Isquemia do nervo óptico após intervenção cirúrgica na coluna vertebral: relato de caso

Corso, Clóvis Marcelo; Tanaka, Pedro Paulo; Khon, Karina

doi:10.1590/s0034-70942006000300007

Cited by 4 publications

(1 citation statement)

References 8 publications

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“…Alguns fatores de risco referentes ao paciente os tornam predisponentes para complicações como a DAV: idade avançada, presença de aterosclerose, diabetes mellitus, hipertensão arterial sistêmica, tabagismo, glaucoma de ângulo estreito, insuficiência renal, doenças do colágeno, disfunção renal, policitemia e insuficiência vascular 5,14 . Também pode estar relacionada a fatores cirúrgicos, tais como: extensão do tempo cirúrgico, hipotensão arterial, grandes perdas sanguíneas, anemia e/ou reposição volêmica inadequada durante a cirurgia 1,7,10 .…”

Section: Introductionunclassified

Amaurose transitória pós-cirurgia da coluna cervical

Pereira¹,

Lepski²,

Santos³

et al. 2018

jbnc

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Introdução: A amaurose transitória é uma complicação rarapós-cirurgia da coluna vertebral. Tem maior incidência emcirurgias que exigem decúbito ventral. A etiopatogenia é incerta, mas tem sido relacionada com isquemia do nervo óptico, oclusão da artéria central da retina (OACR) e lesão ocular externa. Objetivos: Relatar um caso de amaurose bilateral transitória em uma paciente submetida a tratamento cirúrgico de hérnia discal cervical em decúbito ventral. Relato do caso: JMS, 68 anos, feminina. Dor cervical unilateral e monoradicular no trajeto de C6 há três meses. Exame de RM da coluna cervical demonstrou hérnia discal extrusa no espaço C6-C7 à direita. Foi submetida à cirurgia sob anestesia geral, em decúbito ventral para exérese da hérnia discal cervical. Houve perda sanguínea no ato cirúrgico de 600 ml, sendo reposto durante o procedimento cerca de 300 ml. Duração do ato cirúrgico foi de 185 minutos. No pós-operatóro imediato apresentou perda da acuidade visual bilateral. Ao exame físico não havia sinais de compressão externa dos globos oculares. Exame Fundoscopia: não revelou alterações significantes. No 3º dia de pós-operatório começou apresentar recuperação parcial da acuidade visual e teve melhora total da sua acuidade visual no 16º dia de pós-operatório. Conclusões: Em nosso caso a etiologia provável foi a presença de decúbito ventral prolongado, bem como a perda transitória sanguínea. A profilaxia baseia-se no correto posicionamento do paciente na mesa operatória, hidratação normovolêmica, evitar perda sanguínea abundante no procedimento cirúrgico e redução do tempo anestésico.

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Section: Introductionunclassified

Amaurose transitória pós-cirurgia da coluna cervical

Pereira¹,

Lepski²,

Santos³

et al. 2018

jbnc

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Incidental Transient Cortical Blindness after Lung Resection

Öncel

Sunam

Varoğlu

et al. 2016

Surg J

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Transient visual loss (cortical blindness) in the postoperative period is an uncommon complication and has an incidence varying between 0.05 and 0.1%. 1 Although the exact cause is still speculative, the most likely underlying mechanisms are advanced age, diabetes mellitus, hypertension, smoking, cerebral hypoxia, and procedure duration. 2 This complication is generally associated with cardiac and spine surgeries. 3 Here, we report a patient with diabetes mellitus and bilateral transient visual loss after lung resection. To our knowledge, this case is the first of its kind in the literature. Case ReportA 65-year-old man was admitted to our clinic with a mass that was suspected to be lung cancer; it was an undefined mass. At admission, his blood pressure was 120/80 mm Hg. The patient had had type 2 diabetes for 12 years, treated intramuscularly with insulin and orally with metformin for 5 years. The patient's medical history showed occasional hypoglycemic attacks and autonomic symptoms. Holding metabolic activity was seen at the right upper lung lobe under positron tomography. Sodium, potassium, phosphorus, blood urine nitrogen, creatine, plasma triglyceride, low-density protein, and high-density lipoprotein were within normal limits. His blood glucose level was 112 mg/dL. A right upper lobectomy was performed for diagnostic purposes. There were no complications perioperatively. Pathology included an abscess and inflammatory process in the mass.Cortical blindness developed 12 hours postoperatively. The patient's blood glucose level was 92 mg/dL, and blood gas analysis showed a PO 2 of 82 mm Hg. Cardiac enzymes and electrocardiography were normal. Additionally, the diffusionweighted magnetic resonance imaging (DWI) was normal (►Fig. 1). The patient's neurologic examination was also normal. Keywords► vision loss ► cortical blindness ► lung resection ► diabetes mellitus ► cerebral hypoxia Abstract Transient vision loss after major surgical procedures is a rare clinical complication. The most common etiologies are cardiac, spinal, head, and neck surgeries. There has been no report on vision loss after lung resection. A 65-year-old man was admitted to our clinic with lung cancer. Resection was performed using right upper lobectomy with no complications. Cortical blindness developed 12 hours later in the postoperative period. Results from magnetic resonance imaging and diffusion-weighted investigations were normal. The neurologic examination was normal. The blood glucose level was 92 mg/dL and blood gas analysis showed a PO 2 of 82 mm Hg. After 24 hours, the patient began to see and could count fingers, and his vision was fully restored within 72 hours after this point. Autonomic dysfunction due to impaired microvascular structures in diabetes mellitus may induce posterior circulation dysfunction, even when the hemodynamic state is normal in the perioperative period. The physician must keep in mind that vision loss may occur after lung resection due to autonomic dysfunction, especially in older patients with diabetes m...

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Suporte de cabeça para cirurgia da coluna vertebral: nota técnica

Rocha¹,

Arantes²,

Oliveira³

et al. 2012

Coluna/Columna

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RESUMODescreve-se um suporte de cabeça para cirurgia da coluna vertebral, que permite a colocação da cabeça do paciente em alinhamento neutro com o corpo e monitorização da posição de olhos, boca, nariz e tubo orotraqueal, evitando danos decorrentes de mau posicionamento durante a cirurgia. ABSTRACTWe describe a head support for spinal surgery that allows the placement of the patient's head in neutral alignment with the body and monitoring the position of the eyes, mouth, nose and orotracheal tube, preventing damages from poor positioning during surgery. FIGURa 1 -Suporte de cabeça: A) vista lateral, B) vista anterior, C) vista superior.FIGURa 2 -A) Paciente posicionado para cirurgia da coluna torácica, nota-se o alinhamento neutro da cabeça em relação ao eixo do corpo. B) visão de olhos boca e nariz pelo espelho inclinado.

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Isquemia do nervo óptico após intervenção cirúrgica na coluna vertebral: relato de caso

Cited by 4 publications

References 8 publications

Amaurose transitória pós-cirurgia da coluna cervical

Amaurose transitória pós-cirurgia da coluna cervical

Incidental Transient Cortical Blindness after Lung Resection

Suporte de cabeça para cirurgia da coluna vertebral: nota técnica

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