Acute monocular blindness due to orbital compartment syndrome following a pterional craniotomy - a case report.

Acute monocular blindness due to orbital compartment syndrome following a pterional craniotomy - a case report.

World Neurosurg. 2018 Mar 12;:

Authors: Habets JGV, Haeren RHL, Lie SAN, Bauer NJC, Dings JTA

Abstract
BACKGROUND: We present a case of orbital compartment syndrome (OCS) leading to monocular irreversible blindness following a pterional craniotomy for clipping of an anterior communicating artery (ACoA) aneurysm. OCS is an uncommon but vision-threatening entity requiring urgent decompression to reduce the risk of permanent visual loss. Iatrogenic orbital roof defects are a common finding following pterional craniotomies. However, complications related to these defects are rarely reported.
CASE DESCRIPTION: A 65-year-old female, who underwent an ACoA clipping via a pterional approach 4 days before, developed proptosis, ocular movement paresis and irreversible visual impairment following an orthopedic surgery. Computed-tomography (CT) images revealed an intra-orbital cerebrospinal fluid (CSF) collection which was evacuated via an acute re-craniotomy. The next day, proptosis and intra-orbital CSF collection on CT-images re-occurred and an oral and maxillofacial surgeon evacuated the collection via a blepharoplasty incision and blunt dissection. Additionally, the patient was treated with acetazolamide and an external lumbar CSF drainage during 12 days. Hereafter the CSF collection did not re-occur. Unfortunately, monocular blindness was persistent. We hypothesize the CSF collection occurred due to the combination of a postoperative orbital roof defect and a temporarily increased intracranial pressure (ICP) during the orthopedic surgery.
CONCLUSION: We plead for more awareness of this severe complication after pterional surgeries and emphasize the importance of 1) strict ophthalmologic examination after pterional craniotomies in case of intracranial pressure increasing events, 2) immediate consultation of an oral and maxillofacial surgeon and 3) consider CSF-draining interventions since symptoms are severely invalidating and irreversible within a couple of hours.

PMID: 29545222 [PubMed - as supplied by publisher]

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