Recurrent visual loss due to muslin-induced optochiasmatic arachnoiditis

Introduction: Delayed visual loss may occur in patients who have undergone surgical treatment for intracranial aneurysms due to an inflammatory foreign body reaction known as optochiasmatic arachnoiditis. This inflammatory process may be induced by muslin wrapping of intracranial aneurysms. Case report: A 61-year-old female underwent clipping of a right paraophthalmic artery aneurysm followed by wrapping with muslin. The patient developed recurrent visual loss over several years due to an inflammatory suprasellar mass and optochiasmatic arachnoiditis induced by the muslin. Results: The patient required two surgical decompressions of the optic nerves and chiasm and experienced a partial recovery of visual function after removal of the suprasellar mass. Histopathology of the mass revealed inflammatory cells and muslin. Conclusion: Ophthalmologists should be aware of the risk of optochiasmatic arachnoiditis due to muslin, and neurosurgeons should avoid the use of muslin, if possible, for aneurysms adjacent to the optic nerves or chiasm.