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Aneurysmal compression of the anterior visual pathways

Departments of Neurology (Drs. Norwood and Kline), Ophthalmology (Dr. Kline), Radiology (Dr. Chandra-Sekar), and Neurosurgery (Dr. Harsh), University of Alabama School of Medicine, Birmingham, AL.

Ten patients with aneurysmal compression of the anterior visual pathways had visual loss, unilateral in 4 and bilateral in 6. There was no typical clinical presentation. Visual loss was acute or gradual, acuity sometimes fluctuated, and visual field testing was highly variable. The aneurysms were supraclinoid (four patients), carotid-ophthalmic (two), anterior communicating-anterior cerebral (three), and intracavernous carotid (one). Nine patients had successful clipping of their aneurysm, and in one, ipsilateral common carotid ligation was performed. Postoperatively, visual acuity was improved in six cases, unchanged in three, and worse in one.

Address correspondence and reprint requests to Dr. Kline, Suite 555, 1600 7th Avenue South, Birmingham, AL 35233.

Accepted for publication December 18, 1985.