Posterior ischemic optic neuropathy following supine craniotomy for epidural abscess in a child
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CASE REPORT
Posterior ischemic optic neuropathy following supine craniotomy for epidural abscess in a child Jeffrey D. Oliver 1
&
Andrew J. Kobets 2 & Brendan F. Judy 2 & Alan R. Cohen 2
Received: 11 June 2020 / Accepted: 5 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Post-operative vision loss (POVL) can be a devastating complication of neurosurgical procedures and is unusual in the pediatric population. Mechanisms of POVL include direct optic nerve injury, vascular occlusion, or indirect malperfusion resultant from surgeries with substantial blood loss or fluid shifts, with prone positioning being a major risk factor for these events. Posterior ischemic optic neuropathy (PION) is a rare cause of POVL and is associated with a poor prognosis for recovery of visual function. We present a case of PION following a supine bifrontal craniotomy for a frontal epidural abscess secondary to pansinusitis in a pediatric patient. This is an unusual reported case in that no additional traditional risk factors were identified. We present clinical and radiographic findings, diagnostic considerations, treatment strategies, and a literature review. The patient was managed medically and recovered substantial vision in the affected eye. Keywords Posterior ischemic optic neuropathy . Craniotomy . Pediatric
Introduction Post-operative vision loss (POVL) following neurosurgery is a devastating complication for patient and provider, with lifetime personal and socioeconomic consequences [1]. POVL may result from direct injury to the optic nerve and its blood supply or indirect damage from secondary processes. Vision loss after supine cranial surgery is less understood and reported than after prone spine surgery, especially in the pediatric population. We present a case of acute monocular vision loss from a posterior ischemic optic neuropathy (PION) following an uncomplicated craniotomy for epidural abscess.
Methods/case presentation A 9-year-old boy with a history of allergic rhinitis presented to the emergency department with 3 days of headache, fever, and * Jeffrey D. Oliver [email protected] 1
Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
2
Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
peri-orbital edema. His white blood cell count was 19 and Creactive protein was 8.7. A contrast-enhanced CT scan and MRI demonstrated pan-sinusitis, pre-septal soft tissue swelling, and scant intracranial pneumocephalus with a frontal epidural abscess (Fig. 1). Dilated fundoscopic examination and Ishihara plate testing were unremarkable. Tonometry was notable for intra-ocular pressure of 9 mmHg OD and 19 mmHg OS, with less than 20 mmHg being normal. Antibiotics were initiated and the patient was taken to the operating room for a bifrontal craniotomy. A left frontal epidural abscess was evacuated. Both frontal sinuses were exenterated and covered with a vascularized pericranial graft. E
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