Postoperative visual loss (POVL) is a rare but catastrophic complication of spine surgery. The extremely low incidence has made its study and prevention a challenge for neuroanesthesiologists. This chapter presents a case study of a 62-year-old female who presented for a revision L4-5 foraminotomy and L4-S1 transverse lumbar interbody fusion. There are multiple causes of POVL, including cortical infarction, direct injuries to the eye and ischemic injuries to the retina and optic nerve. The most common permanent injuries are ischemic in nature including central retinal artery occlusion (CRAO) and ischemic optic neuropathy (ION). Many risk factors have been proposed yet understanding of the etiology of ION remains inadequate. Until we have a better understanding of these risk factors, careful attention to the eyes, staged procedures, vigilance with regard to intraocular pressure and the optimization of oxygen-carrying capacity are the best preventative measures available.

Temporal (giant cell) arteritis is a systemic disease, involving various medium-sized and larger arteries, that occurs mostly in elderly patients. Blindness due to ischemic optic neuropathy is probably the most common and most feared sinister manifestation of the disease, but stroke is the leading cause of death in patients with temporal arteritis. Noninvasive angiography using computed tomography (CT) or magnetic resonance imaging (MRI) may reveal sites of vascular stenoses. A typical finding is smoothly tapered stenotic lesions different from the abrupt, irregular stenoses of atherosclerotic disease. These modalities may be helpful in assessing the extent of disease or potentially to aid diagnosis especially in biopsy negative cases. Fludeoxyglucose-positron emission tomography (FD-PET) scanning may reveal uptake in the larger thoracic vessels including aorta, subclavian, and carotid arteries. The mainstay of treatment is corticosteroids, although there is much debate about the optimal dose and use of steroid sparing immunosuppressives.