BRIEF REPORT OF SPECIAL CASE Bilateral intra-orbital ophthalmic artery aneurysms Giovanni Sabatino & Alessio Albanese & Licia Di Muro & Enrico Marchese Received: 26 May 2008 / Accepted: 14 October 2008 / Published online: 5 May 2009 # Springer-Verlag 2009 Abstract Clinical details A 52-year-old man presented with neck pain, nausea and vomiting (Hunt-Hess grade 1). CT scan showed subarachnoid hemorrhage. Cerebral angiography showed multiple arterial aneurysms (right communicating posterior, right anterior choroid, left pericallosal, intraorbital ophthalmic bilaterally). All aneurysms but intraorbital ophthalmic ones were treated with endovascular embolisations. As the intra- orbital aneurysms were asymptomatic no treatment was performed. The patient was dismissed without any neurolog- ical deficits. Discussion Intraorbital ophthalmic aneurysms are very un- common, with extremely rare rupture. No treatment is indicated when the aneurysm is unruptured and asymptomatic. Surgical treatment is advised only after rupture or symptomatic mass effect. Keywords Intra-orbital . Ophthalmic artery aneurysm . Embolisation . Multiple aneurysms Clinical details A 52 year old man presented with acute neck pain, nausea and vomiting. He was disoriented and confused (Hunt-Hess grade 1). The CT brain scan demonstrated subarachnoid haemorrhage. Cerebral angiography revealed multiple aneurysms (right posterior communicating artery, right anterior choroidal artery, left pericallosal artery, right superior cerebellar artery and both intra-orbital ophthalmic arteries. Complete endovascular embolisation of the right posterior communicating right anterior choroidal, left pericallosal and right superior cerebellar aneurysms were performed. CT angiography confirmed their complete exclusion and also defined the anatomical sites of the bilateral intra-orbital ophthalmic artery aneurysms. (Fig. 1). Since the intra-orbital aneurysms were asymptomatic no treatment was performed. The patient was discharged without any neurological deficits. Intra-orbital ophthalmic aneurysms are very rare [1–4]. To the best of our knowledge, this is the first example reported in the literature. These aneurysms have a benign natural history and their rupture seems to be extremely rare. No treatment is indicated when the aneurysm is unruptured and asymptomatic. Nevertheless, considering the high risk of ocular ischaemia, surgical treatment is advised only after rupture or symptomatic mass effect. [1] References 1. Dehdashti AR, Safran AB, Martin JB, Rufenacht DA, de Tribolet N (2002) Intra-orbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm. Neuroradiology 44:600–603. doi:10.1007/s00234-002-0786-y 2. Kikuchi K, Kowada M (1994) Case report: saccular aneurysm of the intra-orbital ophthalmic artery. Br J Radiol 67:1134–1135 3. Kleinschmidt A, Sullivan TJ, Mitchell K (2004) Intra-orbital ophthalmic artery aneurysms. Clin Experiment Ophthalmol 32:112–114. doi:10.1046/j.1442-9071.2004.00773.x 4. Rengachary SS, Kishore PR (1978) Intra-orbital ophthalmic aneurysms and arterio-venous fistulae. Surg Neurol 9:35–41 Acta Neurochir (2009) 151:831–832 DOI 10.1007/s00701-009-0352-z G. Sabatino (*) : A. Albanese : L. Di Muro : E. Marchese Institute of Neurosurgery, Catholic University, 00168 Rome, Italy e-mail: giosaba@inwind.it