Blindness After Frontal Craniotomy

In our practice at our department, we have encountered two clinical cases involving the complete loss of vision and ophthalmoplegia after craniotomy on the vascular pathology of the brain. Both patients underwent microsurgery via bifrontal skin incision. In the first case, the subfrontal craniotomy on the right side was made, and then microsurgical resection of an arteriovenous malformation of the right frontal lobe was performed. In the second case, a fronto-basal interhemispheric craniotomy was made for aneurysm surgery. This surgery included an intracranial anastomosis in a side-to-side fashion between the A3 segments of both anterior cerebral arteries, and a clip was applied proximal to a fusiform aneurysm located in the A2 segment of the anterior cerebral artery. The intracranial part of the procedure was uneventful. However, upon awakening from anesthesia after surgical treatment, both patients developed bilateral amaurosis and ophthalmoplegia.A thorough morbidity and mortality (M&M) analysis of these cases was performed, including a retrospective analysis of the clinical condition of patients and their ophthalmological status prior to surgery. Video recordings of the surgery and of anesthesia management and its records were carried out. Intraoperative iatrogenic direct damage to the cranial nerves and arteries was excluded.From the data obtained, a putative intraoperative explanation of the decisive causative factor was highlighted: direct pressure on the eyeballs from the retracted skin flap during both surgeries.