Recovery of Visual Field after Complete Occlusion of Wide Neck Anterior Communicating Artery Aneurysm with Balloon Assisted Coiling: Case Report

Background: Intracranial aneurysms are characterised by focal dilatations of the cerebral vascular wall and can develop as a result of a complex interaction of several inherited and environmental variables. Symptoms such as headache, third cranial nerve palsy (posterior communicating artery aneurysm), hemianopia (anterior communicating artery aneurysm), and seizures can manifest in different ways depending on the aneurysm's location, size, and rupture risk.
Aim: This study aimed to assess the recovery of visual field after complete occlusion of wide neck anterior communicating artery aneurysm with balloon assisted coiling.
Case report: A 59-years-old female presented with bilateral temporal hemianopia, characterized by the loss of vision in the outer halves of both visual fields. This visual impairment prompted an extensive diagnostic workup, which revealed a wide-neck anterior communicating artery aneurysm. Given the complexity and morphology of the aneurysm, an endovascular approach utilizing balloon-assisted coiling was selected as the preferred intervention. The procedure was performed under general anesthesia with full systemic heparinization to mitigate thromboembolic risks. The balloon-assisted coiling technique provided optimal support for coil placement, ensuring complete occlusion of the aneurysm, classified as Raymond class I. Post-procedure imaging confirmed successful aneurysm exclusion without evidence of residual filling or complications.
Conclusion: This case illustrates the successful management of a wide-neck anterior communicating artery aneurysm using balloon-assisted coiling.  The complete occlusion achieved, classified as Raymond class 1, emphasizes the efficacy of this technique in treating challenging aneurysms.