, treated by endovascular approach. Visual improvement and final complete visual recovery were obtained in all cases but one, in which patient needed also surgical treatment. The goal of treatment is not only excluding the aneurysm but also decreasing the mass effect on the surrounding structures. Surgical decompression may be indicated for patients with progressive visual impairment. Coiling might fail to alleviate symptoms related to mass effect in case of very large carotid-ophthalmic aneurysms. Surgical decompression of the optic nerve can be a good option for patients presenting with progressive visual deterioration.