title: Cortical blindness following posterior lumbar decompression and fusion.
abstract: Perioperative vision loss following non-ocular surgery is a well-documented phenomenon. In particular, perioperative vision loss has been frequently cited following spinal surgery. Although the rate of vision compromise in spinal surgery is relatively low, the consequences can be quite severe and devastating for the patient. We report a 60-year-old woman who initially presented with back and left leg pain as well as paraparesis. Imaging studies of the lumbar spine showed bony erosion consistent with tumor infiltration of the L3 and L4 spinal segments. Laminectomy at the L2-L4 levels for decompression of the intraspinal tumor was performed. Pathology of the resected bone was consistent with metastatic adenocarincoma. Postoperatively, the patient suffered severe anemia and bilateral infarctions of the posterior cerebral arteries and occipital lobes resulting in vision compromise. Although a definitive pathogenesis remains unknown, preoperative cardiovascular issues and intraoperative hemodynamic instabilities have typically been implicated as high risk factors. High risk factors for this novel clinical presentation of visual compromise following posterior lumbar laminectomy with decompression for an intraspinal tumor are reported.
authors.affiliation: Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101-1709, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101-1709, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Hansberry
authors.affiliation: Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101-1709, USA. Electronic address: goldstir@umdnj.edu.
authors.forename: Ira M
authors.initials: IM
authors.lastname: Goldstein
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery; D019575:Blindness, Cortical / Q000209:etiology*; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology*; D013123:Spinal Fusion / Q000009:adverse effects*
keywords: Cortical blindness; Lumbar surgery; Occipital stroke