Orbital compartment syndrome after pterional craniotomy for arachnoid cyst resection

Abstract

Orbital Compartment Syndrome (OCS) represents a critical medical emergency characterized by heightened orbital pressure, jeopardizing blood flow and posing a risk to the optic nerve. Often stemming from surgical procedures such as craniotomies for arachnoid cyst resection, OCS necessitates swift diagnosis and intervention. We report the case of a 77-year-old female in São Paulo, Brazil, who underwent left pterional craniotomy for arachnoid cyst resection. Postoperatively, she manifested reduced visual acuity in the left eye, restricted ocular movement, and peripalpebral hematoma indicative of orbital compression syndrome. Computed tomography scans confirmed pneumocephalus and pneumo-orbital complications, prompting an immediate diagnosis of OCS. Immediate interventions, including lateral canthotomy and cantholysis, were employed, resulting in successful decompression and substantial symptom improvement within a 10-day period. This case underscores the significance of preoperative imaging, prompt diagnostic measures, and collaborative postoperative care in managing orbital complications following neurosurgery.

Keywords

• orbital compartment syndrome
• pneumocephalus
• pneumo-orbital