Literature Review

Pipeline Embolization Device for small paraophthalmic artery aneurysms with an emphasis on the anatomical relationship of ophthalmic artery origin and aneurysm

Selected in Journal of Neurosurgery by NEKI Hiroaki

Authors: Griessenauer CJ, Ogilvy CS, Foreman PM, Chua MH, Harrigan MR, Stapleton CJ, Patel AB, He L, Fusco MR, Mocco J, Winkler PA, Patel AS, Thomas AJ

Reference: J Neurosurg. 2016 Dec;125(6):1352-1359

Published: December 2016

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Thursday 13 April 2017
Summary
  • This article reviews data on the use of PED (Pipeline Embolization Device) for small (≦7mm) paraophthalmic artery aneurysms.
  • Ophthalmic artery (OA) origin was classified as three types: Type 1, OA separate from the aneurysm (72.5%); Type 2, OA from the aneurysm neck (17.4%); and Type 3, OA from the aneurysm dome (10.1%).
  • Radiographic outcome was good as complete and near occlusion rate was 87.1% in median 11.5 months follow-up. But, complete occlusion rate was lower in type 3.
  • Transient visual deficit occurred in two cases (3%), and no patient experienced a permanent visual deficit. However, type 3 was associated with visual deficits and a lower rate of OA patency.
  • PED is safe and effective for small paraophthalmic artery aneurysms. But an aneurysm where the OA arises from the aneurysm should be carefully treated.
Comment

PED was reported as safe and efficient for small aneurysms (JNS. 122(6): 1498-1502, 2014). Some authors reported about OA covered with FDS including PED. OA covered with FDS had potential visual deficits. In this paper, the authors classified OA origin in three types. Types 2 and 3 had the majority of OA origins. OA in type 3 was minor, but we should consider surgical indication and procedures for aneurysms with OA in type 3. 

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