Optochiasmal arachnoiditis induced by muslin wrapping of intracranial aneurysms. A report of two cases and a review of the literature

Abstract

Muslin wrapping of intracranial aneurysms has been used for many years, but muslin-induced optochiasmal arachnoiditis was first reported only in 1978, as a complication with catastrophic loss of vision. In this study of 54 cases wrapped with muslin over the last six years, two cases of optochiasmal arachnoiditis occurred. Three patients had early rebleeding among the 27 who had wrapping as the only treatment of the aneurysm.

Muslin induced granuloma following wrapping of intracranial aneurysms: The role of infection as an additional precipitating factor

“…CT scanning with contrast enhancement may reveal an enhancing mass at the site of the aneurysm wrapped with muslin suggestive of the formation of a granuloma. This was evident in 10 out of the reviewed 21 patients [2,4,9,10]. It was also noted that in 4 of these patients an earlier CT scan during the course of their disease failed to demonstrate these masses [2,10].…”

“…Our two cases presented with visual impairment and one had hypopituitarism. The clinical course was variable as some presented insidiously while others presented more acutely [2], however many showed stepwise progression with relatively long periods of quiescence in between [7,9].…”

“…Seven of the reviewed patients received no treatment and their symptoms resolved spontaneously in all of them [1,2,9]. In one patient the neurological deficits resolved completely while the other 6 demonstrated improvement or at least stabilisation of their condition.…”

“…In these cases, the use of muslin has been incriminated in the resulting neurological or cranial nerve deficits by inducing a "foreign b o d y " reaction. The reaction to muslin results in localised arachnoiditis [1,7,8,11], or the formation of a mass due to a g r a n u l o m a [2,4,9,10]. These appearances p r o b a b l y represent the extremes of a spectrum.…”

“…In all of these cases muslin was used; in 4 cases w r a p p i n g only with muslin was p e r f o r m e d [1, 4, 9, 10], whereas in 17 cases m u slin wrapping was used in addition to clipping [1,2,[7][8][9][10]. In 2 of these cases additional coating material was used; one with cyanoacrylate m o n o m e r and the other with methyl methacrylate [4,9]. The presence of blood in the basal cisterns cannot be strongly incriminated in the pathogenesis of this condition as in 4 cases no prior history of subarachnoid h a e m o rrhage from a ruptured aneurysm occurred [1,11].…”