Cases of vision loss after bifrontal access

Abstract

The objective is to present 2 clinical cases of complete vision loss after bifrontal access during craniotomy due to vascular brain pathology.Materials and methods. In one case, a bifrontal skin incision was used during subfrontal craniotomy to remove frontal lobe arteriovenous malformation, in the other one – to apply intracranial side-to-side anastomosis between A3 segments of both anterior cerebral arteries, and to clip proximal aneurysms of the anterior connecting artery and the anterior cerebral artery on the right. After the surgery, patients developed bilateral amaurosis and ophthalmoplegia. We analyzed data on patients’ general clinical condition and their ophthalmological status prior to the surgery, as well as surgical videos and anesthesia records.Results. Intraoperative iatrogenic damage of cranial nerves and arteries was excluded. We distinguished that a suspected intraoperative factor, playing a decisive role, was a piece of skin applying direct pressure on the eyeballs. It was removed during the surgery.Conclusion. To prevent the development of such a complication as vision loss, it is necessary to carefully evaluate all possible risks at preoperative and intraoperative stages. During the surgery, all organs and systems at risk should be monitored. It is important to prevent a sudden drop in blood pressure and massive blood loss. During craniotomy, any eyeballs compression must be avoided.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to publication of their data.