ArticleJournal of neurosurgery. Case lessons2026
Delayed transient optic neuritis after flow diverter placement with coil embolization for an asymptomatic paraclinoid internal carotid artery aneurysm: illustrative case.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDelayed optic neuropathy after flow diversion for paraclinoid internal carotid artery (ICA) aneurysms has mainly been reported in patients with preoperative mass effect; risk in asymptomatic, electively treated patients is unclear. The authors report transient, steroid-responsive optic neuritis after Pipeline Shield placement with coiling for an asymptomatic paraclinoid aneurysm. OBSERVATIONS: A woman in her 50s underwent elective flow diversion for a growing, asymptomatic left paraclinoid ICA aneurysm (10.4 mm). A Pipeline Shield and two coils were deployed uneventfully; she was discharged on day 5. On day 10, she developed progressive vision loss. Fundoscopy was normal, but critical flicker frequency (CFF) was reduced and a paracentral scotoma was present, indicating retrobulbar optic neuropathy. MRI showed a doughnut sign without aneurysm enlargement, distinguishing inflammatory from compressive or ischemic mechanisms. Corticosteroid therapy produced complete recovery within 1 month, with CFF normalization. LESSONS: Delayed optic neuritis can follow flow diversion in preoperatively asymptomatic patients; proximity of the optic nerve to the aneurysm, rather than mass effect, confers this risk. A normal fundus, reduced CFF, a scotoma, and a doughnut sign without sac enlargement identify inflammatory optic neuritis and warrant prompt corticosteroid treatment. Elective paraclinoid flow diversion merits counseling and early visual surveillance even when asymptomatic. https://thejns.org/doi/10.3171/CASE26638.
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