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That's a wrap.

Parisa Taravati1, Andrew G Lee, M Tariq Bhatti

  • 1Department of Ophthalmology, The University of Iowa Hospitals and Clinics (PT), Iowa City, USA.

Survey of Ophthalmology
|July 5, 2006
PubMed
Summary
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A rare complication of intracranial aneurysm surgery, muslin-induced optochiasmatic arachnoiditis, can cause delayed visual loss. Avoid muslin wrapping near the optic apparatus to prevent this serious complication.

Area of Science:

  • Neurosurgery
  • Ophthalmology
  • Neuropathology

Background:

  • Surgical repair of intracranial aneurysms is a common neurosurgical procedure.
  • Muslin wrapping is sometimes used as an adjunct to aneurysm clipping.
  • Optochiasmatic arachnoiditis is inflammation of the arachnoid mater affecting the optic nerves and chiasm.

Observation:

  • A 52-year-old male presented with progressive visual loss and bitemporal hemianopsia 8 months after aneurysm clipping and muslin wrapping.
  • Neuroimaging revealed a suprasellar mass, but no aneurysm recurrence.
  • The patient's symptoms improved significantly after treatment with prednisone.

Findings:

  • The patient's presentation was consistent with muslin-induced optochiasmatic arachnoiditis.
  • Delayed visual loss following aneurysm surgery may indicate this rare complication.

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  • Histopathological examination of the suprasellar mass would be definitive but was not performed.

    • Implications:

    • Muslin wrapping of intracranial aneurysms, particularly those near the optic apparatus, should be reconsidered.
    • Early recognition and treatment with corticosteroids may improve visual outcomes.
    • This case highlights the importance of considering iatrogenic causes for delayed neurological deficits after surgery.