To explore the microsurgical techniques and methods of the treatment of ophthalmic segment artery aneurysms (OSAs).

The treatment methods and results of 23 cases of OSAs, admitted to Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital from June 2010 to June 2020, were retrospectively analyzed. There were 10 cases of headache, 7 cases of decreased vision and visual field defect, 1 case of menstrual disorder, and 5 cases of asymptomatic. A total of 32 aneurysms were detected in 23 patients, 11 of them were multiple aneurysms, including 6 bilateral aneurysms (4 bilateral OSAs), and 5 ruptured aneurysms. OSAs were 4-30 mm in diameter, with an average of (8.2±2.3) mm. There were 2 cases of giant aneurysms. Epidural approach or intradural approach were applied for the anterior clinoidectomy. The neck incision revealed the internal carotid artery to assist with intraoperative occlusion. Intracranial and extracranial bypass techniques were used in condition of unable clipping.

In 23 cases of OSAs, 17 cases with cervical carotid artery temporarily blocked, 13 cases used the epidural approach and 8 cases used the subdural approach (with 5 cases of ruptured aneurysms), giant OSAs in 2 cases accepted intracranial and extracranial bypass, 1 aneurysm was trapping and another was treated with carotid artery ligation. Twenty-one cases recovered well, symptoms of 9 cases of headache were eliminated, 6 cases of vision decreased and visual field defect improved, and 1 case of menstrual disorder improved after surgery. Follow-up was 2-63 months, 2 cases (8.7%) recurred, 3 cases were complicated with hydrocephalus. Three months after surgery, the GOS 5 scores were achieved in 20 cases, 4 scores in 2 cases, 3 scores in 1 case and no deaths.

Experienced micro-neurosurgical technique is the key to the treatment of ophthalmic segment artery aneurysms. The microsurgical clipping of OSAs is safe and effective.