Suspected cavernous sinus thrombosis and blindness after lumbar spine surgery: A rare case report and literature review.

Introduction And Importance: Postoperative visual loss (POVL) is a relatively rare but devastating complication. We reported a case of POVL after spine surgery caused by ischemia of retina and optic nerve, and firstly introduced the possibility of cavernous sinus thrombosis in POVL development.

Case Presentation: A 67-year-old woman diagnosed with "lumbar spinal stenosis" was admitted to undergo posterior lumbar spinal canal decompression surgery because of the persistent lumbago and numbness. The operation was performed in the prone position under general anesthesia uneventfully. On the second day, the visual acuity of her right eye suddenly decreased to no light perception. The ophthalmic examination indicated edematous eyelid, chemosis, ptosis, ophthalmoplegia, relative afferent pupillary defect and higher orbital pressure in her affected eye, and funduscopic examination revealed pale optic disc, diffuse retinal welling and attenuated arteries. Cerebral magnetic resonance angiography implied the stenosis of cavernous sinus segment of right internal carotid artery. Aseptic cavernous sinus thrombosis and the secondary combined occlusion of central retinal and optic nerve vessels were suspected. Therefore, anticoagulation, vasodilation, oxygen and anti-inflammation treatment were timely administrated. One month after the treatment, swelling eyelid and ocular motion had markedly improved. However, there was no remarkable improvement in the patient's visual acuity.

Clinical Discussion: Postoperative visual loss (POVL) after spine surgery is regarded as a serious complication with irreversible vision damage. It was alarming that cavernous sinus thrombosis might be a possible cause of POVL. High-volume fluid replacement, unstable hemodynamic parameters, prone position and prolonged surgical duration might bring about microvascular diseases and hypercoagulable state, contributing to the occurrence of POVL.

Conclusion: Our study firstly implied the possibility of cavernous sinus thrombosis in the POVL development. Detailed assessment, fluids management, hemodynamic stabilizing and duration optimization were proposed for POVL prevention.