Transient cortical blindness

see Cortical blindness.

Children may develop transient cortical blindness lasting 1-2 days , usually after a blow to the back of the head.

In a Single-patient case report detailing transient cortical blindness following pineal region meningioma surgery Yip et al. from the University of Edinburgh and NHS Lothian, Edinburgh, UK. published in *BMJ Case Reports*, June 27, 2025; Volume 18(6):e264865. to highlight the occurrence of transient cortical blindness following occipital lobe retraction during a pineal meningioma resection and raise awareness about anatomical risk factors.

- Middle-aged woman with pineal meningioma causing triventriculomegaly. - Underwent ETV followed by tumor resection via parieto-occipital interhemispheric approach. - Post-op: complete cortical blindness, no MRI evidence of ischemia. - Gradual visual recovery: partial by 3 weeks, full by 8 months. - Implicated cause: bilateral occipital retraction injury despite uneventful surgery ¹⁾.

- Strengths:

1. Describes a rare but important surgical complication, especially relevant in posterior fossa and pineal surgery.
2. Clear clinical timeline with good recovery documentation.
3. Highlights subtleties of non-ischemic cortical dysfunction and relevance of fMRI in post-op assessment.

- Limitations:

1. Lack of functional imaging (e.g., fMRI, perfusion studies) to correlate with presumed retraction injury.
2. No intraoperative monitoring data (e.g., visual evoked potentials) or detail on retraction technique.
3. Tentorial angle mention is appropriate, but no imaging shown to support that anatomical claim.
4. Single case, hence anecdotal and non-generalizable.

- Score: 4.5/10 — educationally useful for neurosurgical awareness but limited by lack of objective neurophysiologic or imaging data.

Occipital lobe retraction—even absent radiographic ischemia—can cause reversible cortical blindness, particularly in posterior approaches. Gentle retraction and patient selection (tentorial angle, age) may reduce risk.

Transient cortical blindness may follow occipital lobe manipulation without infarction; full recovery is possible but underscores need for cautious occipital retraction during pineal region surgeries.

Transient cortical blindness following occipital lobe retraction in a pineal region meningioma resection. Yip NZW, et al. *BMJ Case Rep.* 2025;18(6):e264865. doi:10.1136/bcr-2025-264865. Corresponding author: Catriona Barbour-Hastie, catriona.barbour-hastie@nhs.scot