• World Neurosurg · Oct 2018

    Case Reports

    Extraocular Pressure Measurements to Avoid Orbital Compartment Syndrome in Aneurysm Surgery.

    • Tae-Shin Kim, Junseok W Hur, Dong-Hyuk Park, Shin-Hyuk Kang, Jung-Yul Park, Yong-Gu Chung, and Kyung-Jae Park.
    • Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Republic of Korea.
    • World Neurosurg. 2018 Oct 1; 118: e601-e609.

    BackgroundOrbital compartment syndrome (OCS) is a rare but devastating complication following pterional craniotomy. Although the causes of OCS are unclear, external compression of the orbit by a myocutaneous flap is commonly mentioned as a major factor. We evaluated the ocular influence of external compression using an extraocular pressure monitor.MethodsWe measured extraocular pressure in 86 patients who underwent surgery for cerebral aneurysm via a pterional approach. Clinical information and radiologic parameters, including the area of the medial rectus muscle (MRM) and the craniotomy height from the bottom of the anterior skull base, were collected. As a control group, 117 patients who underwent surgery without pressure monitoring were also evaluated.ResultsExtraocular pressure reached a maximum during craniotomy (mean, 22.0 mm Hg; range, 18.4-51.0 mm Hg) and decreased after myocutaneous flap adjustment (mean, 7.9 mm Hg; range, 5.4-17.5 mm Hg). Pressure before myocutaneous flap manipulation differed between patients with anterior communicating artery (Acomm) aneurysms and other patients (mean, 16.5 mm Hg vs. 9.4 mm Hg; P = 0.003). Among Acomm aneurysm cases, the monitored group showed a significantly lower MRM swelling ratio (postoperative MRM area/preoperative MRM area) compared with the control group (1.03 ± 0.10 vs. 1.17 ± 0.15; P = 0.036).ConclusionsMyocutaneous flaps can produce unnoticed overpressure on the orbit, resulting in OCS-related blindness during aneurysm clipping surgery, especially in cases involving mandatory lower craniotomy. The continuous extraocular compressive pressure monitoring technique is a simple and effective approach to prevent such a serious complication.Copyright © 2018 Elsevier Inc. All rights reserved.

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