Diagnosis and treatment of traumatic optic neuropathy with carotid artery cavernous segment pseudoaneurysm.

OBJECTIVES/HYPOTHESIS To summarize our experience in diagnosis of carotid cavernous segment pseudoaneurysm in patients with traumatic optic neuropathy, and to make recommendations for treatment. STUDY DESIGN Retrospective study. METHODS Clinical data of 133 cases with traumatic optic neuropathy (TON) were reviewed. The diagnosis and treatment of four cases with carotid cavernous segment pseudoaneurysm (PSA) were analyzed. RESULTS The incidence of traumatic optic neuropathy with pseudoaneurysm for this group of patients was 3.01% (4/133). Preliminary screening was performed with vascular-enhanced computed tomography (CT) scan, and was further confirmed by digital subtraction angiography (DSA). Among the four cases with pseudoaneurysm, three cases were successfully treated with vascular embolization. In one of the three cases, coil embolization was employed; and in the other two cases stent embolization was performed. The pseudoaneurysm disappeared after embolization, and nosebleeds subsided without significant complications. All four patients did not undergo nasal endoscopic optic nerve decompression. There was no recurrence of nose bleeding after embolization in the following 1 to 12 months, and in one case the patient's vision improved from no light perception to perceiving hand movement. CONCLUSIONS There is a possibility of fatal epistaxis for traumatic optic neuropathy with carotid artery cavernous segment pseudoaneurysm. Endoscopic optic nerve decompression treatment (EOND) is not suitable for these cases; instead, it is recommended that patients with traumatic optic neuropathy go through vascular-enhanced computed tomography screening. Suspected cases should be diagnosed by digital subtraction angiography and be treated by embolization in a timely manner, with stent vascular interventional embolization being the ideal choice.