Central retinal artery occlusion combined with posterior ciliary artery occlusion after preoperative embolization of the middle meningeal artery for intracranial meningioma: A case report

RATIONALE: Preoperative embolization of brain tumors has been widely used to minimize hemorrhaging during surgery, but anastomosis between vessels is sometimes overlooked and complications can occur. Herein we describe a case of rare complications of central retinal artery occlusion (CRAO) and posterior ciliary artery occlusion after embolization of the middle meningeal artery. PATIENT CONCERNS: A 48-year-old woman experienced acute, painless loss of vision in her left eye during embolization of the middle meningeal artery for meningioma. DIAGNOSIS: The patient was diagnosed with CRAO and posterior ciliary artery occlusion based on indirect ophthalmoscopy, optical computed tomography of the macula, and fundus angiography. INTERVENTIONS: Ocular massage, oral acetazolamide, and topical brimonidine eyedrops were administered. OUTCOMES: Visual acuity decreased from hand motion to no light perception within 2 months. Optic disc atrophy with retinal thinning was evident after 2 to 4 months. LESSONS: The blood supply and any collateral vessels of the ophthalmic artery should be vigilantly scrutinized to prevent complications during embolization of the middle meningeal artery that may lead to a poor visual outcome.