gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Intraocular pressure during intradural spine surgery in prone position – preliminary results of a prospective single center trial

Meeting Abstract

  • Patrick Czorlich - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf, Germany
  • Nikolas Kluge - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf, Germany
  • Christos Skevas - Augenklinik, Universitätsklinikum Hamburg-Eppendorf, Germany
  • Volker Knospe - Augenklinik, Universitätsklinikum Hamburg-Eppendorf, Germany
  • Manfred Westphal - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf, Germany
  • Sven Oliver Eicker - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.18.06

doi: 10.3205/16dgnc210, urn:nbn:de:0183-16dgnc2107

Published: June 8, 2016

© 2016 Czorlich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Postoperative loss of vision (PLV) is a rare but serious complication in approximately 0.05% of all spinal surgeries performed in prone position. The intraocular pressure (IOP) increases in the prone position and it is supposed that this leads to a decrease of the perfusion pressure of the optic nerve. Reports of PLV are known for extradural spinal surgery but no reports of PLV were identified for intradural spinal procedures so far. We assumed that the IOP is related to the intracranial/intradural pressure. Therefore we designed this prospective explorative study to evaluate the intraoperative IOP course in intradural spinal surgery.

Method: After approval by the local ethic committee we started to enrol patients with an intradural pathology. Enrolled patients underwent an extensive preoperative ophthalmological examination including measuring the IOP. The IOP was then measured after intubation, after placement in the prone position, every 30 minutes from this point on-going, after opening of the dura mater and loss of cerebrospinal fluid (CSF), at the end of surgery in the prone position and after return in the supine position. Additionally blood pressure and data regarding the intraoperative volume management were collected. Statistical analysis was performed using Student's t-test.

Results: Up to date 5 patients were enrolled in this study. IOP after intubation in the supine position was 13.6 ± 5.8 mmHg in contrast to 23.2 ± 5.0 mmHg after placement in the prone position (p=0.006). The maximum IOP in the spine position before opening of the dura mater was 31.2 ± 6.9 mmHg and after loss of CSF the IOP was 26.4 ± 6.3 mmHg (p=0.058). IOP at the end of the surgery in prone position (29.6 ± 5.0 mmHg) was lower than at the maximum before loss of CSF (31.2 ± 6.9 mmHg) (p=0.57). Up to date no patient suffered from PLV.

Conclusions: Our results underline that the IOP increases in the prone position in contrast to the supine position. As we hypothesized the IOP decreased after opening of the dura mater and loss of CSF, which might be the reason for missing reports of PLV in intradural spinal surgeries.