Visual improvement following the treatment of internal carotid complex aneurysms through internal carotid ligation combined with STA-MCA bypass.

Objective: The combination of internal carotid artery (ICA) ligation with superficial temporal artery (STA) to middle cerebral artery (MCA) bypass has proven effective in the treatment of internal complex carotid aneurysms (ICCAs). Indirect exclusion through thrombosis is anticipated to alleviate the mass effect on adjacent neurovascular structures. However, visual impairment may occur secondary to thrombosis of the ICA and ophthalmic artery. The purpose of this study is to emphasise the paradoxical stabilisation and improvement of vision observed in certain cases. Methods: A retrospective study was conducted from 2016 to 2020, analysing data from a cohort of patients with ICCAs, among whom nine patients underwent ICA ligation in combination with STA-MCA anastomosis. Preoperative and postoperative visual findings were analysed and compared. Results: All patients underwent STA-MCA bypass in addition to complete ICA ligation. Postoperative clinical outcomes remained unchanged in 8 out of 9 patients. Complete aneurysm exclusion through thrombosis was achieved at 12 months. The STA-MCA anastomosis remained patent in 6 out of 9 patients, with no clinical deterioration observed, except in one case. Notably, irrespective of graft patency, this patient experienced a minor parietal stroke, from which full recovery was achieved after six months. Furthermore, an improvement in visual acuity was observed in two patients at three months. Conclusion: The ICCA treatment, which involves ICA ligation combined with STA-MCA bypass, alleviates the mass effect on adjacent neurovascular structures. Despite the occurrence of ICA thrombosis, an enhancement in visual acuity has been documented, which can be attributed to the patency of the ophthalmic artery via the meningeal anastomotic circuits.