Flow diverter reconstruction for traumatic ophthalmic artery aneurysm with visual improvement: Case report and literature review

Background Traumatic intracranial aneurysms are rare, and those arising from the ophthalmic artery are exceedingly uncommon. Management remains challenging because of vessel fragility and proximity to critical structures. Although flow diverters are established for unruptured internal carotid aneurysms, their role in traumatic ophthalmic artery aneurysms remains undefined. Methods A literature review was performed according to PRISMA guidelines, searching PubMed, Scopus, and Web of Science for traumatic ophthalmic artery aneurysms. Only lesions originating from the ophthalmic artery itself were included; para-ophthalmic internal carotid artery aneurysms with neck arising from the internal carotid artery wall were explicitly excluded. Clinical presentation, imaging findings, treatments, and outcomes were summarized. Additionally, we report an illustrative case successfully treated with a flow diverter. Results Fourteen reports describing 15 patients were included. Most were treated with surgical clipping or endovascular coiling, and none involved flow diverter use. Ophthalmic artery sacrifice was required in 9 of 12 treated patients (75%). Among all 15 reported cases, visual recovery occurred in only one case (6.7%). In our illustrative case, a 41-year-old man with post-traumatic visual decline was treated with a flow diverter covering the ophthalmic artery origin, achieving complete occlusion at 6 months and marked visual improvement by 1 year. Conclusions In selected patients, flow diversion may be a feasible reconstructive option for traumatic ophthalmic artery aneurysms when parent artery sacrifice is undesirable. However, this conclusion is based on a single illustrative case in this rare pathology, and further case accumulation is needed to better define the safety, durability, and indications of this approach.