Postoperative posterior ischemic optic neuropathy a left far-lateral craniectomy for resection of craniocervical meningioma.

Postoperative posterior ischemic optic neuropathy a left far-lateral craniectomy for resection of craniocervical meningioma.

World Neurosurg. 2018 Apr 05;:

Authors: Eli IM, Kim RB, Kilburg C, Pecha TJ, Couldwell WT, Menacho ST

Abstract
BACKGROUND: Postoperative posterior ischemic optic neuropathy (PION) is a rare cause of postoperative vision loss, most often seen when surgical patients are placed in the prone position for a prolonged period of time. The authors report a case of bilateral PION after a far-lateral craniectomy in the lateral position.
CASE DESCRIPTION: A 36-year-old man with a history of right extremity numbness, weakness, and muscle atrophy was discovered to have a craniocervical meningioma. Surgery in the lateral position lasted 9:52 hours; the patient had 2 L of blood loss. On postoperative day 1, the patient demonstrated bilateral vision loss, which prompted further work-up. Diffusion-weighted imaging of the orbits demonstrated restricted diffusion within the bilateral optic nerves. His clinical presentation of painless vision loss after surgery with these imaging findings led to a diagnosis of PION. At the time of discharge, he had not recovered any visual function.
CONCLUSION: This case suggests that PION can also occur in the lateral position where there is not direct pressure on the orbits. PION is often not discussed as a potential complication during the preoperative consent process. This case suggests it may be prudent to extend the discussion of PION in similar neurosurgical cases. Intraoperative blood transfusion should be considered in prolonged surgeries in the lateral position where slow blood loss over a long period could be a contributing factor to the development of PION.

PMID: 29627627 [PubMed - as supplied by publisher]

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