Bilateral central retinal artery occlusion: An exceptional complication after frontal parasagittal meningioma resection
- Department of Neurosurgery, Hospital Nacional Guillermo Almenara, Lima, Peru,
- Department of Ophthalmology, Hospital Nacional Guillermo Almenara, Lima, Peru,
- Department of Neurosurgery, School of Biomedical Sciences, Universidad Austral, Buenos Aires, Argentina,
- Department of Neurosurgery, Mater Dei Hospital, Bari, Italy
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
Nicola Montemurro, Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
DOI:10.25259/SNI_571_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Jafeth Lizana1, Carlos M. Dulanto Reinoso2, Nelida Aliaga3, Walter Marani4, Nicola Montemurro5. Bilateral central retinal artery occlusion: An exceptional complication after frontal parasagittal meningioma resection. 09-Aug-2021;12:397
How to cite this URL: Jafeth Lizana1, Carlos M. Dulanto Reinoso2, Nelida Aliaga3, Walter Marani4, Nicola Montemurro5. Bilateral central retinal artery occlusion: An exceptional complication after frontal parasagittal meningioma resection. 09-Aug-2021;12:397. Available from: https://surgicalneurologyint.com/surgicalint-articles/11031/
Background: Central retinal artery occlusion (CRAO) is a rare acute disease associated with great morbidity. It is reported as a complication of surgical procedures, but rarely associated with brain surgery and no reports before due to parasagittal meningioma resection.
Case Description: We present the case of a 41-year-old female who underwent surgery for a parasagittal meningioma and developed a bilateral CRAO as an acute postoperative complication. Most common causes, such as cardiac embolism, carotid pathology and coagulation problems, were discussed and all clinical and neuroradiological exams performed were reported.
Conclusion: Bilateral CRAO as results of brain surgery is extremely rare; however, if it occurs, it should be early recognized and treated to minimize its high morbidity.
Keywords: Case report, Ophthalmic artery, Postoperative management, Retinal artery occlusion, Surgical complication
Non-arteritic central retinal artery occlusion (CRAO) has an incidence of 0.85/100000/year. It has often been related to different surgical procedures; however, rarely to brain surgeries.[
Here, we reported a 41-year-old female with a medical history of obesity and diabetes type 2, who underwent surgical resection of a frontal parasagittal with no intraoperative surgical and anesthetic complications and developed complete blindness on awakening as a complication. Postoperative ophthalmological examination revealed bilateral mydriasis and non-reactive to light in both eyes, although bilateral mydriasis can occur after general anesthesia.[
Preoperative (a) and postoperative (b) CT head scans show the site of a parasagittal meningioma and its subsequent complete resection. Bilateral electroretinogram in scotopic (c) and phototopic (d) protocols, which show prolonged latencies, decreased amplitudes and distortion in a and b waves, as signs of moderate to severe diffuse retinopathy in both eyes. Right (e) and left (f) eyes retinal fluorescein biography shows delay in the arterial phase as well as in the optic nerve head hypofluorescence in late phases. The macula is marked with black arrows while the absence of cilioretinal arteries with black arrowheads. Spectral domain optical coherence tomography (at 3 months after surgery) of the right eye (g) and left eye (h) show chronic changes caused by CRAO.
Postoperative right (a) and left (b) internal carotid digital subtraction angiography (DSA) shows ophthalmic artery (black asterisks) on the same side, the ciliary arteries (black arrows) and the attenuated choroidal blush of the eye (black arrowheads). Right (c) and left (d) external carotids DSA shows no choroidal blush nor the presence of some dangerous anastomosis of the ophthalmic artery with the middle meningeal artery (black arrows) or with the internal maxillary (black arrowheads). Postoperative DSA (e) shows the right ophthalmic artery (white arrow), the origin of the central retinal artery (white arrowhead), and the delay in filling in phase of the distal portion of the central retinal artery (black arrowheads), which is partially supplied by the vascular ring of Zinn (black arrow). (f) shows left ophthalmic artery (white arrow), the posterior ciliary artery (white arrowhead), in addition to a delay in the filling of the central retinal artery (black arrow heads) and partial replacement through the vascular ring of Zinn (black arrow). Sagittal (g) T2-weighted brain MRI shows hyperintensity of both optic nerves in its intra-orbital segment (white arrowhead), suggestive of bilateral optic nerve infarction. Right and left fundi (h) at 3 months follow-up after surgery. Axial (i) T2-weighted brain MRI shows hyperintensity of both optic nerves.
CRAO is an ophthalmological emergency due to the short time retina tolerates ischemia (12–15 min) and this is due to the fact that the oxygen consumption rate (13 ml/100 g/min) of the retina is even greater than the brain (3.8 ml/100 g/min).[
The supply of the internal and external retina is the central retinal artery and the posterior short ciliary arteries, respectively.[
The present image report showed a rare case of bilateral CRAO as an acute complication of cranial surgery, which is extremely unusual according to the bibliography, reporting all clinical and neuroradiological exams performed to understand what the cause is, even if it remains unknown.
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