Transient perioperative visual loss after an elective neurosurgical procedure.

OBJECTIVE

To describe a case of reversible visual loss after a neurosurgical intervention and to discuss the role of the prone position as a potential risk factor.

OBSERVATION: A 63-year-old woman without significant medical previous history underwent elective resection of a left parieto-occipital meningioma. Preoperatively, the patient presented a right homonymous lower quadranopsia. The surgical procedure was not complicated. The patient was positioned in prone with a mild inclination of the table in reverse Trendelenburg position. The head was maintained in a Mayfield skull clamp, and ocular compression was excluded. There was no significant hypotension, hemodilution or vasopressors infusion during the procedure. Immediately after recovery from anesthesia, the patient experienced total blindness and flash visual evoked potentials confirmed the absence of retinal, primary or late occipital activities. A progressive, but finally complete recovery started after 24 hours.

CONCLUSION

This case illustrates the individual risk for visual injury after the prone position during some neurosurgical interventions.