Intraocular pressure during neurosurgical procedures in context of head position and loss of cerebrospinal fluid

View More View Less
  • 1 Departments of Neurosurgery,
  • | 2 Ophthalmology, and
  • | 3 Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

Perioperative visual loss (POVL) is a rare but serious complication in surgical disciplines, especially in spine surgery. The exact pathophysiology of POVL remains unclear, but elevated intraocular pressure (IOP) is known to be part of it. As POVL is rarely described in patients undergoing intracranial or intradural surgery, the aim of this study was to investigate the course of IOP during neurosurgical procedures with opening of the dura mater and loss of CSF.

METHODS

In this prospective, controlled trial, 64 patients fell into one of 4 groups of 16 patients each. Group A included patients undergoing spine surgery in the prone position, group B patients had intracranial procedures in the prone position, and group C patients were treated for intracranial pathologies in a modified lateral position with the head rotated. In groups A–C, the dura was opened during surgery. Group D patients underwent spine surgeries in the prone position with an intact dura. IOP was measured continuously pre-, peri-, and postoperatively.

RESULTS

In all groups, IOP decreased after induction of anesthesia and increased time dependently after final positioning for the operation. The maximum IOP in group A prior to opening of the dura was 28.6 ± 6.2 mm Hg and decreased to 23.44 ± 4.9 mm Hg directly after dura opening (p < 0.0007). This effect lasted for 30 minutes (23.5 ± 5.6 mm Hg, p = 0.0028); after 60 minutes IOP slowly increased again (24.5 ± 6.3 mm Hg, p = 0.15). In group B, the last measured IOP before CSF loss was 28.1 ± 5.0 mm Hg and decreased to 23.5 ± 6.1 mm Hg (p = 0.0039) after dura opening. A significant IOP decrease in group B lasted at 30 minutes (23.6 ± 6.0 mm Hg, p = 0.0039) and 60 minutes (23.7 ± 6.0 mm Hg, p = 0.0189). In group C, only the lower eye showed a decrease in IOP up to 60 minutes after loss of CSF (opening of dura, p = 0.0007; 30 minutes, p = 0.0477; 60 minutes, p = 0.0243). In group D (control group), IOP remained stable throughout the operation after the patient was prone.

CONCLUSIONS

This study is the first to demonstrate that opening of the dura with loss of CSF during neurosurgical procedures results in a decrease in IOP. This might explain why POVL predominantly occurs in spinal but rarely in intracranial procedures, offers new insight to the pathophysiology of POVL, and provides the basis for further research and treatment of POVL.

German Clinical Trials Register (DRKS) no.: DRKS00007590 (drks.de)

ABBREVIATIONS

BP = blood pressure; ION = ischemic optic neuropathy; IOP = intraocular pressure; POVL = perioperative visual loss.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    American Society of Anesthesiologists Task Force on Perioperative Visual Loss: Practice advisory for perioperative visual loss associated with spine surgery: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss. Anesthesiology 116:274285, 2012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Amm M, Hedderich J: [Transpalpebral tonometry with a digital tonometer in healthy eyes and after penetrating keratoplasty.] Ophthalmologe 102:7076, 2005 (Ger)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Berg KT, Harrison AR, Lee MS: Perioperative visual loss in ocular and nonocular surgery. Clin Ophthalmol 4:531546, 2010

  • 4

    Carey TW, Shaw KA, Weber ML, DeVine JG: Effect of the degree of reverse Trendelenburg position on intraocular pressure during prone spine surgery: a randomized controlled trial. Spine J 14:21182126, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Chan JW: Current concepts and strategies in the diagnosis and management of idiopathic intracranial hypertension in adults. J Neurol 264:16221633, 2017

  • 6

    Cheng MA, Todorov A, Tempelhoff R, McHugh T, Crowder CM, Lauryssen C: The effect of prone positioning on intraocular pressure in anesthetized patients. Anesthesiology 95:13511355, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    David R, Zangwill L, Briscoe D, Dagan M, Yagev R, Yassur Y: Diurnal intraocular pressure variations: an analysis of 690 diurnal curves. Br J Ophthalmol 76:280283, 1992

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Deniz MN, Erakgün A, Sertöz N, Yilmaz SG, Ateş H, Erhan E: The effect of head rotation on intraocular pressure in prone position: a randomized trial. Braz J Anesthesiol 63:209212, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Emery SE, Daffner SD, France JC, Ellison M, Grose BW, Hobbs GR, et al.: Effect of head position on intraocular pressure during lumbar spine fusion: a randomized, prospective study. J Bone Joint Surg Am 97:18171823, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Farag E, Sessler DI, Kovaci B, Wang L, Mascha EJ, Bell G, et al.: Effects of crystalloid versus colloid and the α-2 agonist brimonidine versus placebo on intraocular pressure during prone spine surgery: a factorial randomized trial. Anesthesiology 116:807815, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Gilbert ME: Postoperative visual loss: a review of the current literature. Neuro-Ophthalmology 32:194199, 2008

  • 12

    Goepfert CE, Ifune C, Tempelhoff R: Ischemic optic neuropathy: are we any further? Curr Opin Anaesthesiol 23:582587, 2010

  • 13

    Grant GP, Szirth BC, Bennett HL, Huang SS, Thaker RS, Heary RF, et al.: Effects of prone and reverse Trendelenburg positioning on ocular parameters. Anesthesiology 112:5765, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Ho VT, Newman NJ, Song S, Ksiazek S, Roth S: Ischemic optic neuropathy following spine surgery. J Neurosurg Anesthesiol 17:3844, 2005

