对于患者和手术团队来说，仰卧位开颅手术后的视力丧失是一种意想不到的、毁灭性的并发症。术后视力丧失 (POVL) 通常与心脏、脊柱、颈部和俯卧头部手术相关，因为它们具有共同的危险因素，例如俯卧位、术中低血压、较长的麻醉时间和使用血管加压药。在此，作者报告了一个仰卧位额部开颅手术后不可逆视力丧失的病例，并回顾了文献。总结了自 1970 年首次报道以来文献中发表的所有病例。讨论了可能的病因和建议的预防措施。不同的病理，例如血管、轴内和轴外病变，与 POVL 相关，并且具有相似的临床过程和不恢复率，这提出了 POVL 是否在暴露期间开始的问题这些手术的一部分。预防措施可能包括避免在皮瓣反射过程中直接施加眼压，使用松紧带或鱼钩以避免拉伸眼眶内容物和损害静脉流出，以及仔细检查额叶肿瘤的静脉引流，这可能有助于避免不必要的大静脉血栓或打蜡。术中视觉神经生理学监测在预测 POVL 中的作用需要进一步探索。 https://thejns.org/doi/10.3171/CASE2434。

Vision loss following supine craniotomy is an unexpected and devastating complication for the patient and the operating team. Postoperative vision loss (POVL) is commonly associated with cardiac, spinal, neck, and prone head surgeries, as they share common risk factors, such as a prone position, intraoperative hypotension, a longer anesthesia duration, and the use of vasopressors. Herein, the authors report a case of irreversible vision loss following a frontal craniotomy in the supine position together with a review of the literature. All published cases in the literature since the first reported case in 1970 are summarized. Possible etiologies and proposed preventive measures are discussed.Different pathologies, such as vascular, intra-axial, and extra-axial lesions, are associated with POVL and have similar clinical courses and nonrecovery rates, which raises the question of whether POVL begins during the exposure part of these surgeries.Preventive measures could include avoiding direct ocular pressure during flap reflection, the use of elastic bands or fishhooks to avoid stretching the orbital contents and impairing venous outflow, and a careful review of the venous drainage of frontal tumors, which could help avoid unnecessary large venous thrombi or waxing. The role of intraoperative visual neurophysiological monitoring in predicting POVL requires further exploration. https://thejns.org/doi/10.3171/CASE2434.