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Unilateral Orbital Compartment Syndrome after Cervical Spine Surgery-A Case Report
頸椎手術後發生之單側眼窩腔室症候群－病例報告
摘要
目的：報告一例頸椎手術後發生單側眼窩腔室症候群之病例。 方法：病例報告。 結果：48歲男性因患第三至第四頸椎之脊髓脊神經根病，所以接受了第三至第四頸椎椎板切除及固定手術。在恢復室時病人主述右眼疼痛並且完全失去視力。外眼檢查發現右眼紅、熱、眼瞼腫脹、明顯凸眼、結膜水腫以及完全眼肌癱瘓。右眼視力為無光覺眼壓為58毫米汞柱。間接眼底鏡發現右眼視網膜瀰漫性水腫合併有一不明顯的櫻桃紅斑點。診斷為眼窩腔室症候群。立即給予靜脈注射甘露醇、高劑量的類固醇、局部乙型阻斷劑與口服碳酸酐抑制劑。治療後眼窩腔室症候群被緩解但右眼視力仍然是無光覺。在之後九個月的追蹤中右眼視力並沒有恢復。 結論：在全身麻醉中因為不適當的姿勢所給予眼球的不正常壓力可能會導致眼窩腔室症候群。迅速的診斷與治療是最重要的預後因子。
關鍵字
無資料並列摘要
Purpose: To report a case of unilateral orbital compartment syndrome after C3-C4 laminectomy and C3-C4 fixation operation. Method: Case report. Result: A 48-year-old man received C3-C4 laminectomy and fixation for C3-C4 myeloradiculopathy. The patient complained of severe ocular pain in the right eye and loss of vision in the recovery room. External examination revealed erythema, warmth, eyelid edema, marked proptosis, conjunctival chemosis and complete ophthalmoplegia in the right eye. The visual acuity was no light perception and the intraocular pressure(IOP) was 58mmHg in the right eye. Indirect ophthalmoscopy of the right eye revealed diffuse retina edema with a poorly defined cherry red spot. Orbital compartment syndrome was impressed. Intravenous mannitol, high dose methylprednisolone, topical β-blocker and oral carbonic anhydrase inhibitor were administered. The orbital compartment syndrome was relieved after treatment, however the visual acuity of the right eye remained no light perception. During the follow-up period of 9 months, his visual status didn't recover. Conclusion: Orbital compartment syndrome may occur as a consequence of inadvertent pressure on the globe due to improper position during spinal surgery. Prompt diagnosis and management is the most important prognostic factor.