Cerebral vasospasm and ischemia after orbital decompression for graves ophthalmopathy

Purpose: We describe the first reported cases of cerebral vasospasm, ischemia, and infarct after orbital decompression surgery for Graves disease-related ophthalmopathy. Methods: We present two patients who had inadvertent penetration of the dura mater during orbital decompression surgery. One case was recognized at surgery; the other was not. All patient data were gathered and relayed in accordance with state and U.S. laws. Results: Postoperative cerebrospinal fluid leak, radiographic evidence of subarachnoid hemorrhage, and severe neurologic morbidity occurred in each case. Cerebral ischemia and infarction resulting from subarachnoid hemorrhage-induced cerebral vasospasm occurred in each case. Conclusions: The risk of dural penetration, cerebral vasospasm, and ischemia should be considered during preoperative evaluation for orbital decompression surgery. The diagnosis, treatment, and prevention of this previously unreported serious complication of this procedure is paramount.