Skip to main content

Transcranial approach for treatment for traumatic optic chiasm syndrome

Acta Neurochirurgica volume 151, Article number: 1711 (2009) Cite this article

Abstract

To describe the visual outcome of patients with a traumatic optic chiasm syndrome, with and without neurosurgical intervention. The retrospective clinical interventional study included 14 patients, who either underwent a neurosurgical intervention with transcranial decompression of the optic canal (11 patients) in combination with a high-dosage systemic corticosteroid therapy or who received a high-dosage systemic corticosteroid tretament only (3 patients). In the surgical group, visual field improved after surgery in 6 (55%) patients and remained unchanged in 5 (45%) patients, while in none of the patients without surgery, the visual field improved. Neurosurgical decompression of the optic chiasm and optic nerve canal may be associated with a visual improvement in some patients with a traumatic optic chiasm syndrome.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig.1

References

  1. Arkin MS, Rubin PA, Bilyk JR, Buchbinder B (1996) Anterior chiasmal optic nerve avulsion. AJNR Am J Neuroradiol 17:1777–1781

    CAS  PubMed  Google Scholar 

  2. Atipo-Tsiba PW, Borruat FX (2003) Traumatic dysfunction of the optic chiasm. Klin Monatsbl Augenheilkd 220:138–141. doi:10.1055/s-2003-38171

    Article  PubMed  Google Scholar 

  3. Crompton MR (1970) Visual lesions in closed head injury. Brain 93:785–792. doi:10.1093/brain/93.4.785

    Article  CAS  PubMed  Google Scholar 

  4. De Nunzio M, McAuliffe W, Chakera TM (1997) Magnetic resonance imaging of traumatic transection of the optic chiasm. Australas Radiol 41:155–156

    PubMed  Google Scholar 

  5. Domingo Z, De Villiers JC (1993) Post-traumatic chiasmatic disruption. Br J Neurosurg 7:141–147. doi:10.3109/02688699309103470

    Article  CAS  PubMed  Google Scholar 

  6. Foroozan R (2003) Chiasmal syndromes. Curr Opin Ophthalmol 14:325–331. doi:10.1097/00055735-200312000-00002

    Article  PubMed  Google Scholar 

  7. Fulmek R (1975) Chiasma injury following skull trauma. Klin Monatsbl Augenheilkd 167:45–54

    CAS  PubMed  Google Scholar 

  8. Goh KY, Schatz NJ, Glaser JS (1996) Traumatic chiasmal syndrome: a feature photograph. Ann Acad Med Singapore 25:614–615

    CAS  PubMed  Google Scholar 

  9. Hassan A, Crompton JL, Sandhu A (2002) Traumatic chiasmal syndrome: a series of 19 patients. Clin Exp Ophthalmol 30:273–280. doi:10.1046/j.1442-9071.2002.00534.x

    Article  Google Scholar 

  10. Hayashi T, Wakamoto H, Shimamoto Y, Miyazaki H, Ishiyama N (1997) Bitemporal hemianopsia after skull base fracture. No Shinkei Geka 25:1021–1025

    CAS  PubMed  Google Scholar 

  11. Heinz GW, Nunery WR, Grossman CB (1994) Traumatic chiasmal syndrome associated with midline basilar skull fractures. Am J Ophthalmol 117:90–96

    CAS  PubMed  Google Scholar 

  12. Kawai K, Narita Y, Nagai A, Nakagomi T, Kobayashi K, Kirino T, Tamura A (1998) Traumatic chiasmal syndrome presenting with bitemporal hemianopsia. Trauma 44:224–229. doi:10.1097/00005373-199801000-00038

    Article  CAS  Google Scholar 

  13. Levin LA, Beck RW, Joseph MP, Seiff S, Kraker R (1999) The treatment of traumatic optic neuropathy. The International Optic Nerve Trauma Study. Ophthalmology 106:1268-1277. doi:10.1016/S0161-6420(99)00707-1

    Google Scholar 

  14. Mark AS, Phister SH, Jackson DE, Kolsky MP (1992) Traumatic lesions of the suprasellar region: MR imaging. Radiology 182:49–52

