PMC8422536_01
Preoperative (a) and postoperative (b) CT head scans show the site of a parasagittal meningioma and its subsequent complete resection. Bilateral electroretinogram in scotopic (c) and phototopic (d) protocols, which show prolonged latencies, decreased amplitudes and distortion in a and b waves, as signs of moderate to severe diffuse retinopathy in both eyes. Right (e) and left (f) eyes retinal fluorescein biography shows delay in the arterial phase as well as in the optic nerve head hypofluorescence in late phases. The macula is marked with black arrows while the absence of cilioretinal arteries with black arrowheads. Spectral domain optical coherence tomography (at 3 months after surgery) of the right eye (g) and left eye (h) show chronic changes caused by CRAO.
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F1
Fluorescein angiography showed adequate choroidal filling in both eyes with delayed arterial phase and all subsequent phases; as well as, in late phases an absence of bilateral optic nerve staining occurred, confirming a bilateral CRAO [Figure 1].
Postoperative right (a) and left (b) internal carotid digital subtraction angiography (DSA) shows ophthalmic artery (black asterisks) on the same side, the ciliary arteries (black arrows) and the attenuated choroidal blush of the eye (black arrowheads). Right (c) and left (d) external carotids DSA shows no choroidal blush nor the presence of some dangerous anastomosis of the ophthalmic artery with the middle meningeal artery (black arrows) or with the internal maxillary (black arrowheads). Postoperative DSA (e) shows the right ophthalmic artery (white arrow), the origin of the central retinal artery (white arrowhead), and the delay in filling in phase of the distal portion of the central retinal artery (black arrowheads), which is partially supplied by the vascular ring of Zinn (black arrow). (f) shows left ophthalmic artery (white arrow), the posterior ciliary artery (white arrowhead), in addition to a delay in the filling of the central retinal artery (black arrow heads) and partial replacement through the vascular ring of Zinn (black arrow). Sagittal (g) T2-weighted brain MRI shows hyperintensity of both optic nerves in its intra-orbital segment (white arrowhead), suggestive of bilateral optic nerve infarction. Right and left fundi (h) at 3 months follow-up after surgery. Axial (i) T2-weighted brain MRI shows hyperintensity of both optic nerves.
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F2
Postoperative digital subtraction angiography was performed showing adequate blood flow through both OAs and a significant decrease in bilateral choroidal blush [Figures 2]. Brain MRI showed no suggestive lesions of stroke in the DWI sequence and intra-orbital segment hyperintensity in T2-weighted sequences, suggesting for bilateral optic nerve infarction [Figure 2].