엎드린 자세 요추수술 후 발생한 단안 시력 상실 및 전체 눈근육 마비
Visual Loss with Ophthalmoplegia after Prone Position Spinal Surgery
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목적: 척추수술 전 편측 속목동맥 폐색에 따른 해부학적 변이로 곁가지 순환에 동측 안구 혈류 공급을 의존했던 환자에서 술 후 발생한 동측 단안 실명 및 전체 눈근육 마비를 경험하였기에 이를 보고하고자 한다. 증례요약: 74세 남자 환자가 엎드린 자세 요추수술 후 발생한 단안 시력 저하 및 외안근 마비를 주소로 술 후 1일만에 의뢰되었다. 내원 당시 시력은 우안 0.8, 좌안 광각무였다. 안압은 정상이었으며, 좌안에 상대구심동공운동장애가 있었고 전방향 안구운동 제한과 안검하수를 보였다. 안저검사상 좌안 중심와 앵두반점 및 창백 망막 소견이 관찰되었다. 뇌 자기공명영상 혈관조영검사상 좌측 속목동맥의 완전 폐색 소견이 확인되었다. 3일간 1 g 메틸프레드니솔론 정맥 내 주사 치료 후 퇴원하였고 7개월 후 전방향 운동 제한은 호전되었으나 시력은 회복되지 않았다. 결론: 기저질환으로 편측 속목동맥의 완전 폐색으로 안구혈류공급을 곁가지 순환에 의존했던 환자에서 척추수술 후 발생한 중심망막동맥폐쇄에 의한 시력 저하 및 외안근 마비가 발생한 경우이며, 유사 사례 발생 시 기존에 보고된 원인들 외에도 환자의 기저질환과 관련된 해부학적 변이에 의한 사례일 가능성을 염두에 두어야 한다.
Abstract
Purpose: We report a case of acute visual loss with ophthalmoplegia after prone position spinal surgery who had blood supply dependence on collateral circulation due to occlusion of the Internal carotid artery. Case summary: A 74-year-old man was referred to the department of ophthalmology for acute visual loss and ophthalmoplegia after lumbar spine surgery performed in prone position. On the initial visit, his right visual acuity was 0.8 and the left visual acuity was negative light perception. Intraocular pressure was normal. There was a relative afferent pupillary defect and ophthalmoplegia of all directions in the left eye. Because of the ptosis of the upper eyelid in the left eye, it was impossible to tune the eye voluntarily. The cherry red spot and pale retina were observed on the fundus examination. On brain magnetic resonance imaging angiography, we found complete obstruction of the left internal carotid artery. He had intravenous injection of 1 g methylprednisolone for 3 days, and discharged with per oral medicine. After 1 month of treatment, the ophthalmoplegia was slightly improved, but visual acuity was not recovered. Conclusions: In this case, unlike previous reports, acute visual loss and ophthalmoplegia occurred after spinal surgery the patient who had collateral circulation for ocular blood supply because of complete obstruction of the left internal carotid artery. This report highlights the importance of being aware of the anatomical variant in possible complications of external ocular compression after non-ocular surgery.
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