Visual loss after neurosurgical repair of paraclinoid aneurysms.

OBJECTIVE: To describe three cases of unexplained visual loss after technically successful clipping of paraclinoid aneurysms.
DESIGN: Three case reports are presented.
RESULTS: Profound blindness occurred in all three patients. Only one patient had marked visual recovery. Two clinical patterns were observed. A fulminant orbital syndrome presumably from compromise of large draining veins of the orbit was observed in one patient. A retrobulbar optic neuropathy that might have resulted from either direct injury or damage to small dural vessels of the posterior optic nerve was observed in the other two patients.
CONCLUSIONS: There is a risk of postoperative blindness after clipping of paraclinoid aneurysms. The frequency of this complication may increase because attempts to repair these aneurysms are becoming more common. Patients with paraclinoid aneurysms should receive preoperative and postoperative neuro-ophthalmologic examinations.