ArticleJournal of neurosurgery. Case lessons2026
Late-stage microsurgical intrasaccular thrombectomy for visual decline after flow diversion of a large ophthalmic internal carotid artery aneurysm: a hybrid management strategy. Illustrative case.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLarge internal carotid artery (ICA) ophthalmic segment aneurysms are increasingly being managed endovascularly. However, symptomatic mass effect may persist or worsen despite angiographic occlusion. OBSERVATIONS: A 43-year-old woman presented with a progressive right visual field defect and sensitivity loss. MRI and digital subtraction angiography revealed a large, unruptured, right ICA ophthalmic segment aneurysm. Endovascular management with a flow diversion device was performed, resulting in complete angiographic occlusion at 6 months. Despite angiographic success, her visual symptoms progressed to involve the postchiasmatic optic tract-a left visual field defect developed alongside the further progressing right visual field defect and acuity loss. Microsurgical thrombectomy via a right pterional craniotomy assisted with temporary endovascular balloon occlusion of the right ICA was performed 8 months after the flow diversion procedure. The patient's visual symptoms slowly improved postoperatively, and her visual fields had recovered nearly completely at 17 months after the surgery. LESSONS: Delayed microsurgical thrombectomy can yield near-total visual recovery even after initial endovascular treatment. A hybrid approach combining flow diversion for aneurysm occlusion followed by targeted surgical decompression may be considered in select cases with persistent mass effect-related symptoms. https://thejns.org/doi/10.3171/CASE25847.
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