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Blindness following bilateral radical neck dissection.

S C Marks¹, D A Jaques, R M Hirata

¹Department of Otolaryngology, Johns Hopkins University, School of Medicine, Baltimore, Maryland.

|July 1, 1990

Summary

Blindness after bilateral radical neck dissection is rare. This case reveals optic nerve infarction due to hypotension and venous hypertension from internal jugular vein ligation.

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Area of Science:

Ophthalmology
Neurosurgery
Vascular Surgery

Background:

Bilateral radical neck dissection (BRND) is a surgical procedure to remove lymph nodes in the neck.
Blindness is a rare but severe complication following BRND.

Observation:

A patient experienced total blindness after simultaneous BRND.
This is the fifth reported case of blindness post-BRND.
It is the first case with pathological examination of the optic tracts.

Findings:

Microscopic examination showed bilateral intraorbital hemorrhagic optic nerve infarction.
No evidence of embolization or ophthalmic artery occlusion was found.
The probable cause is prolonged hypotension, potentially exacerbated by venous hypertension from bilateral internal jugular vein ligation.

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Implications:

This study highlights a potential mechanism for blindness after BRND.
It suggests careful hemodynamic monitoring during and after bilateral neck dissections is crucial.
Understanding these vascular complications can inform surgical strategies and patient management.