Blindness: a potential complication of bilateral neck dissection

When cancer spreads to both sides of the neck, as occurs in approximately 5 percent of head and neck cancers, it is considered an ominous sign. A bilateral neck dissection is often used as a means of controlling and, in some cases, curing the disease. In this surgical procedure the main muscles on the sides of the neck and the soft tissue, including the lymph nodes and the jugular veins, are removed in a single bloc of tissue. The main arterial supply, the carotid system, is left intact. Venous drainage, previously served by the removed jugular system, is conveyed by a complex interconnection of veins including those around the vertebral column. A case history describes a 49-year-old male with cancer of the larynx (voice box) that spread to the lymph nodes on both sides of the neck. The patient underwent a total laryngectomy (removal of the larynx). Following the operation his recovery was relatively normal, but four months later the disease had spread to the lymph nodes. A bilateral neck dissection was performed and the patient recovered well from the immediate effects of the surgery with the exception of severe facial swelling, which was great enough to close the patient's eyes. Examination of the eyes indicated increased pressure of the cerebral spinal fluid (CSF), but no signs of damage to the blood vessels of the retina was found. A spinal tap performed the following day confirmed the suspicion of elevated CSF pressure. The facial edema slowly resolved, and although the patient has become completely blind, he remains otherwise well. This case history suggests that the loss of sight was secondary to the elevated CSF pressure; it is hypothesized that the CSF pressure elevation may have been due to increased venous pressure within the skull (cavernous sinus) when venous blood was not adequately drained by the vertebral plexus of veins. The case points out that blindness is an infrequent, but truly devastating potential complication of bilateral neck dissection. (Consumer Summary produced by Reliance Medical Information, Inc.)