Orbital Compartment Syndrome After Frontotemporal Craniotomy: Case Report and Review of Literature

Pahl, Félix Hendrik; Oliveira, Matheus F. de; Lúcio, José Erasmo Dal Col; Castro, Emerson F. Souza e

doi:10.1016/j.wneu.2017.09.167

Cited by 13 publications

(4 citation statements)

References 8 publications

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“…Although there are previous reports of orbital compartment syndrome developing after different neurosurgical procedures such as cerebral aneurism surgery, craniotomy, or cavernous sinus fistula, [2][3][4] to our knowledge this is the only report of orbital venous congestion with visual compromise developing after a brow lift procedure.…”

Section: Casementioning

confidence: 77%

Severe Orbital Congestion After a Brow Lift Due to an Osteodural Arteriovenous Fistula

Brossard-Barbosa¹,

Krings²,

Margolin³

2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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The authors describe a 73-year-old woman who developed worsening proptosis, binocular diplopia, and periorbital pain shortly after undergoing an open subperiosteal brow lift procedure. She was found to have a pre-existing osteodural fistula (ODF) within left frontal bone, which was draining through supraorbital vein (SOV) in cavernous sinus. When SOV was inadvertently severed during a brow lift, blood from the fistula was now redirected in the orbit. This is the first report of a decompensated ODF after a brow lift procedure. It underscores the complexity of orbital venous drainage and the importance in preserving the supraorbital and supratrochlear veins during brow lift.

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Section: Casementioning

confidence: 77%

Severe Orbital Congestion After a Brow Lift Due to an Osteodural Arteriovenous Fistula

Brossard-Barbosa¹,

Krings²,

Margolin³

2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…In fact, the exact incidence of OCS after neurosurgery is not well established. Some of the risk factors for the development of OCS include long duration in the prone position, flap compression, and the use of retraction devices during surgery, while orbital compression by the flap is considered to be the most important cause 8,10,11 . In this patient, wet cotton gauze was placed under the skin flap to prevent flap necrosis, which may have increased compression in the orbit.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Orbital Compartment Syndrome Following a Craniotomy With Coronal Incision

Wang,

Guo,

Ding

et al. 2023

Journal of Craniofacial Surgery

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Background: Orbital compartment syndrome is a rare ophthalmic emergency characterized by increased intraorbital pressure and hypoperfusion of critical neural structures, most of which were caused by trauma, and can also be caused by periorbital surgery, local injections, other preexisting medical conditions and so on. It requires rapid identification and immediate treatment for the preservation of vision. Clinical Presentation: A 61-year-old female with left frontal lobe-parafalcine meningioma underwent a craniotomy with a bicoronal incision. Postoperatively, the patient presented absence of pupillary reaction in both eyes, and complained loss of vision after recovery from anesthesia. Bilateral orbital compartment syndrome was considered 18 hours postoperatively since the marked bilateral proptosis with eyelid edema and conjunctival chemosis. The patient was treated with methylprednisolone, mannitol, hyperbric oxygenation, and neurotrophic agents as recommended by the ophthalmologist. There was no improvement in visual acuity at discharge or at 3-month follow-up postoperatively. Discussion and Conclusion: This is a rare case of bilateral irreversible blindness caused by orbital compartment syndrome after a craniotomy with coronal incision. Neurosurgeons need to improve the awareness of this complication for adequate prevention, such as direct ocular pressure from skin flaps, congestion from head positioning, and adequate intraoperative eye protection, and also earlier recognition and management.

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“…This case represents a unique mechanism through which orbital compartment syndrome developed following frontotemporal craniotomy. Previous cases of orbital compartment syndrome following surgical procedures involving frontotemporal craniotomies have been reported, the mechanisms of which included: direct compression of the globe and orbit through a myocutaneous flap or instruments holding the flap, 4 postoperative straining, 5 and prolonged Trendelenburg positioning. 6 In our case, the flap was retracted anteriorly without compression on orbital structures.…”

Section: Discussionmentioning

confidence: 99%

Severe Intraoperative Orbital Venous Congestion during Resection of a Frontal Meningioma Presenting with Post-operative Vision Loss and Ophthalmoplegia: A Case Report

Leung

Shemesh

Shafai

et al. 2018

Neuro-Ophthalmology

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We describe a unique case of a middle-aged man who noticed complete vision loss in the right eye after awaking from resection of a large right-sided frontal meningioma. Visual acuity was hand motions, and there were multiple signs of right orbital venous congestion. Magnetic resonance imaging and venography (MRI/V) of the brain and orbits demonstrated expected post-operative findings with no evidence of cavernous sinus thrombosis or fistula. Empiric treatment with intravenous antibiotics and intravenous methylprednisolone were ineffective.Immediate post-operative computerised tomography (CT) images were re-reviewed and revealed right restricted diffusion of the entire intraorbital right optic nerve. Discussion with the neurosurgical team revealed that during craniotomy, a prominent diploic venous plexus in the frontal bone adjacent to the meningioma was identified and coagulated with bone wax. Review of pre-operative imaging revealed large diploid flow voids in the right frontal bone, corresponding to the intraoperative findings. This prominent venous plexus appeared to drain from the meningioma posteriorly into the vein of Labbe. A second pathway drained anteriorly through the right angular vein into the orbit.We hypothesise that the posterior outflow pathway was coagulated intraoperatively, causing redirection of all venous outflow from the meningioma into the right orbit through the anterior pathway. This resulted in significant orbital hypertension with manifest signs and symptoms. Furthermore, sudden rise in intraorbital pressure led to infarction of the optic nerve, leaving the patient with hand motions vision. We suggest that pre-operative vascular imaging should be performed in patients with large meningiomas, as pre-operative embolisation of venous outflow channels may prevent severe post-operative complications.

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Orbital Compartment Syndrome After Frontotemporal Craniotomy: Case Report and Review of Literature

Cited by 13 publications

References 8 publications

Severe Orbital Congestion After a Brow Lift Due to an Osteodural Arteriovenous Fistula

Severe Orbital Congestion After a Brow Lift Due to an Osteodural Arteriovenous Fistula

Bilateral Orbital Compartment Syndrome Following a Craniotomy With Coronal Incision

Severe Intraoperative Orbital Venous Congestion during Resection of a Frontal Meningioma Presenting with Post-operative Vision Loss and Ophthalmoplegia: A Case Report

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