RESUMO
Superior ophthalmic vein (SOV) thrombosis is a rare complication of carotid-cavernous fistula (CCF) embolization and is usually associated with a paradoxical worsening of signs followed by subsequent spontaneous resolution. We report a case in a 69-year-old female who developed orbital compartment syndrome due to SOV thrombosis following transvenous embolization of an indirect CCF. The patient was treated with an urgent lateral canthotomy and cantholysis and had good recovery. This report demonstrates that the paradoxical worsening due to SOV thrombosis in CCF may result in orbital compartment syndrome and require early recognition and prompt decompressive measures to avoid permanent visual sequelae.
Assuntos
Fístula Carótido-Cavernosa/terapia , Síndromes Compartimentais/etiologia , Embolização Terapêutica/efeitos adversos , Doenças Orbitárias/etiologia , Idoso , Blefaroptose/diagnóstico por imagem , Blefaroptose/etiologia , Blefaroptose/cirurgia , Fístula Carótido-Cavernosa/diagnóstico por imagem , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/cirurgia , Exoftalmia/diagnóstico por imagem , Exoftalmia/etiologia , Exoftalmia/cirurgia , Feminino , Humanos , Pressão Intraocular , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/cirurgia , Distúrbios Pupilares/diagnóstico por imagem , Distúrbios Pupilares/etiologia , Distúrbios Pupilares/cirurgia , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/cirurgiaRESUMO
Orbital surgery is often conducted in areas with limited exposure where vital structures are tightly crowded together. A bloodless field is paramount in orbital surgery for the proper identification of normal and pathologic tissue and even minimal bleeding can obscure the surgical field, making surgery more difficult and increasing the risk of complications. Surgery for highly vascular orbital lesions is an additional situation where maintaining an adequate surgical field is often challenging but paramount. The role of the anaesthetist in controlling surgical blood loss has been increasingly recognized in the last few decades. Various techniques including hypotensive anaesthesia have been described, but the control of intraoperative bleeding does not rely on a single particular technique, but a series of well-designed interventions that result in optimal conditions. An understanding of the anaesthetic considerations pertinent to haemostasis is invaluable for oculoplastic surgeons. Additionally, with the growing use of endonasal approaches to medial wall decompression and accessing the medial orbit, it has become increasingly important that orbital surgeons understand the anaesthetic requirements of their colleagues in other disciplines.
