CASE REPORT
Introdução: A amaurose transitória é uma complicação rara pós-cirurgia da coluna vertebral. Tem maior incidência em cirurgias que exigem decúbito ventral. A etiopatogenia é in-certa, mas tem sido relacionada com isquemia do nervo ópti-co, oclusão da artéria central da retina (OACR) e lesão ocular externa. Objetivos: Relatar um caso de amaurose bilateral transitória em uma paciente submetida a tratamento cirúr-gico de hérnia discal cervical em decúbito ventral. Relato do caso: JMS, 68 anos, feminina. Dor cervical unilateral e mo-noradicular no trajeto de C6 há três meses. Exame de RM da coluna cervical demonstrou hérnia discal extrusa no espaço C6-C7 à direita. Foi submetida à cirurgia sob anestesia geral, em decúbito ventral para exérese da hérnia discal cervical. Houve perda sanguínea no ato cirúrgico de 600 ml, sendo reposto durante o procedimento cerca de 300 ml. Duração do ato cirúrgico foi de 185 minutos. No pós-operatóro ime-diato apresentou perda da acuidade visual bilateral. Ao exa-me físico não havia sinais de compressão externa dos globos oculares. Exame Fundoscopia: não revelou alterações sig-nificantes. No 3º dia de pós-operatório começou apresentar recuperação parcial da acuidade visual e teve melhora total da sua acuidade visual no 16º dia de pós-operatório. Conclusões: Em nosso caso a etiologia provável foi a presença de decúbito ventral prolongado, bem como a perda transitória sanguínea. A profilaxia baseia-se no correto posicionamento do paciente na mesa operatória, hidratação normovolêmica, evitar perda sanguínea abundante no procedimento cirúrgico e redução do tempo anestésico.
Introduction: Transient amaurosis is a rare complication af-ter spinal surgery, with a higher incidence in surgeries that re-quire the prone position. Its pathogenesis is uncertain, but has been related to ischemia of the optic nerve, occlusion of central retinal artery (OCRA) and external ocular injury. Objectives: To report a case of transient bilateral amaurosis in a patient underwent surgical treatment of cervical disc herniation in the prone position. Report of case: JMS, 68 years old, female. Unilateral neck pain and monoradicular in the path of C6 for three months. MNR of the cervical spine showed extruded disc herniation at C6-C7 space on the right. She underwent surgery under general anesthesia in the prone position for resection of cervical disc herniation. There was blood loss during surgery than 600 ml, being replaced during the procedure about 300 ml. Surgical time was 185 minutes. In the immediate postop-erative period showed bilateral loss of visual acuity. Physical examination revealed no signs of external compression of the eyeballs. Fundus eyes examination, revealed no significant changes. At day 3 after surgery there was partial recovery of visual acuity and there was a total improvement of their visual acuity on the day 16 postoperatively. Conclusion: In our case the probable etiology was the presence of prolonged prone posi-tion and the temporary loss of blood. Prophylaxis is based on the positioning of the patient on the operating table, normo-volemic hydration, prevent blood loss in surgery and abundant reduction of anesthetic time.
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1. Professor Adjunto do Departamento de Medicina, Universidade Federal de Sergipe. Aracaju-Se. Brasil.
2. Neurocirurgião. Serviço de Neurocirurgia da Universidade de Tuebingen. Tuebingen – Alemanha.
3. Acadêmicas de Medicina. Universidade Federal de Sergipe, Aracaju-Se. Brasil.
Recebido em outubro de 2010, aceito em dezembro de 2010
