Yip Nicholas Zhe Wei, Barbour-Hastie Catriona, Barron Peter, McKee Justin B, Kaliaperumal Chandrasekaran
Medical School, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK.
Ophthalmology, NHS Fife, Dunfermilne, UK
BMJ Case Rep. 2025 Jun 27;18(6):e264865. doi: 10.1136/bcr-2025-264865.
A woman in her 50s experiences complete cortical blindness following a successful resection of a pineal region meningioma, most likely secondary to intraoperative bilateral occipital lobe retraction. The post-operative MRI did not demonstrate any ischaemia. The index presentation was worsening recurrent falls and cognitive decline from a large mass in the pineal recess resulting in triventriculomegaly, managed successfully with an endoscopic third ventriculostomy 7 months prior. The enlarging mass was resected via a parieto-occipital interhemispheric approach with a 7 hour operative time and no complications. Immediately post-operatively, she experienced cortical blindness lasting 3 days, improving over 3 weeks to then normal visual function by 8 months. This raises awareness of intraoperative occipital lobe retraction increasing the risk of transient cortical blindness post-operatively, along with the known risk factors of increased age and tentorial angles. Future research with functional MRI is required to further investigate cases of post-operative cortical blindness.
一名50多岁的女性在成功切除松果体区脑膜瘤后出现完全性皮质盲，最可能继发于术中双侧枕叶牵拉。术后MRI未显示任何缺血情况。最初的表现是由于松果体隐窝的巨大肿块导致三脑室扩大，进而出现反复跌倒和认知功能下降，7个月前通过内镜下第三脑室造瘘术成功治疗。通过顶枕部半球间入路切除增大的肿块，手术时间为7小时，无并发症。术后立即出现持续3天的皮质盲，3周内有所改善，到8个月时视觉功能恢复正常。这提高了人们对术中枕叶牵拉会增加术后短暂性皮质盲风险的认识，以及已知的年龄增长和小脑幕夹角等风险因素。需要进行功能性MRI的进一步研究以深入调查术后皮质盲的病例。
