Reinforcement with muscle, cotton, fibrin glue, or some other material is an alternative to clipping in some intracranial aneurysms¹; the surgeon must balance the need to create local inflammation (to reinforce the arterial wall) with the risk that the inflammation will spread and damage adjacent structures. Wrapping of clinoidal aneurysms, in particular, rarely may produce delayed and severe visual loss or ocular motor dysfunction.^2–7 The clinical course and potential outcome of damage to the visual pathway, ocular motor tracts, or both remains controversial, as does the optimum management when visual loss occurs. We present the case of a patient who developed severe bilateral visual loss and neuroimaging evidence of inflammation in the paraclinoid and suprasellar regions 2 months after wrapping of bilateral clinoidal aneurysms with cotton and fibrin glue, but who recovered visual function and whose neuroimaging appearance improved after treatment with systemic corticosteroids.

Case report

A 61 year old woman underwent magnetic resonance imaging (MRI) and angiography after experiencing a minor stroke. The studies revealed aneurysms of the clinoidal portion of both internal carotid arteries. Endovascular treatment was unsuccessful. Accordingly, craniotomy was performed. As neither aneurysm could be clipped, both were wrapped with cotton gauze saturated with fibrin glue. The patient did well postoperatively until 2 months after surgery, when she noted blurred vision in the right eye. An incomplete left …