Flow-Diversion for Ophthalmic Segment Aneurysms BACKGROUND: The use of flow-diversion to treat ophthalmic segment aneurysms (OSA) has not been well evaluated. OBJECTIVE: To assess the visual outcomes, the obliteration rate, and the need for retreatment of OSA treated by the pipeline embolization device (PED). METHODS: Patients who underwent treatment with PED for OSA from 2009 to 2014 were selected and retrospectively reviewed. Patient’s age, sex, mode of presentation, and aneu- rysm size were recorded. The complication rates, the need for retreatment (due to recurrence of the aneurysm or worsening symptoms), the aneurysm occlusion rates, the evolution of visual symptoms, and the evolution of headache/retro-orbital pain were registered. RESULTS: Forty-one patients harboring 44 OSA treated by flow-diversion were iden- tified. Females constituted 87.80% (37/41) of the cohort. The mean age was 59.16 6 12.54 years. At final angiographic follow-up, 77.27% (34/44) had complete occlusion, 6.81% (3/44) had near-complete occlusion, and 15.90% (7/44) had incomplete occlusion. Of the 22 symptomatic OSA, complete resolution or significant improvement was noted in 72.72% (16/22), while worsening of symptoms occurred in 4.54% (1/22). Five patients out of 22 (22.72%; 5/22) had no significant changes in their symptoms. The complication rate was 2.27% (1/44). The mortality rate was 0%. CONCLUSION: The low complication rate, the high obliteration rate, and the high rate of improvement in the visual symptoms make flow-diversion an appealing option for the treatment of OSA. KEY WORDS: Endovascular, Mass effect, Ophthalmic segment aneurysms, PED, Pipeline, Visual symptoms Neurosurgery 76:286–290, 2015 DOI: 10.1227/NEU.0000000000000607 www.neurosurgery-online.com O phthalmic segment aneurysms (OSA) are treated to prevent future rupture and to improve visual field function and acuity. Recently, high rates of aneurysm occlusion and low rates of recurrence have been reported for various intracranial aneurysms treated with the pipeline embolization device (PED). 1-9 However, data on the evolution of symptoms for OSA treated using the PED is lacking. In our study, we evaluate the occlusion, complication, and retreatment rates as well as the evolution of symptoms after PED placement for OSA. METHODS Study Design The Thomas Jefferson University Institutional Review Board approved the study. The data were collected from prospectively maintained databases of patients treated with flow-diversion. Patients who underwent treatment with PED for OSA from 2009 to 2014 were selected and retrospectively reviewed. Medical charts, angiographic studies, magnetic resonance imaging, and computed tomographic scans were carefully evaluated. Patient’ s age, sex, mode of presentation, and aneurysm size were recorded. Treatment was dictated by the dual-trained attending neurosurgeons. Thromboembolic and ische- mic complications were diagnosed clinically or on computed tomographic scans or by magnetic resonance imaging. Procedure Description Patients undergoing PED therapy for unruptured OSA received 75 mg/d of clopidogrel and 81 mg/d of aspirin for 10 days prior to the intervention. Platelet function tests were routinely performed using aspirin assay and P2Y12 assay (VerifyNow; Accumetrics, San Diego, California) to obtain a level of platelet inhibi- tion of 30% to 90%. Patients with ruptured aneurysms were loaded 8 hours prior to surgery with 600 mg of clopidogrel and 650 mg of aspirin. An initial 100-U/kg of heparin bolus was administered, and activated clotting time was maintained at 2 times the patient’s Mario Zanaty, MD* Nohra Chalouhi, MD* Guilherme Barros, BS* Eric Winthrop Schwartz, BS* Mark Philip Saigh, BA* Robert M. Starke, MD‡ Alex Whiting, MD* Stavropoula I. Tjoumakaris, MD* David Hasan, MD§ Robert H. Rosenwasser, MD* Pascal Jabbour, MD* *Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; ‡Department of Neurosurgery, University of Virginia, Charlottesville, Virginia; §Depart- ment of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa Correspondence: Pascal M. Jabbour, MD, Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut St, 3rd Floor, Philadelphia, PA 19107. E-mail: pascal.jabbour@jefferson.edu Received, June 30, 2014. Accepted, October 23, 2014. Published Online, January 12, 2015. Copyright © 2015 by the Congress of Neurological Surgeons. ABBREVIATIONS: OSA, ophthalmic segment aneurysms; PED, pipeline embolization device RESEARCH—HUMAN—CLINICAL STUDIES RESEARCH—HUMAN—CLINICAL STUDIES 286 | VOLUME 76 | NUMBER 3 | MARCH 2015 www.neurosurgery-online.com Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited