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Liao C, Li S, Ouyang H, Zhang W. Optic nerve decompression through pterional and supraorbital approaches in the treatment of severe traumatic optic neuropathy. Neurosurg Rev 2024; 47:306. [PMID: 38977519 DOI: 10.1007/s10143-024-02536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/19/2024] [Accepted: 06/22/2024] [Indexed: 07/10/2024]
Abstract
To investigate the effectiveness of optic nerve decompression (OND) in the treatment of severe traumatic optic neuropathy (TON) through pterional and supraorbital approaches, and to identify the prognostic factor for postoperative visual acuity (VA) following OND. Patients with severe TON treated with OND through either pterional or supraorbital approach in our institute from September 2019 to June 2022 were retrospectively reviewed in this study. Demographic information, trauma factors, the interval between trauma and complete blindness, the interval between trauma and surgery, and the associated craniofacial traumas were recorded. Hospitalization days and the postoperative VA of patients in two groups were compared. There were 54 severe TON patients with NLP included in this study; 21 patients underwent OND through the pterional approach, and the other 33 underwent the supraorbital approach. Respectively, in groups of pterional and supraorbital approaches, the average hospitalization days were 9.8 ± 3.2 and 10.7 ± 2.9 days (p = 0.58), the mean durations of follow-up were 18.9 ± 4.3 and 20.8 ± 3.7 months (p = 0.09), and the average circumference of OND were 53.14 ± 15.89 ◦ (range 220 ◦ -278◦) and 181.70 ± 6.56◦ (range 173 ◦ -193◦) (p<0.001). The overall improvement rates of pterional and supraorbital approaches are 57.1% and 45.5% (p = 0.40), respectively. Optic canal fracture (OCF) was revealed to be significantly associated with postoperative VA in the supraorbital approach (Binary: p = 0.014, CI: 1.573-57.087; Ordinal: p = 0.003, CI: 1.517-5.503), but not in the pterional approach. In the group of supraorbital approach, patients with OFC had a higher rate of a better outcome (78.6%) than those without (21.4%). Patients with severe traumatic TON may benefit from OND through either the pterional or supraorbital approach. OCF is a potential prognostic factor for postoperative VA following OND through the supraorbital approach.
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Affiliation(s)
- Chenlong Liao
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, NO.639 Shanghai Zhizaoju Road, Huangpu District, Shanghai, China
| | - Shuo Li
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, NO.639 Shanghai Zhizaoju Road, Huangpu District, Shanghai, China
| | - Huoniu Ouyang
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, NO.639 Shanghai Zhizaoju Road, Huangpu District, Shanghai, China.
| | - Wenchuan Zhang
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, NO.639 Shanghai Zhizaoju Road, Huangpu District, Shanghai, China.
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Yu Z, Qi J, Wang L, Yang X, Liu Z, Chen X, Xu H, Li Y, Chen Y, Dai C, Gu Z. Managing intraoperative rupture of internal carotid pseudoaneurysms during endoscopic transnasal optic canal decompression: a case report. Front Neurol 2024; 15:1382793. [PMID: 38962479 PMCID: PMC11220115 DOI: 10.3389/fneur.2024.1382793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
Background Endoscopic transnasal optic canal decompression is widely used in the treatment of traumatic optic neuropathy (TON) following head and craniofacial trauma. Intraoperative hemorrhage is a catastrophic surgical complication during optic canal decompression. Case description We present two cases of patients with TON who suffered unexpected intra-operative massive bleeding during endoscopic transnasal optic canal decompression. After intraoperative hemostasis was achieved, emergent cerebral angiograms demonstrated the formation of internal carotid pseudoaneurysms, which were immediately embolized with coils combined with or without Onyx with balloon assistance. One of these cases was also complicated by a postoperative cerebrospinal fluid leak, which failed to be treated with lumbar drainage but was successfully repaired with endoscopic transnasal surgery. Conclusion The intra-operative rupture of ICA pseudoaneurysm is a rare but catastrophic complication in TON patients. Intraoperative massive bleeding indicates rupture of ICA pseudoaneurysm. Postoperative emergency angiography and endovascular therapy should be arranged to evaluate and repair the cerebral vascular injury. Endoscopic trans-nasal surgery repairing CSF leaks resistant to lumbar drainage could be efficient and safe following pseudoaneurysm embolization.
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Affiliation(s)
- Zeran Yu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Junhui Qi
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Lei Wang
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Xiang Yang
- Department of Obstetrics, The First People’s Hospital of Yunnan, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Zhengqiao Liu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Xu Chen
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Hongling Xu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Yajie Li
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Yuyun Chen
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Chengguo Dai
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Zhen Gu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
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Bhattacharjee K, Soni D, Venkatraman V, Grewal AM, Rehman O, Bhattacharjee P, Bhattacharjee H. Navigation-guided transcaruncular orbital optic canal decompression in indirect traumatic optic neuropathy: long-term outcomes. Br J Ophthalmol 2024; 108:779-787. [PMID: 37414533 DOI: 10.1136/bjo-2023-323282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To determine the surgical outcomes using navigation-guided transcaruncular orbital optic canal decompression (NGTcOCD) and investigate the relationship between visual prognosis. visual evoked potential (VEP), association with DeLano type of optic canal and Onodi cells in patients with indirect traumatic optic neuropathy (TON). DESIGN Prospective observational. METHODS Fifty-two consecutive patients with indirect TON unresponsive to steroid therapy were divided into three groups where Group I comprised of cases with optic canal fracture who underwent NGTcOCD, Group II without optic canal fracture who underwent NGTcOCD and Group III, no-decompression group who chose not to undergo NGTcOCD. An improvement in visual acuity (VA) at 1 week, 3 months and 1 year and amplitude and latency of VEP at 1 year were considered as primary and secondary outcomes, respectively. RESULTS The mean VA improved from 2.55±0.67 and 2.62±0.56 LogMAR at presentation to 2.03±0.96 and 2.33±0.72 LogMAR at final follow-up among Group I and Group II patients, respectively (p<0.001 and p=0.01). Statistically significant improvement observed among both the Groups in VEP amplitude (p=<0.01) and among Group II in VEP latency (p<0.01). Both Group I and Group II patients have better outcomes than patients in no-decompression group. VA at presentation and Type 1 DeLano optic canal were observed as significant prognostic factors. CONCLUSIONS NGTcOCD serves as a minimally invasive transcaruncular route to the optic canal which enables ophthalmologists to perform decompression from the anterior-most orbital end under direct visualisation. Patients with indirect TON with or without optic canal fracture and unresponsive to steroid therapy when managed with NGTcOCD have shown comparable and superior outcomes.
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Affiliation(s)
- Kasturi Bhattacharjee
- Ophthalmic Plastic and Reconstructive Surgery, Ocular Oncology and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Deepak Soni
- Ophthalmic Plastic and Reconstructive Surgery, Ocular Oncology and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Vatsalya Venkatraman
- Ophthalmic Plastic and Reconstructive Surgery, Ocular Oncology and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Aditi Mehta Grewal
- Ophthalmic Plastic and Reconstructive Surgery, Ocular Oncology and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Obaidur Rehman
- Ophthalmic Plastic and Reconstructive Surgery, Ocular Oncology and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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Wang X, Zhou J, Wang Y, Li X, Hu Q, Luo L, Liu X, Liu W, Ye J. Effect of astrocyte GPER on the optic nerve inflammatory response following optic nerve injury in mice. Heliyon 2024; 10:e29428. [PMID: 38638966 PMCID: PMC11024623 DOI: 10.1016/j.heliyon.2024.e29428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
Activated astrocytes are a primary source of inflammatory factors following traumatic optic neuropathy (TON). Accumulation of inflammatory factors in this context leads to increased axonal damage and loss of retinal ganglion cells (RGCs). Therefore, in the present study, we explored the role of the astrocyte G protein-coupled estrogen receptor (GPER) in regulating inflammatory factors following optic nerve crush (ONC), and analyzed its potential regulatory mechanisms. Overall, our results showed that GPER was abundantly expressed in the optic nerve, and co-localized with glial fibrillary acidic proteins (GFAP). Exogenous administration of G-1 led to a significant reduction in astrocyte activation and expression of inflammation-related factors (including IL-1β, TNF-α, NFκB, and p-NFκB). Additionally, it dramatically increased the survival of RGCs. In contrast, astrocytes were activated to a greater extent by exogenous G15 administration; however, RGCs survival was significantly reduced. In vitro, GPER activation significantly reduced astrocyte activation and the release of inflammation-related factors. In conclusion, activation of astrocyte GPER significantly reduced ONC inflammation levels, and should be explored as a potential target pathway for protecting the optic nerve and RGCs after TON.
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Affiliation(s)
- Xuan Wang
- Department of Ophthalmology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, 400042, China
| | - Jiaxing Zhou
- Department of Ophthalmology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, 400042, China
| | - Yuwen Wang
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Xinqiao Road, Shapingba District, Chongqing, 400032, China
| | - Xue Li
- Department of Ophthalmology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, 400042, China
| | - Qiumei Hu
- Department of Ophthalmology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, 400042, China
| | - Linlin Luo
- Department of Ophthalmology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, 400042, China
| | - Xuemei Liu
- Department of Ophthalmology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, 400042, China
| | - Wei Liu
- Department of Ophthalmology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, 400042, China
| | - Jian Ye
- Department of Ophthalmology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, 400042, China
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Sollini G, Giorli A, Zoli M, Farneti P, Arena G, Astarita F, Mazzatenta D, Pasquini E. Endoscopic transnasal approach to remove an intraorbital bullet: systematic review and case report. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024:1-7. [PMID: 38712521 DOI: 10.14639/0392-100x-n2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/05/2024] [Indexed: 05/08/2024]
Abstract
Introduction Intraorbital foreign bodies (IOFBs) represent a clinical challenge: surgical management can be controversial and different strategies have been proposed. When removal is recommended, depending on the location and nature of the IOFB both external and endoscopic approaches have been proposed, with significantly different surgical corridors to the orbit and different morbidities. Methods We performed a literature review of cases of IOFBs that received exclusive endoscopic transnasal surgical treatment to evaluate the role of this surgery in these occurrences. We also present a case of an intraorbital intraconal bullet that was successfully removed using an endoscopic transnasal approach with good outcomes in terms of ocular motility and visual acuity. Results A limited number of cases of IOFBs have been treated with an exclusive endoscopic transnasal approach. When in the medial compartment, this approach appears to be safe and effective. In our case, two months after surgery the patient showed complete recovery with no significant long-term sequelae. Conclusions When feasible, an endoscopic transnasal approach for intraorbital foreign bodies represents a valid surgical technique with optimal outcomes and satisfactory recovery.
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Affiliation(s)
- Giacomo Sollini
- Department of Otolaryngology and Head and Neck Surgery, Bellaria Hospital, AUSL Bologna, Bologna, Italy
| | - Alessia Giorli
- ENT Department, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Matteo Zoli
- Department of Bio-Medical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi-Pituitary Unit, Bologna, Italy
| | - Paolo Farneti
- Department of Otolaryngology and Head and Neck Surgery, Bellaria Hospital, AUSL Bologna, Bologna, Italy
| | - Giorgio Arena
- ENT Division, University of Eastern Piedmont, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Fabio Astarita
- UO Rete Chirurgia del Volto e Odontoiatria Ospedaliera e Territoriale, AUSL Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Bio-Medical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi-Pituitary Unit, Bologna, Italy
| | - Ernesto Pasquini
- Department of Otolaryngology and Head and Neck Surgery, Bellaria Hospital, AUSL Bologna, Bologna, Italy
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Muthukumar R, Mahesh Kumari R, Shenbagavalli S, Nerthipriya R. Surgical Outcome in Patients with Traumatic and Atraumatic Optic Neuropathy Following Endoscopic Optic Nerve Decompression. Indian J Otolaryngol Head Neck Surg 2024; 76:1569-1574. [PMID: 38566727 PMCID: PMC10982217 DOI: 10.1007/s12070-023-04361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/13/2023] [Indexed: 04/04/2024] Open
Abstract
Endoscopic optic nerve decompression is a highly effective and reliable approach for patients with select cases of optic neuropathy. It reduces the hydrostatic pressure and helps in relieving the compressive forces within the intracanalicular portion of the optic nerve consequently preserving and arresting the deterioration of vision. The advantages of the endoscopic approach over other procedures include preservation of olfaction, quick recovery, lack of external scars and less morbidity. The objective of the study is to assess the surgical outcome of endoscopic optic nerve decompression in patients with traumatic and atraumatic optic neuropathy. The case records of consequent patients attending ENT department with defective vision due to traumatic and atraumatic causes were reviewed. The outcome was measured in terms of improvement in visual acuity by log MAR scale. Among the 14 patients studied, 57% were females and the median age of presentation was 33 years. As compared to preoperative baseline visual acuity, the overall improvement was achieved in 11 patients, with an effective rate of 78.5% postoperatively. Patients presenting with no light perception and residual vision had significant improvement in visual acuity after surgery. Trans-nasal endoscopic surgery helps in decompressing the optic nerve with proper exposure of the orbital apex and optic canal without any intracranial or intra-orbital complications. Further, being a minimally invasive procedure has great advantage in cases of optic neuropathy.
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Affiliation(s)
- R Muthukumar
- Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu 600003 India
| | - R Mahesh Kumari
- Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu 600003 India
| | - S Shenbagavalli
- Upgraded Institute of Otorhinolaryngology, Madras Medical College, Chennai, Tamil Nadu 600003 India
| | - R Nerthipriya
- Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu 600003 India
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Hassan B, Yoon J, Elegbede A, Merbs SL, Liang F, Miller NR, Manson PN, Grant MP. The Association Between Craniofacial Fracture Patterns and Traumatic Optic Neuropathy. J Craniofac Surg 2024:00001665-990000000-01418. [PMID: 38534175 DOI: 10.1097/scs.0000000000010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 03/28/2024] Open
Abstract
Traumatic optic neuropathy (TON) is a rare but potentially devastating complication of craniofacial trauma. Approximately half of patients with TON sustain permanent vision loss. In this study, we sought to identify the most common fracture patterns associated with TON. We performed a retrospective review of craniomaxillofacial CT scans of trauma patients who presented to the R Adams Cowley Shock Trauma Center from 2015 to 2017. Included were adult patients who had orbital fractures with or without other facial fractures. Patients diagnosed with TON by a formal ophthalmologic examination were analyzed. Craniofacial fracture patterns were identified. Bivariate analysis and multivariate logistic regression were performed to identify craniofacial fracture patterns most commonly associated with TON. A total of 574 patients with orbital fractures who met inclusion criteria [15 (2.6%)] were diagnosed with TON. The median [interquartile range (IQR)] age was 44 (28-59) years. Patients with optic canal fractures and sphenoid sinus fractures had greater odds of TON compared with patients who did not have these fracture types [adjusted odds ratio (aOR) 95% confidence interval (CI) 31.8 (2.6->100), 8.1 (2.7-24.4), respectively]. Patients who sustain optic canal and sphenoid sinus fractures in the setting of blunt facial trauma are at increased odds of having a TON. Surgeons and other physicians involved in the care of these patients should be aware of this association.
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Affiliation(s)
- Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Joshua Yoon
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD
- Department of Surgery, George Washington University Hospital, Washington, DC
| | - Adekunle Elegbede
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Shannath L Merbs
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Fan Liang
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Neil R Miller
- Departments of Ophthalmology, Neurology, and Neurosurgery, Johns Hopkins Hospital, Baltimore, MD
| | - Paul N Manson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Michael P Grant
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD
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Cheng H, Lin Y, Yang W, Chang X, Feng J, Yang S, Liu S, Yu T, Peng X, Zheng P, Zhang C, Jia H, Qin H, Wang H. Visual conservation treatment dilemmas in neuroblastoma with bilateral blindness. Discov Oncol 2024; 15:48. [PMID: 38403682 PMCID: PMC10894793 DOI: 10.1007/s12672-024-00898-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVE To investigate the clinical features, treatment strategies, and prognosis of neuroblastoma with bilateral blindness. METHODS The clinical data of five patients with bilateral blindness neuroblastoma admitted to Beijing Children's Hospital from April 2018 to September 2020 were retrospectively collected to summarize their clinical characteristics. RESULTS All patients were female and the median age at presentation was 25 (23, 41) months. The median intervention time from the onset of symptoms of bilateral blindness to the start of treatment was 10 (10, 12) days. All five cases were staged as stage M and grouped as high risk. Four cases were MYCN gene amplification and one case was MYCN acquisition. Five children were treated according to a high-risk neuroblastoma treatment protocol. Four children did not recover their vision after treatment, and one case improved to have light perception. All patients were effectively followed up for a median of 20 (12, 31) months, with three deaths, one tumor-free survival, and one recurrent tumor-bearing survival. CONCLUSION Neuroblastoma with bilateral blindness is rare in the clinic, mostly in children of young age, and is often associated with MYCN amplification and multiple metastases. Early hormone shock therapy and optic nerve decompression are beneficial for preserving the child's vision. A joint multi-disciplinary treatment may help in the formulation of treatment decisions. Achieving a balance between good visual preservation and survival within the short optic nerve neurotherapeutic window is extremely challenging.
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Affiliation(s)
- Haiyan Cheng
- Department of Oncology Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Yu Lin
- Department of Oncology Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Wei Yang
- Department of Oncology Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Xiaofeng Chang
- Department of Oncology Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Jun Feng
- Department of Oncology Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Shen Yang
- Department of Oncology Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Shan Liu
- Department of Oncology Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Tong Yu
- Medical Imaging Center, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Xiaojiao Peng
- Department of Neurosurgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Panpan Zheng
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Chengyue Zhang
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Haiwei Jia
- Department of Radiotherapy, Beijing Fengtai You Anmen Hospital, Beijing, 10069, China
| | - Hong Qin
- Department of Oncology Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Huanmin Wang
- Department of Oncology Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China.
- MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China.
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Anis I, Baig MA. Traumatic optic neuropathy from an air gun pellet injury: a case report. Oxf Med Case Reports 2024; 2024:omad130. [PMID: 38292163 PMCID: PMC10823325 DOI: 10.1093/omcr/omad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/10/2023] [Accepted: 10/08/2023] [Indexed: 02/01/2024] Open
Abstract
Orbital apex fractures are a debilitating condition that can cause vision problems and are often associated with intracranial injury. Traumatic Optic Neuropathy (TON), which results in vision loss following a traumatic injury to the optic nerve, can be caused by various mechanisms, but most cases involve injuries to the globe, orbit, or adnexa. We are reporting a case of an 18 year old male with a history of an air gun being accidentally discharged into his left eye. He was evaluated and found to have an Orbital apex fracture with left eye TON. Patient was administered high dose steroids. Detailed evaluation by Ophthalmology revealed a left eye traumatic stage I macular hole which was conservatively treated with visual improvement reported during patient follow up.
