Extraocular Pressure Measurements to Avoid Orbital Compartment Syndrome in Aneurysm Surgery
| Autor: | Tae Shin Kim, Jung Yul Park, Junseok W. Hur, Dong Hyuk Park, Yong Gu Chung, Shin Hyuk Kang, Kyung Jae Park |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Compartment Syndromes Surgical Flaps 03 medical and health sciences Postoperative Complications 0302 clinical medicine Aneurysm medicine.artery medicine Humans Ocular Physiological Phenomena Craniotomy Aged Aged 80 and over business.industry Medial rectus muscle Intracranial Aneurysm Middle Aged medicine.disease eye diseases Surgery Anterior communicating artery medicine.anatomical_structure 030221 ophthalmology & optometry Female Neurology (clinical) Complication business Orbit 030217 neurology & neurosurgery Orbit (anatomy) |
| Zdroj: | World Neurosurgery. 118:e601-e609 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2018.06.248 |
| Popis: | Background Orbital 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. Methods We 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. Results Extraocular 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). Conclusions Myocutaneous 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. |
| Databáze: | OpenAIRE |
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