■术后视力丧失(POVL)是一种相对罕见但破坏性的并发症。我们报道了1例脊柱手术后视网膜和视神经缺血引起的POVL,首先介绍了海绵窦血栓形成在POVL发育中的可能性。
方法:一名诊断为“腰椎管狭窄症”的67岁女性因持续腰痛和麻木而接受腰椎后路减压手术。手术在全身麻醉下以俯卧位顺利进行。第二天,她右眼的视力突然下降到没有光的感觉。眼科检查显示眼睑水肿,化疗,上睑下垂,眼肌麻痹,相对传入瞳孔缺损和较高的眼眶压力,眼底镜检查显示视盘苍白,弥漫性视网膜留置和减弱的动脉。磁共振脑血管造影提示右颈内动脉海绵窦段狭窄。怀疑无菌海绵窦血栓形成和视网膜中央和视神经血管的继发性合并闭塞。因此,抗凝,血管舒张,及时给予吸氧和抗炎治疗。治疗后一个月,眼睑肿胀和眼球运动明显改善。然而,患者的视力没有显著改善。
■脊柱手术后视力丧失(POVL)被认为是不可逆视力损害的严重并发症。令人震惊的是,海绵窦血栓形成可能是POVL的可能原因。高容量液体更换,不稳定的血液动力学参数,俯卧位和手术时间延长可能会导致微血管疾病和高凝状态,有助于POVL的发生。
结论:我们的研究首先暗示了海绵窦血栓形成在POVL发展中的可能性。详细评估,流体管理,建议稳定血流动力学和优化持续时间以预防POVL。
UNASSIGNED: Postoperative visual loss (POVL) is a relatively rare but devastating complication. We reported a
case of POVL after spine surgery caused by ischemia of retina and optic nerve, and firstly introduced the possibility of cavernous sinus thrombosis in POVL development.
METHODS: A 67-year-old woman diagnosed with \"lumbar spinal stenosis\" was admitted to undergo posterior lumbar spinal canal decompression surgery because of the persistent lumbago and numbness. The operation was performed in the prone position under general anesthesia uneventfully. On the second day, the visual acuity of her right eye suddenly decreased to no light perception. The ophthalmic examination indicated edematous eyelid, chemosis, ptosis, ophthalmoplegia, relative afferent pupillary defect and higher orbital pressure in her affected eye, and funduscopic examination revealed pale optic disc, diffuse retinal welling and attenuated arteries. Cerebral magnetic resonance angiography implied the stenosis of cavernous sinus segment of right internal carotid artery. Aseptic cavernous sinus thrombosis and the secondary combined occlusion of central retinal and optic nerve vessels were suspected. Therefore, anticoagulation, vasodilation, oxygen and anti-inflammation treatment were timely administrated. One month after the treatment, swelling eyelid and ocular motion had markedly improved. However, there was no remarkable improvement in the patient\'s visual acuity.
UNASSIGNED: Postoperative visual loss (POVL) after spine surgery is regarded as a serious complication with irreversible vision damage. It was alarming that cavernous sinus thrombosis might be a possible cause of POVL. High-volume fluid replacement, unstable hemodynamic parameters, prone position and prolonged surgical duration might bring about microvascular diseases and hypercoagulable state, contributing to the occurrence of POVL.
CONCLUSIONS: Our study firstly implied the possibility of cavernous sinus thrombosis in the POVL development. Detailed assessment, fluids management, hemodynamic stabilizing and duration optimization were proposed for POVL prevention.