Improvement of Visual Acuity After Cranioplasty: A New Window for Functional Recovery of Post-Traumatic Visual Lost? Case Report

Case Presentation: A previously healthy 27-years-old man, with history of severe traumatic brain injury in July 2016, admitted in another service submitted bifrontal approach to frontal contusion, on the 3rd postoperative day presents hemispheric brain edema and was to a fronto-temporoparietal decompressive craniectomy. After 5 weaks of neurointensive care the patient evolved with neurological improvement and hospital discharge without motor strenght imparement but he was with important visual acuity impairment referred to our service for cranioplasty. On admition to our service the patient was awake and aware, no motor strength impairements, visual acuity: left eye counts fingers at 30 cm, right eye has sensation of light perception. The patients were submitted to bifrontal and right temporoparietal cranioplasty with acrylic osseous cement, no postoperative complications and discharged at 2nd postoperative day. On the follow-up the patients present to ophthalmological evaluation with 1 month postoperative and referred visual improvement, on examination visual acuity was left eye: 20/30/right eye sensation of light perception. No other additional clinical or surgical treatment was performed.

Discussion: We did not find in the literature previous reports of improvement of visual acuity after cranioplasty, except in cases of optic nerve decompression. We believe that the improvement of the patient presented should be the normalization of the intracerebral pressure taking into account that the great bone failure could cause alterations in the cerebral circulation of the cerebral blood flow and the intracranial pressure, the cranioplasty as a functional procedure with evidence of cognitive improvement is relatively well documented in the literature, however, we believe that if we present a small evidence of possible functional gains for patients undergoing this procedure, the presentation of this case aims to suggest to the academic community a more rigorous follow-up of the pre and postoperative visual acuity in order to generate evidence or not between craniectomy, cranioplasty and visual acuity.