A 58-year-old woman underwent left frontotemporal
craniotomy for clipping of an unruptured
cerebral aneurysm. A small defect was accidentally created in the orbital roof intraoperatively. The patient developed left eyelid
edema and ocular
pain after recovery from
anesthesia. The following day, the eyelid
edema worsened, and she had difficulty opening her eyes. On the 9th postoperative day, she noticed diminished visual acuity and
diplopia in her left eye when she was able to spontaneously open her eyes. Ophthalmological evaluation revealed mild left visual loss, decreased light reflex,
ophthalmoplegia, ptosis, and chemosis. Computed tomography(CT)/magnetic resonance imaging revealed left
proptosis, optic nerve stretching, intra-orbital fluid retention, and orbital/palpebral
emphysema. She was diagnosed with orbital
compartment syndrome(OCS)and received
conservative treatment;however, her visual acuity did not improve. OCS observed after
cerebral aneurysm surgery is rare;to date, only 24 cases have been reported in the available literature. Although the mechanism of OCS after
craniotomy is unclear, it may be attributed to ocular compression by a muscle flap or increased intra-orbital pressure secondary to
venous congestion. In the present case, the left superior ophthalmic vein and cavernous sinus were not clearly visualized on CT angiography. Therefore, we concluded that the right superior ophthalmic vein and superficial facial veins underwent dilatation and served as collateral circulation of the left orbital venous system. We speculate that OCS occurred secondary to increased intra-orbital pressure, possibly caused by inflow of cerebrospinal fluid with air into the orbit through a small bone defect that was accidentally created during
craniotomy in a setting of orbital
venous congestion.