Basurrah Abdulaziz A, Atteiah Abdulgadir T, Ajlan Balgees A, Subhan Irshad A, Alharthi Mohammed S, Rezk Essam M
Departments of Neurosurgery, King Abdullah Medical City, Makkah, Saudi Arabia.
Department of Neurosurgery, King Fahad Hospital, Jeddah, Saudi Arabia.
J Neurosurg Case Lessons. 2024 Aug 19;8(8). doi: 10.3171/CASE2434.
Vision loss following supine craniotomy is an unexpected and devastating complication for the patient and the operating team. Postoperative vision loss (POVL) is commonly associated with cardiac, spinal, neck, and prone head surgeries, as they share common risk factors, such as a prone position, intraoperative hypotension, a longer anesthesia duration, and the use of vasopressors. Herein, the authors report a case of irreversible vision loss following a frontal craniotomy in the supine position together with a review of the literature. All published cases in the literature since the first reported case in 1970 are summarized. Possible etiologies and proposed preventive measures are discussed.
Different pathologies, such as vascular, intra-axial, and extra-axial lesions, are associated with POVL and have similar clinical courses and nonrecovery rates, which raises the question of whether POVL begins during the exposure part of these surgeries.
Preventive measures could include avoiding direct ocular pressure during flap reflection, the use of elastic bands or fishhooks to avoid stretching the orbital contents and impairing venous outflow, and a careful review of the venous drainage of frontal tumors, which could help avoid unnecessary large venous thrombi or waxing. The role of intraoperative visual neurophysiological monitoring in predicting POVL requires further exploration. https://thejns.org/doi/10.3171/CASE2434.
仰卧位开颅术后视力丧失对患者和手术团队来说是一种意想不到的灾难性并发症。术后视力丧失（POVL）通常与心脏、脊柱、颈部和俯卧位头部手术相关，因为它们有共同的危险因素，如俯卧位、术中低血压、较长的麻醉时间以及血管升压药的使用。在此，作者报告一例仰卧位额部开颅术后不可逆视力丧失的病例，并对文献进行综述。总结了自1970年首例报道病例以来文献中所有已发表的病例。讨论了可能的病因及建议的预防措施。
不同的病理情况，如血管性、轴内和轴外病变，都与POVL相关，且具有相似的临床病程和未恢复率，这就引发了一个问题，即POVL是否在这些手术的暴露阶段就已开始。
预防措施可包括在翻开骨瓣时避免直接压迫眼球，使用弹力带或鱼钩以避免拉伸眶内容物并损害静脉流出，以及仔细检查额叶肿瘤的静脉引流情况，这有助于避免不必要的大静脉血栓形成或出血。术中视觉神经生理监测在预测POVL中的作用需要进一步探索。https://thejns.org/doi/10.3171/CASE2434
