Posted By CCF NSG MD /gsh on October 14, 1998 at 21:57:12:
In Reply to: Aneurysm clipping follow-up and several questions posted by Cathy A. Alger on October 04, 1998 at 12:00:57:
I posted a question several weeks ago concerning clipping of a left ICA ophthalmic aneurysm. The surgery took place 4 years ago, and at first was thought to be quite successful. About a month after the surgery, I started to have severe headaches, visual disturbances and progressive loss of vision in the left eye. After 4 months, another angiogram was performed which showed that scar tissue had built up under the aneurysm clips that subsequently pushed the clips up and into the left optic nerve, thus causing the vision problems. A second emergency surgery was performed to remove the old clips, remove the scar tissue, and then new clips were placed. Over the past four years, I have had progressive worsening of the vision in the left eye to the point of there being no "useable" vision remaining. Another angiogram performed a year ago showed a residual 9 mm. aneurysm from the previous site with it being oriented slightly more cephalad than in prior studies. Also noted were: aysmmetric filling of the cavernous sinuses, right greater than left; a fetal origin of left posterior cerebral artery; and a low origin of posterior inferior cerebellar arteries bilaterally at level of C1. At this point, no one seems to know if this residual aneurysm will get any larger, if scarring will continue to force the clips into areas that will cause me more blindness or more symptoms of eye disturbances, head pain, weakness, balance problems, etc. (all of which I am experiencing). There seems to be very little follow-up to my case, other than what I initiate myself. I do not know what types of tests I should be having done on a follow-up basis, what for, and how often. Also, I have a doctor that adamantly refuses to perform any MRI testing, because of the clipping (they are titanium clips). The attitude seems to be "let's wait and see what happens", and this leaves me feeling very uncomfortable and uneasy. Can I fly safely? Would the changes in air pressure cause any problems with the clips? Any advice that you may be able to give me, or if you could possibly point me in the right direction, would be most appreciated and would definitely help ease my mind. Thank you. Cathy
You are understandably frustrated with your situation. Occasionally an aneurysm clip will migrate after surgery causing compression on local structures. It may, as in your case, require repeat surgery to place the clip properly again. Often there will be scarring around the area that will prevent migration of the clip in time. You also stated that you have a residual aneurysm in the area. This is indeed at risk to bleed and, over the course of a lifetime, may be significant. A commonly quoted incidence of aneurysmal rupture is 1-2% per year.
There should be no problem with an MRI if your aneurysm clip was made of titanium. This was the whole impetus behind creating the clips in that they would be compatible with MRI.
Speak to your surgeon again about the following issues. First, you have a residual aneurysm that is at risk to bleed. Second, the clip may be causing progressive deficits, especially in your vision. Either of these are significant causes of concern and may be reason enough to warrant intervention. If the clip is adequately placed your surgeon may consider endovascular coiling of the aneurysm as opposed to a third surgery. In any event, talk to him about it.
As always, if you are not happy with your surgeon, then seek a second opinion.
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