Improvement of visual acuity after cranioplasty: a new window for functional recovery of post-traumatic visual loss?

Abstract

The association between cranioplasty and improvement in visual function is not well established. A 27-year-old man presented to the emergency department of a different hospital with severe traumatic brain injury in July 2016. He was treated with a bifrontal approach to a frontal contusion, and on the third post-operative day developed a hemispheric brain edema for which he underwent a decompressive craniectomy. After 5 weeks of neurointensive care, he was discharged with significant visual acuity impairment and referred to us for cranioplasty. On admission, the patient was awake and aware with no motor strength impairments. Visual acuity in the left eye: ability to count fingers at 30 cm; in the right eye: sensation of light perception. He subsequently underwent a cranioplasty with no post-operative complications. At the 1-month follow-up post-surgery, he was evaluated ophthalmologically and showed visual improvement. Visual acuity in the left eye was 20/30, while the right eye exhibited mere sensation of light perception. No additional clinical or surgical treatment was performed. No previous reports of improvement of visual acuity after cranioplasty were found, except in cases of optic nerve decompression. We believe that the improvement of the patient was due to the normalization of the intracranial pressure, taking into account that the massive bone damage could have caused alterations in the cerebral circulation of the cerebral blood flow and in the intracranial pressure. With this report, we intend to stimulate new investigations in this field and to draw the attention of the medical community to the importance of cranioplasty as a functional surgery.