Late complications of visual impairment and hydrocephalus after flow diverter-assisted coil embolisation for intracranial large aneurysm: a case report and literature review

Large or giant paraclinoid aneurysms typically have good indication for flow diverter (FD) treatment. Here, we report a very rare case of a patient with an unruptured supraclinoid large aneurysm who underwent FD deployment with coil embolisation that resulted in delayed visual field defect (VFD) and hydrocephalus. A 75-year-old woman with a large right supraclinoid aneurysm presented with severe hemianopia in the right eye. She underwent FD deployment with coil embolisation of the aneurysm. However, permanent left visual field loss occurred four months after surgery. Magnetic resonance imaging (MRI) showed severe oedema surrounding the aneurysm along the optic tract. Inflammation led to postoperative hydrocephalus, requiring ventriculoperitoneal shunt placement. To the best of our knowledge, this is the first report of both a delayed VFD and hydrocephalus following FD treatment. In cases of FD treatment with coil embolisation for large paraclinoid aneurysms, clinicians should keep in mind that postoperative visual impairment or/and hydrocephalus may occur.