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Retinal hemorrhage after pediatric neurosurgical procedures
Caroline W Chung1, Alex V Levin2, Brian J Forbes1
1The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Neurosurgery in children does not cause retinal hemorrhage. A study found no cases where neurosurgery independently caused retinal bleeding, suggesting it
Area of Science:
- Ophthalmology
- Pediatric Neurosurgery
- Child Abuse Forensics
Background:
- Neurosurgical procedures in children may precede eye exams, complicating diagnosis of abusive head trauma.
- Questions arise regarding neurosurgery's role in postoperative retinal hemorrhages.
Purpose of the Study:
- To determine the prevalence and patterns of retinal hemorrhage attributable to neurosurgical intervention in children.
Main Methods:
- Retrospective cohort study of children undergoing neurosurgery with postoperative ophthalmoscopy.
- Review of medical records to identify confounding factors and pre-existing conditions.
Main Results:
- No cases of post-neurosurgery retinal hemorrhage were attributed to the procedure itself.
- Retinal hemorrhages observed were pre-existing or linked to known causes like head trauma, hydrocephalus, or retinopathy of prematurity.
Conclusions:
- Neurosurgery is unlikely to independently cause retinal hemorrhage in children.
- Neurosurgery is not a significant confounding factor in evaluating retinal hemorrhage patterns in child abuse cases.
Background:
Neurosurgical procedures may occur prior to eye examination in children with suspected abusive head trauma and raise questions by child abuse physicians and ophthalmologists regarding the contribution of neurosurgery to retinal hemorrhage found postoperatively. The purpose of this study was to determine the prevalence and patterns of retinal hemorrhage attributable to neurosurgical intervention in children.
Methods:
We conducted a retrospective cohort study of children undergoing neurosurgery who had postoperative ophthalmoscopy. Some children were also examined preoperatively. Primary outcome measures were the prevalence and patterns of retinal hemorrhage attributable to neurosurgical intervention. Medical records were reviewed to identify confounding coexistent diseases.
Results:
Among 267 children undergoing 289 neurosurgical procedures, there were no cases in which children had post-procedural retinal hemorrhage that could be attributed to neurosurgery. Retinal hemorrhage was seen in 32 (12%) cases, but in every case they were either already present on preoperative examination (13 cases) or matched the pattern of a coexistent known cause of retinal hemorrhage, including head trauma with unambiguous history and/or nonocular signs (13), hydrocephalus-related increased intracranial pressure with papilledema-associated peripapillary retinal hemorrhage (5), and retinopathy of prematurity ridge-associated retinal hemorrhage (1). No retinal hemorrhage could be attributed only to neurosurgery.
Conclusions:
Although children undergoing child abuse evaluations may have intracranial hemorrhage requiring neurosurgery that occurs before a dilated retinal examination can be performed, our data suggest that neurosurgery independently is unlikely to produce retinal hemorrhage and therefore is not a significant confounding factor in the interpretation of retinal hemorrhage patterns in child abuse evaluations.
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