{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:50:46Z","timestamp":1791334246108,"version":"4.3.1"},"reference-count":13,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"14","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Delayed optic neuropathy after flow diversion for paraclinoid internal carotid artery (ICA) aneurysms has mainly been reported in patients with preoperative mass effect; risk in asymptomatic, electively treated patients is unclear. The authors report transient, steroid-responsive optic neuritis after Pipeline Shield placement with coiling for an asymptomatic paraclinoid aneurysm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A woman in her 50s underwent elective flow diversion for a growing, asymptomatic left paraclinoid ICA aneurysm (10.4 mm). A Pipeline Shield and two coils were deployed uneventfully; she was discharged on day 5. On day 10, she developed progressive vision loss. Fundoscopy was normal, but critical flicker frequency (CFF) was reduced and a paracentral scotoma was present, indicating retrobulbar optic neuropathy. MRI showed a doughnut sign without aneurysm enlargement, distinguishing inflammatory from compressive or ischemic mechanisms. Corticosteroid therapy produced complete recovery within 1 month, with CFF normalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Delayed optic neuritis can follow flow diversion in preoperatively asymptomatic patients; proximity of the optic nerve to the aneurysm, rather than mass effect, confers this risk. A normal fundus, reduced CFF, a scotoma, and a doughnut sign without sac enlargement identify inflammatory optic neuritis and warrant prompt corticosteroid treatment. Elective paraclinoid flow diversion merits counseling and early visual surveillance even when asymptomatic.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26638\">https:\/\/thejns.org\/doi\/10.3171\/CASE26638<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26638","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:01:29Z","timestamp":1790726489000},"source":"Crossref","is-referenced-by-count":0,"title":["Delayed transient optic neuritis after flow diverter placement with coil embolization for an asymptomatic paraclinoid internal carotid artery aneurysm: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Yuji","family":"Agawa","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taketo","family":"Hatano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"J Neurosurg","first-page":"1511","article-title":"Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms","volume":"129","author":"Kamide","year":"2018","unstructured":"Kamide TTabani HSafaee MMBurkhardt JKLawton MT.Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms. J Neurosurg. 2018;129(6):1511-1521. doi:10.3171\/2017.7.JNS17673"},{"issue":"9","key":"bib2","series-title":"J Neurointerv Surg","first-page":"892","article-title":"Flow diversion for compressive unruptured internal carotid artery aneurysms with neuro-ophthalmological symptoms: a systematic review and meta-analysis","volume":"15","author":"Kaiser","year":"2023","unstructured":"Kaiser DPOCuberi ALinn JGawlitza M.Flow diversion for compressive unruptured internal carotid artery aneurysms with neuro-ophthalmological symptoms: a systematic review and meta-analysis. J Neurointerv Surg. 2023;15(9):892-897. doi:10.1136\/jnis-2022-019249"},{"issue":"7","key":"bib3","series-title":"AJNR Am J Neuroradiol","first-page":"998","article-title":"Flow diversion for ICA aneurysms with compressive neuro-ophthalmologic symptoms: predictors of morbidity, mortality, and incomplete aneurysm occlusion","volume":"43","author":"Kaiser","year":"2022","unstructured":"Kaiser DPOBoulouis GSoize SFlow diversion for ICA aneurysms with compressive neuro-ophthalmologic symptoms: predictors of morbidity, mortality, and incomplete aneurysm occlusion. AJNR Am J Neuroradiol. 2022;43(7):998-1003. doi:10.3174\/ajnr.A7550"},{"key":"bib4","series-title":"Surg Neurol Int","first-page":"250","article-title":"Visual symptoms after flow-diverter stenting of internal carotid artery aneurysms: a retrospective cohort study","volume":"16","author":"Tanaka","year":"2025","unstructured":"Tanaka YMatsuda YTsumoto TTerada T.Visual symptoms after flow-diverter stenting of internal carotid artery aneurysms: a retrospective cohort study. Surg Neurol Int. 2025;16:250. doi:10.25259\/SNI_306_2025"},{"issue":"5","key":"bib5","series-title":"Radiol Case Rep","first-page":"1487","article-title":"Two patients of visual disturbance and optic perineuritis after placement of a flow diverter","volume":"17","author":"Tanaka","year":"2022","unstructured":"Tanaka YNagatsuka HMiki YTwo patients of visual disturbance and optic perineuritis after placement of a flow diverter. Radiol Case Rep. 2022;17(5):1487-1490. doi:10.1016\/j.radcr.2022.01.085"},{"issue":"2","key":"bib6","series-title":"AJNR Am J Neuroradiol","first-page":"330","article-title":"Visual outcomes with flow-diverter stents covering the ophthalmic artery for treatment of internal carotid artery aneurysms","volume":"36","author":"Rouchaud","year":"2015","unstructured":"Rouchaud ALeclerc OBenayoun YVisual outcomes with flow-diverter stents covering the ophthalmic artery for treatment of internal carotid artery aneurysms. AJNR Am J Neuroradiol. 2015;36(2):330-336. doi:10.3174\/ajnr.A4129"},{"issue":"4","key":"bib7","series-title":"Eur J Ophthalmol","first-page":"e74","article-title":"Tirofiban as treatment for acute retinal artery occlusion following internal carotid artery flow diverter implantation","volume":"26","author":"Pierro","year":"2016","unstructured":"Pierro LLa Spina CCorvi FTirofiban as treatment for acute retinal artery occlusion following internal carotid artery flow diverter implantation. Eur J Ophthalmol. 2016;26(4):e74-e76. doi:10.5301\/ejo.5000735."},{"key":"bib8","series-title":"World Neurosurg","first-page":"e108","article-title":"Mass effect after flow diversion for unruptured large and giant cavernous or paraclinoid internal carotid artery aneurysm","volume":"180","author":"Moon","year":"2023","unstructured":"Moon EPark WSong YLee DHAhn JSPark JC.Mass effect after flow diversion for unruptured large and giant cavernous or paraclinoid internal carotid artery aneurysm. World Neurosurg. 2023;180:e108-e116. doi:10.1016\/j.wneu.2023.08.129"},{"issue":"8","key":"bib9","series-title":"Neurol Med Chir (Tokyo)","first-page":"343","article-title":"Flow diverter stenting for symptomatic intracranial internal carotid artery aneurysms: clinical outcomes and factors for symptom improvement","volume":"63","author":"Nishimoto","year":"2023","unstructured":"Nishimoto KOzaki TKidani TFlow diverter stenting for symptomatic intracranial internal carotid artery aneurysms: clinical outcomes and factors for symptom improvement. Neurol Med Chir (Tokyo). 2023;63(8):343-349. doi:10.2176\/jns-nmc.2022-0389"},{"issue":"20","key":"bib10","series-title":"J Neurosurg Case Lessons","first-page":"CASE24143","article-title":"Visual dysfunction and neurodegeneration caused by severe inflammatory optic neuropathy after coil embolization of a paraclinoid aneurysm: illustrative case","volume":"7","author":"Okuyama","year":"2024","unstructured":"Okuyama TKurisu KOsanai TVisual dysfunction and neurodegeneration caused by severe inflammatory optic neuropathy after coil embolization of a paraclinoid aneurysm: illustrative case. J Neurosurg Case Lessons. 2024;7(20):CASE24143. doi:10.3171\/CASE24143"},{"issue":"6","key":"bib11","series-title":"Interv. 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