Management of carotid-ophthalmic aneurysms

The authors present 26 cases of carotid-ophthalmic aneurysms that were surgically treated. Contrary to the opinion that these aneurysms, which often are of giant size, must be treated conservatively or by common carotid ligation, the authors favor radical surgery, believing that carotid ligation does not provide assurance against the risk of rebleeding, and frequently is associated with failure to restore useful vision. Often these aneurysms have a neck more suitable for ligation than shown by angiography, since a giant aneurysm may overlap the carotid artery in the angiogram. Preoperative criteria and some details of radical treatment are discussed.