脳動脈瘤クリッピング術後に失明をきたした4症例の検討  [in Japanese] Clinical Study of 4 Cases with Blindness after Aneurysm Surgery  [in Japanese]

An analysis of postoperative complications in 637 cases of aneurysm surgery that were performed at 3 associated institutions during 10 years between October 1, 1995, and September 30, 2004, revealed 4 cases of postoperative blindness. We present the etiology, patient background, and course of these cases. The 4 cases comprised 3 men and 1 woman, aged 40 to 63 years. Patients had a history of hypertension (n=3), and diabetes (n=1). Aneurysms were located at the distal ACA (n=2), A-corn. (n=1), and MCA (n=1), and comprised ruptured (n=3), and unruptured (n=1) aneurysms. All patients became blind on the side that craniotomy was performed on. Although cerebral angiography was performed postoperatively for 2 patients, no vascular occlusion was detected as a possible cause. After follow-up of 2 to 9 years, patients currently have blindness (n=1), light perception (n=1), and hand movement vision (n=2). Blindness was thought to have been caused by an increase in intraorbital pressure during reflection of the skin flap, which led to ocular hypertension and caused circulatory insufficiency in the central retinal and short posterior ciliary arteries, which are responsible for nourishing the retina and optic nerve.