Visual deterioration 1½ years after wrapping an un-clippable anterior communicating artery aneurysm: report of a case and review of the literature regarding opto-chiasmatic arachnoiditis

Abstract

Objective: Optochiasmatic arachnoiditis (OCA) is a serious complication that can occur after wrapping of aneurysms in the
proximity of the optic pathways. This paper seeks to illustrate one such case with a view to drawing attention to the dangers of
this practice. Method: Single case report and review of the literature. Results: The clinical and radiological features of OCA
are presented and discussed, which in this patient involved failing visual acuity as well as an inflammatory mass of the
suprasellar area with oedema of the optic apparatus. Conclusion: Optochiasmatic arachnoiditis and its attendant visual
morbidity is a serious condition. In the setting described, it arose as a result of wrapping an unclippable aneurysm. The tide of
aneurysm management has turned, and presently more and more of them are being obliterated by endovascular techniques.
Among other benefits, this reduces the likelihood of such complications as OCA.

Keywords: Cerebral aneurysms; Optochiasmatic arachnoiditis; Aneurysm coiling; Aneurysm clipping; Aneurysm wrapping

African Journal of Psychiatry Vol. 10 (3) 2007: pp. 164-166