Fukuda Yutaka, Shiozaki Eri, Ogawa Yuka, Morofuji Yoichi, Ito Takehiro, Honda Kazuya, Kawahara Ichiro, Ono Tomonori, Haraguchi Wataru, Tsutsumi Keisuke
Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
No Shinkei Geka. 2020 Dec;48(12):1129-1138. doi: 10.11477/mf.1436204336.
A 58-year-old woman underwent left frontotemporal craniotomy for clipping of an unruptured cerebral aneurysm. A small defect was accidentally created in the orbital roof intraoperatively. The patient developed left eyelid edema and ocular pain after recovery from anesthesia. The following day, the eyelid edema worsened, and she had difficulty opening her eyes. On the 9 postoperative day, she noticed diminished visual acuity and diplopia in her left eye when she was able to spontaneously open her eyes. Ophthalmological evaluation revealed mild left visual loss, decreased light reflex, ophthalmoplegia, ptosis, and chemosis. Computed tomography(CT)/magnetic resonance imaging revealed left proptosis, optic nerve stretching, intra-orbital fluid retention, and orbital/palpebral emphysema. She was diagnosed with orbital compartment syndrome(OCS)and received conservative treatment;however, her visual acuity did not improve. OCS observed after cerebral aneurysm surgery is rare;to date, only 24 cases have been reported in the available literature. Although the mechanism of OCS after craniotomy is unclear, it may be attributed to ocular compression by a muscle flap or increased intra-orbital pressure secondary to venous congestion. In the present case, the left superior ophthalmic vein and cavernous sinus were not clearly visualized on CT angiography. Therefore, we concluded that the right superior ophthalmic vein and superficial facial veins underwent dilatation and served as collateral circulation of the left orbital venous system. We speculate that OCS occurred secondary to increased intra-orbital pressure, possibly caused by inflow of cerebrospinal fluid with air into the orbit through a small bone defect that was accidentally created during craniotomy in a setting of orbital venous congestion.
一名58岁女性接受了左额颞开颅手术，以夹闭未破裂的脑动脉瘤。术中意外在眶顶造成一个小缺损。患者麻醉苏醒后出现左眼睑水肿和眼痛。第二天，眼睑水肿加重，睁眼困难。术后第9天，当她能够自主睁眼时，发现左眼视力下降和复视。眼科检查显示左眼轻度视力丧失、光反射减弱、眼球运动麻痹、上睑下垂和结膜水肿。计算机断层扫描（CT）/磁共振成像显示左眼球突出、视神经牵拉、眶内液体潴留以及眼眶/眼睑气肿。她被诊断为眼眶间隔综合征（OCS）并接受了保守治疗；然而，她的视力并未改善。脑动脉瘤手术后出现OCS很罕见；迄今为止，现有文献中仅报道了24例。虽然开颅术后OCS的机制尚不清楚，但可能归因于肌瓣对眼球的压迫或静脉淤血继发的眶内压力升高。在本病例中，CT血管造影未清晰显示左眼上静脉和海绵窦。因此，我们得出结论，右眼上静脉和面部浅静脉扩张并成为左眼眶静脉系统的侧支循环。我们推测OCS是由于眶内压力升高继发引起的，可能是在开颅手术过程中意外造成的小骨缺损处，脑脊液与空气流入眼眶，在眼眶静脉淤血的情况下导致的。