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Affiliation(s)
- Iqra Anis
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Akbar Baig
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Sujithra H, Shah K, Greeshma C. Clinical profile and visual outcome in patients with traumatic optic neuropathy. Indian J Ophthalmol 2023; 71:3046-3052. [PMID: 37530279 PMCID: PMC10538853 DOI: 10.4103/ijo.ijo_3318_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Purpose To analyze the visual outcome in patients with traumatic optic neuropathy (TON) with respect to different treatment modalities, to study the correlation of initial visual loss with the final visual outcome, and to find out the predictor of final visual outcome in patients with indirect TON. Methods A retrospective analysis of 36 eyes with TON was done. Data on clinical profile, including demographics, mode of trauma, best corrected visual acuity (BCVA), pupillary reflex examination, and anterior and posterior segment examination, was collected. Presence and location of orbital and cranial fractures were identified from computed tomography scan. Visual outcomes following steroid therapy, optic nerve (ON) decompression, and in untreated patients were analyzed. Pre- and post-treatment BCVA were divided into three groups based on logarithm of the minimum angle of resolution (logMAR) as follows: group A: 3, group B: 2.9-1.3, and group C<1.3. BCVA values at follow-up visits were taken as the primary outcome measure. Association between various risk factors and final visual outcome in patients with indirect TON was also analyzed. Results Out of 34 patients whose 36 eyes were studied, three (8.8%) patients were females and 31 (91.2%) patients were males. Most common mode of trauma was road traffic accident (RTA; 91.2%), which was followed by fall (8.8%) and assault (2.9%). Pre- and post-treatment BCVA values of 36 eyes were compared, and improvement in BCVA after treatment was found to be statistically significant. Also, 28.6% of patients with presenting BCVA of no light perception showed improvement compared to 94.1% and 100% in groups B and C, respectively. Orbital wall fractures were seen in 80.5% (n = 29) of the patients, with lateral wall fracture being the most common (58.3%) followed by medial wall (33.3%), roof (27.7%), floor (27.7%), and optic strut (5%). Conclusion Baseline BCVA had significant association with final vision improvement. Lateral wall fracture was the most common fracture associated with indirect TON. Patients treated with high-dose corticosteroids, irrespective of the time of presentation, had a better visual outcome.
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Affiliation(s)
- H Sujithra
- Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Kannisha Shah
- Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - C Greeshma
- Department of Biostatistics,, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Buonfiglio F, Böhm EW, Pfeiffer N, Gericke A. Oxidative Stress: A Suitable Therapeutic Target for Optic Nerve Diseases? Antioxidants (Basel) 2023; 12:1465. [PMID: 37508003 PMCID: PMC10376185 DOI: 10.3390/antiox12071465] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Optic nerve disorders encompass a wide spectrum of conditions characterized by the loss of retinal ganglion cells (RGCs) and subsequent degeneration of the optic nerve. The etiology of these disorders can vary significantly, but emerging research highlights the crucial role of oxidative stress, an imbalance in the redox status characterized by an excess of reactive oxygen species (ROS), in driving cell death through apoptosis, autophagy, and inflammation. This review provides an overview of ROS-related processes underlying four extensively studied optic nerve diseases: glaucoma, Leber's hereditary optic neuropathy (LHON), anterior ischemic optic neuropathy (AION), and optic neuritis (ON). Furthermore, we present preclinical findings on antioxidants, with the objective of evaluating the potential therapeutic benefits of targeting oxidative stress in the treatment of optic neuropathies.
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Affiliation(s)
- Francesco Buonfiglio
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (E.W.B.); (N.P.)
| | | | | | - Adrian Gericke
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (E.W.B.); (N.P.)