    CAS  PubMed  Google Scholar 

  15. Marriott E, Jay WM (2007) Traumatic bitemporal hemianopsia. Semin Ophthalmol 22:3–7. doi:10.1080/08820530601182543

    Article  PubMed  Google Scholar 

  16. McCann JD, Seiff S (1994) Traumatic neuropathies of the optic nerve, optic chiasm, and ocular motor nerves. Curr Opin Ophthalmol 5:3–10. doi:10.1097/00055735-199412000-00002

    Article  CAS  PubMed  Google Scholar 

  17. Onofrey CB, Tse DT, Johnson TE, Neff AG, Dubovy S, Buck BE, Casiano R (2007) Optic canal decompression: a cadaveric study of the effects of surgery. Ophthal Plast Reconstr Surg 23:261–266. doi:10.1097/IOP.0b013e3180cac220

    Article  PubMed  Google Scholar 

  18. Papageorgiou KI, Mathew RG, Ghazi-Nouri SM, Andreou PS, Sinha AJ (2007) Optochiasmal avulsion secondary to minor occipital trauma. Orbit 26:71–74. doi:10.1080/01676830600675350

    Article  CAS  PubMed  Google Scholar 

  19. Perunovic B, Quilty RD, Athanasiou A, Love S (2001) Damage to intracranial optic pathways in fatal closed head injury in man. J Neurol Sci 185:55–62. doi:10.1016/S0022-510X(01)00463-4

    Article  CAS  PubMed  Google Scholar 

  20. Savino PJ, Glaser JS, Schatz NJ (1980) Traumatic chiasmal syndrome. Neurology 30:963–970

    CAS  PubMed  Google Scholar 

  21. Sharma R, Goyal M, Sharma A, Dada VK, Berry M (1998) Traumatic transection of the optic chiasm: magnetic resonance evaluation. Australas Radiol 42:80–82. doi:10.1111/j.1440-1673.1998.tb00572.x

    Article  CAS  PubMed  Google Scholar 

  22. Tang RA, Kramer LA, Schiffman J, Woon C, Hayman LA, Pardo G (1994) Chiasmal trauma: clinical and imaging considerations. Surv Ophthalmol 38:381–383. doi:10.1016/0039-6257(94)90076-0

    Article  CAS  PubMed  Google Scholar 

  23. Wang J, Wang NL, Wang WY (2005) Operation time selection for traumatic optic nerve injuries. Chin J Neurosurg 21:546–549

    Google Scholar 

  24. Wijdicks EF (2006) Clinical scales for comatose patients: the Glasgow Coma Scale in historical context and the new FOUR Score. Rev Neurol Dis 3:109–117

    PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Affiliations

  1. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China

    Jian Wang, Qi Sheng You, Liang Xu & Jost B. Jonas

  2. Department of Neurosugery, Beijing Tongren Hospital, Capital Medical University, Beijing, China

    Tianming Zhang & E. Qiu

  3. Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany

    Jost B. Jonas

Authors
  1. Jian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qi Sheng You
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liang Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tianming Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jost B. Jonas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jost B. Jonas.

Additional information

Comment

In this report 14 patients were treated for post-traumatic loss of vision that was attributed to a chiasmatic damage either by surgery (n = 11) or steroids (n = 3). The timing of the operations after the trauma varied considerably between 8 and 120 days (mean: 41 days). Recovery of vision was better in the surgical group. Interestingly, visual acuity improved in every patient in this series. 6 out of 12 operated patients also had an improvement of visual fields. Whether the post-traumatic deterioration of vision is due to damage of optic nerves or chiasm is difficult to determine.

Michael Buchfelder

Erlangen, Germany

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wang, J., Sheng You, Q., Xu, L. et al. Transcranial approach for treatment for traumatic optic chiasm syndrome. Acta Neurochir 151, 1711 (2009). https://doi.org/10.1007/s00701-009-0308-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00701-009-0308-3

Keywords

  • Traumatic optic chiasm syndrome
  • Traumatic neuropathy
  • Temporal hemianopsia