  • 15

    Hunt K, Bajekal R, Calder I, Meacher R, Eliahoo J, Acheson JF: Changes in intraocular pressure in anesthetized prone patients. J Neurosurg Anesthesiol 16:287290, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Kelly DJ, Farrell SM: Physiology and role of intraocular pressure in contemporary anesthesia. Anesth Analg 126:15511562, 2018

  • 17

    Kendrick H: Post-operative vision loss (POVL) following surgical procedures. J Anesth Clin Res 3:184, 2012

  • 18

    Kla KM, Lee LA: Perioperative visual loss. Best Pract Res Clin Anaesthesiol 30:6977, 2016

  • 19

    Kotelis D, Bianchini C, Kovacs B, Müller T, Bischoff M, Böckler D: Early experience with automatic pressure-controlled cerebrospinal fluid drainage during thoracic endovascular aortic repair. J Endovasc Ther 22:368372, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Lee LA: Perioperative visual loss and anesthetic management. Curr Opin Anaesthesiol 26:375381, 2013

  • 21

    Lee LA, Deem S, Glenny RW, Townsend I, Moulding J, An D, et al.: Effects of anemia and hypotension on porcine optic nerve blood flow and oxygen delivery. Anesthesiology 108:864872, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Lee LA, Newman NJ, Wagner TA, Dettori JR, Dettori NJ: Postoperative ischemic optic neuropathy. Spine (Phila Pa 1976) 35 (9 Suppl):S105S116, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, et al.: The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology 105:652659, 867–868, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Lee LA, Roth S, Todd MM: Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology 116:1524, 2012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Lirng JF, Fuh JL, Wu ZA, Lu SR, Wang SJ: Diameter of the superior ophthalmic vein in relation to intracranial pressure. AJNR Am J Neuroradiol 24:700703, 2003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Mirakhur RK, Shepherd WF, Darrah WC: Propofol or thiopentone: effects on intraocular pressure associated with induction of anaesthesia and tracheal intubation (facilitated with suxamethonium). Br J Anaesth 59:431436, 1987

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Molloy BL, Cong X, Watson C: Preventive dorzolamide-timolol for rising intraocular pressure during steep Trendelenburg position surgery. AANA J 84:189196, 2016

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Myers MA, Hamilton SR, Bogosian AJ, Smith CH, Wagner TA: Visual loss as a complication of spine surgery. A review of 37 cases. Spine (Phila Pa 1976) 22:13251329, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Neel S, Deitch R Jr, Moorthy SS, Dierdorf S, Yee R: Changes in intraocular pressure during low dose intravenous sedation with propofol before cataract surgery. Br J Ophthalmol 79:10931097, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Newman NJ: Perioperative visual loss after nonocular surgeries. Am J Ophthalmol 145:604610, 2008

  • 31

    Ozcan MS, Praetel C, Bhatti MT, Gravenstein N, Mahla ME, Seubert CN: The effect of body inclination during prone positioning on intraocular pressure in awake volunteers: a comparison of two operating tables. Anesth Analg 99:11521158, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Patil CG, Lad EM, Lad SP, Ho C, Boakye M: Visual loss after spine surgery: a population-based study. Spine (Phila Pa 1976) 33:14911496, 2008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Pazos GA, Leonard DW, Blice J, Thompson DH: Blindness after bilateral neck dissection: case report and review. Am J Otolaryngol 20:340345, 1999

  • 34

    Reitsamer HA, Kiel JW, Harrison JM, Ransom NL, McKinnon SJ: Tonopen measurement of intraocular pressure in mice. Exp Eye Res 78:799804, 2004

  • 35

    Rinaldi I, Botton JE, Troland CE: Cortical visual disturbances following ventriculography and/or ventricular decompression. J Neurosurg 19:568576, 1962

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36

    Sator-Katzenschlager S, Deusch E, Dolezal S, Michalek-Sauberer A, Grubmüller R, Heinze G, et al.: Sevoflurane and propofol decrease intraocular pressure equally during non-ophthalmic surgery and recovery. Br J Anaesth 89:764766, 2002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Shen Y, Drum M, Roth S: The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg 109:15341545, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Singh S, Dass R: The central artery of the retina. I. Origin and course. Br J Ophthalmol 44:193212, 1960

  • 39

    Singleton J, Dagan A, Edlow JA, Hoffmann B: Real-time optic nerve sheath diameter reduction measured with bedside ultrasound after therapeutic lumbar puncture in a patient with idiopathic intracranial hypertension. Am J Emerg Med 33:860.e5860.e7, 2015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40

    Taketani Y, Mayama C, Suzuki N, Wada A, Oka T, Inamochi K, et al.: Transient but significant visual field defects after robot-assisted laparoscopic radical prostatectomy in deep Trendelenburg position. PLoS One 10:e0123361, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Vahedi P, Meshkini A, Mohajernezhadfard Z, Tubbs RS: Post-craniotomy blindness in the supine position: Unlikely or ignored? Asian J Neurosurg 8:3641, 2013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42

    Vinik HR: Intraocular pressure changes during rapid sequence induction and intubation: a comparison of rocuronium, atracurium, and succinylcholine. J Clin Anesth 11:95100, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Walick KS, Kragh JE Jr, Ward JA, Crawford JJ: Changes in intraocular pressure due to surgical positioning: studying potential risk for postoperative vision loss. Spine (Phila Pa 1976) 32:25912595, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44

    Williams EL, Hart WM Jr, Tempelhoff R: Postoperative ischemic optic neuropathy. Anesth Analg 80:10181029, 1995

  • 45

    Yamada MH, Takazawa T, Iriuchijima N, Horiuchi T, Saito S: Changes in intraocular pressure during surgery in the lateral decubitus position under sevoflurane and propofol anesthesia. J Clin Monit Comput 30:869874, 2016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 430 34 23
Full Text Views 799 240 0
PDF Downloads 476 191 0
EPUB Downloads 0 0 0