Penetrating Injury of Optic Chiasm after Head Injury

Bum Joon Kim; Il Young Shin; Kyung Jae Park; Hoon Kap Lee; Yong Gu Chung

doi:10.13004/jknts.2009.5.1.29

Journal List > J Korean Neurotraumatol Soc > v.5(1) > 1084046

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Kim, Shin, Park, Lee, and Chung: Penetrating Injury of Optic Chiasm after Head Injury

Case Report

Journal of Korean Neurotraumatology Society 2009; 5(1): 29-32.

Published online: 30 June 2009

DOI: https://doi.org/10.13004/jknts.2009.5.1.29

Penetrating Injury of Optic Chiasm after Head Injury

Bum Joon Kim, MD, Il Young Shin, MD, Kyung Jae Park, MD, Hoon Kap Lee, MD, Yong Gu Chung, MD

Department of Neurosurgery, Anam Hospital, Korea University, College of Medicine, Seoul, Korea.

Address for correspondence: Il Young Shin, MD. Department of Neurosurgery, Anam Hospital, Korea University, College of Medicine, 126-1 Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Korea. Tel: +82-2-920-5729, Fax: +82-2-929-0629, kosaken@lycos.co.kr

Received 17 February 2009 Revised 3 April 2009 Accepted 3 April 2009

Abstract

We report a case of penetrating injury of optic chiasm caused by severe head injury. Direct injury to the anatomically privileged optic chiasm is relatively rare complication. A 67-year-old male suffered a blunt head injury due to a fall accident. He complained total blindness of both eyes. Computed tomography (CT) revealed fracture of planum sphenoidale and the bone fragment which seems to compress the optic chiasm. The patient was taken to the operating room emergently for a intracranial decompression of the optic chiasm. Postoperatively, we performed a high-dose steroid therapy. The patient required prolonged hospitalization followed by transfer to a rehabilitation facility. Two months after the accident, the patient underwent a neuroophthalmologic evaluation. At that time, he was still blind in both eyes. On visual evoked potential (VEP), no evoked potential was noted.

Keywords: Head injury, Traumatic optic neuropathy, Traumatic chiasmal injury

Figures and Tables

FIGURE 1

A 67-year old male. His initial skull X-ray (A, B) showed multiple craniofacial fractures.

FIGURE 2

Computed tomography revealed fracture of planum sphenoidale (A) and the bone fragment (arrow) which seems to compress the optic chiasm (B).

FIGURE 3

Intraoperatively, the right optic nerve (ON), which was separated from the optic chiasm and displaced downwardly, and the bone fragment (*) were identified.

FIGURE 4

Postoperatively, the bone fragment was totally removed.

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