Bowen Randy C, Possin Michael E, Altaweel Michael M
Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
J Vitreoretin Dis. 2019 Oct 16;4(2):136-138. doi: 10.1177/2474126419868888. eCollection 2020 Mar-Apr.
This interventional case report discusses inadvertent bilateral temporal globe penetration during placement of intramuscular wire electrodes to the lateral rectus muscles for intraoperative neurophysiological monitoring (IONM) via electromyography.
An 11-year-old girl underwent surgical resection of massive medulloblastoma within the fourth ventricle, requiring IONM. Placement of an electrode in each lateral rectus muscle resulted in bilateral globe penetration, with choroidal rupture, retinal tears, and hemorrhage.
Sterile needle perforation of the globe did not result in endophthalmitis. Encircling laser retinopexy was performed, and no retinal detachments occurred.
Insertion of needle electrodes without guidance imaging can potentially lead to globe penetration and incorrect electrode placement. Direct visualization with ultrasound, electromyography, or other advanced image-guided systems may offer a safe solution for electrode placement to avoid injury. Verbal patients should be made aware of postoperative warning signs of globe penetration. For nonverbal patients, a postoperative dilated exam is warranted.
本介入性病例报告讨论了在通过肌电图对外侧直肌进行术中神经生理监测（IONM）时，将肌内线状电极放置于外侧直肌过程中意外发生的双侧眼球穿透。
一名11岁女孩接受了第四脑室内巨大髓母细胞瘤的手术切除，术中需要进行IONM。在每条外侧直肌中放置电极导致双侧眼球穿透，伴有脉络膜破裂、视网膜裂孔和出血。
无菌针穿透眼球未导致眼内炎。进行了环形激光视网膜光凝术，未发生视网膜脱离。
在无引导成像的情况下插入针电极可能会导致眼球穿透和电极放置错误。使用超声、肌电图或其他先进的图像引导系统进行直接可视化操作，可能为电极放置提供安全的解决方案，以避免损伤。对于能言语表达的患者，应告知其眼球穿透的术后警示症状。对于不能言语表达的患者，术后进行散瞳检查是必要的。
