Case ReportOrbital compartment syndrome following aneurysm surgery
Introduction
Visual failure due to orbital compartment syndrome (OCS) is a rare condition characterised by increased intraorbital pressure and subsequent hypoperfusion of critical neural structures and usually associated with external ophthalmoplegia. This syndrome has a very poor prognosis if not recognised and treated rapidly. The following case highlights the occurrence of OCS in the uncommon setting of a recent intracranial cerebrovascular surgery.
Section snippets
Case report
A 58-year-old male presented for an elective craniotomy and clipping of an anterior communicating artery aneurysm. The patient had been diagnosed after investigation of multiple episodes of intermittent vertical diplopia for which he had seen an ophthalmologist and been found to have uncorrected visual acuities of right 6/5 (6/4 with hypermetropic correction), left 6/4, with a normal intraocular pressure, physiologically deep optic disc cups with normal visual fields and intact extra-ocular
Discussion
OCS is a rare ophthalmological emergency characterised by an acute rise in orbital pressure and may result in complete irreversible blindness if not rapidly treated.1 It occurs as a result of acute increase in volume within the confined space of the orbit, which results in a sudden increase in intraorbital pressure causing ischaemia of the orbital structures. There are fewer than 100 cases of OCS reported occurring secondary to a wide variety of aetiologies.1 Fewer than 10 patients with this
Conclusion
This report highlights a rare cause of severe blindness, which may have been precipitated by severe straining in the setting of intracranial surgery in a patient with known preoperative proptosis. We advocate early surgical decompression with adjunctive medical treatments such as corticosteroids and osmotic agents; however, the efficacy of these treatments remains unclear. Electrodiagnostics and OCT may be useful in the diagnosis of OCS, and in particular may aid in prognostication of vision
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Orbital compartment syndrome following bicoronal flap and craniotomy for a basifrontal meningioma
2020, Journal of Clinical NeuroscienceExtraocular Pressure Measurements to Avoid Orbital Compartment Syndrome in Aneurysm Surgery
2018, World NeurosurgeryCitation Excerpt :They suggested preoperative bilateral prominent eyeballs, intraoperative head-down position, increased abdominal pressure in the jackknife position, and increased intracranial pressure as possible predisposing factors. Gauden et al.4 reported elective Acomm aneurysm clipping with a pterional approach followed by ipsilateral OCS. They presumed that direct compression of the eyeball by the cranial skin flap during surgery could have distorted the vascular channel.
Acute Monocular Blindness Due to Orbital Compartment Syndrome Following Pterional Craniotomy
2018, World NeurosurgeryCitation Excerpt :This rare complication resulted in rapid and persistent monocular visual loss. To the best of our knowledge, OCS causing such a devastating complication following a pterional craniotomy has only been described rarely.3-7 OCS is a rare entity characterized by proptosis, ocular movement paresis, and visual loss due to increased orbital pressure.
Orbital Compartment Syndrome After Frontotemporal Craniotomy: Case Report and Review of Literature
2018, World NeurosurgeryCitation Excerpt :OCS is characterized by increased intraorbital pressure and subsequent hypoperfusion of critical neural structures and is usually associated with external ophthalmoplegia. This syndrome has a poor prognosis if not recognized and treated rapidly.1-9 We report a case of postoperative OCS following a frontotemporal craniotomy and review pertinent literature.
Lateral Canthotomy: Part of a Neurosurgeon's Toolkit?
2014, World NeurosurgeryBilateral Orbital Compartment Syndrome Following a Craniotomy with Coronal Incision
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