J Korean Neurotraumatol Soc.  2009 Jun;5(1):29-32. 10.13004/jknts.2009.5.1.29.

Penetrating Injury of Optic Chiasm after Head Injury

• Kim BJ
• Shin IY
• Park KJ
• Lee HK
• Chung YG

• KMID: 2019931
• DOI: http://doi.org/10.13004/jknts.2009.5.1.29

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.

Keyword

Head injury; Traumatic optic neuropathy; Traumatic chiasmal injury

MeSH Terms

Blindness
Craniocerebral Trauma
Decompression
Evoked Potentials
Evoked Potentials, Visual
Eye
Head
Head Injuries, Closed
Hospitalization
Humans
Male
Operating Rooms
Optic Chiasm
Optic Nerve Injuries
Temazepam
Temazepam

Figure

• 

  FIGURE 1 A 67-year old male. His initial skull X-ray (A, B) showed multiple craniofacial fractures.

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  FIGURE 2 Computed tomography revealed fracture of planum sphenoidale (A) and the bone fragment (arrow) which seems to compress the optic chiasm (B).

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  FIGURE 3 Intraoperatively, the right optic nerve (ON), which was separated from the optic chiasm and displaced downwardly, and the bone fragment (*) were identified.

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  FIGURE 4 Postoperatively, the bone fragment was totally removed.

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