Aneurysms of the Ophthalmic (C6) Segment of the Internal Carotid Artery: Clinical Experience, Treatment Options, and Strategies (Part 2)

Abstract

Treatment of ophthalmic (C6) segment aneurysms continues to be challenging and technically demanding for neurosurgeons, resulting in high rates of morbidity and mortality. In part 2, we provide a contemporary review of recent clinical series and assess the advantages and limitations of surgical and endovascular treatments relative to published series as well as our own. In part 1, we detailed the key embryologic, anatomical, and radiologic points that now provide the foundation for our critical discussion of such management strategies. We report the results of our 78 patients with 88 C6 segment aneurysms, including 43 with unruptured aneurysms and 35 with subarachnoid hemorrhage (SAH), 9 of which were giant and 25 of which were large. Management strategies included surgical clipping alone in 53 patients, clipping and hemicraniectomy in 2, coiling in 17, extracranial-to-intracranial bypass in 2, and coil occlusion of the internal carotid artery in 2. Of 2 patients who underwent no treatment, 1 had a myocardial infarction after diagnostic angiography and 1 declined treatment. Overall mortality was 6.4% (5 patients with SAH). At discharge, Glasgow Outcome Scale (GOS) scores were good (GOS score of 1 or 2) in 63 (80.8%) patients and poor (GOS score of 3 or 4) in 10 (12.8%) patients. In this review, we describe how the synergistic use of surgical and endovascular procedures seems to offer the best approach to these aneurysms to minimize morbidity associated with treatment and to achieve outstanding outcomes, highlighting the treatment strategies used by the senior surgeon.