Posterior ischemic optic neuropathy following supine craniotomy for epidural abscess in a child

Post-operative vision loss (POVL) can be a devastating complication of neurosurgical procedures and is unusual in the pediatric population. Mechanisms of POVL include direct optic nerve injury, vascular occlusion, or indirect malperfusion resultant from surgeries with substantial blood loss or fluid shifts, with prone positioning being a major risk factor for these events. Posterior ischemic optic neuropathy (PION) is a rare cause of POVL and is associated with a poor prognosis for recovery of visual function. We present a case of PION following a supine bifrontal craniotomy for a frontal epidural abscess secondary to pan-sinusitis in a pediatric patient. This is an unusual reported case in that no additional traditional risk factors were identified. We present clinical and radiographic findings, diagnostic considerations, treatment strategies, and a literature review. The patient was managed medically and recovered substantial vision in the affected eye.