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12
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Otsu Y, Komaki S, Takeshige N, Sakata K, Morioka M. Visual-evoked potential predicts the efficacy of the optical canal decompression for traumatic optic nerve neuropathy showing blindness: A case report. Surg Neurol Int 2023; 14:245. [PMID: 37560571 PMCID: PMC10408612 DOI: 10.25259/sni_450_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/25/2023] [Indexed: 08/11/2023] Open
Abstract
Background The indication for surgical optic canal decompression (OCD) for traumatic optic neuropathy (TON) remains controversial because there is no reliable predictor of a good outcome. We report the case of a blind patient with TON whose remaining visual-evoked potential (VEP) suggested recovery potential of the injured optic nerve after OCD. Case Description A 48-year-old man had fallen from a height of 7 m, striking his head. He immediately complained of right-eye blindness. He had no light perception and the direct light reflex disappeared from the right pupil, although there was no fracture or traumatic lesion on computed tomography and magnetic resonance imaging. Because the amplitude of the VEP with the right eye stimulation remained unchanged, we performed the right OCD. During surgical OCD, the amplitude and latency of VEP began to improve. Finally, the visual field improved in almost all directions, and eyesight improved to 0.2. Conclusion The retained VEP activity in TON may suggest the recovery potential of the injured optic nerve, even in cases of blindness. It is possible that VEP is an indicator of aggressive treatment for TON such as OCD.
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Affiliation(s)
- Yusuke Otsu
- Department of Neurosurgery, Kurume University School of Medicine, Kurume City, Japan
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13
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Pan F, Hu D, Sun LJ, Bai Q, Wang YS, Hou X. Valproate reduces retinal ganglion cell apoptosis in rats after optic nerve crush. Neural Regen Res 2023; 18:1607-1612. [PMID: 36571369 PMCID: PMC10075129 DOI: 10.4103/1673-5374.357913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The retinal ganglion cells of the optic nerve have a limited capacity for self-repair after injury. Valproate is a histone deacetylase inhibitor and multitarget drug, which has been demonstrated to protect retinal neurons. In this study, we established rat models of optic nerve-crush injury and injected valproate into the vitreous cavity immediately after modeling. We evaluated changes in the ultrastructure morphology of the endoplasmic reticulum of retinal ganglion cells over time via transmission electron microscope. Immunohistochemistry and western blot assay revealed that valproate upregulated the expression of the endoplasmic reticulum stress marker glucose-regulated protein 78 and downregulated the expression of transcription factor C/EBP homologous protein, phosphorylated eukaryotic translation initiation factor 2α, and caspase-12 in the endoplasmic reticulum of retinal ganglion cells. These findings suggest that valproate reduces apoptosis of retinal ganglion cells in the rat after optic nerve-crush injury by attenuating phosphorylated eukaryotic translation initiation factor 2α-C/EBP homologous protein signaling and caspase-12 activation during endoplasmic reticulum stress. These findings represent a newly discovered mechanism that regulates how valproate protects neurons.
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Affiliation(s)
- Feng Pan
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Dan Hu
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Li-Juan Sun
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Qian Bai
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yu-Sheng Wang
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Xu Hou
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
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14
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McCartan R, Gratkowski A, Browning M, Hahn-Townsend C, Ferguson S, Morin A, Bachmeier C, Pearson A, Brown L, Mullan M, Crawford F, Tzekov R, Mouzon B. Human amnionic progenitor cell secretome mitigates the consequence of traumatic optic neuropathy in a mouse model. Mol Ther Methods Clin Dev 2023; 29:303-318. [PMID: 37359418 PMCID: PMC10285248 DOI: 10.1016/j.omtm.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/12/2023] [Indexed: 06/28/2023]
Abstract
Traumatic optic neuropathy (TON) is a condition in which acute injury to the optic nerve from direct or indirect trauma results in vision loss. The most common cause of TON is indirect injury to the optic nerve caused by concussive forces that are transmitted to the optic nerve. TON occurs in up to 5% of closed-head trauma patients and there is currently no known effective treatment. One potential treatment option for TON is ST266, a cell-free biological solution containing the secretome of amnion-derived multipotent progenitor (AMP) cells. We investigated the efficacy of intranasal ST266 in a mouse model of TON induced by blunt head trauma. Injured mice treated with a 10-day regimen of ST266 showed an improvement in spatial memory and learning, a significant preservation of retinal ganglion cells, and a decrease in neuropathological markers in the optic nerve, optic tract, and dorsal lateral geniculate nucleus. ST266 treatment effectively downregulated the NLRP3 inflammasome-mediated neuroinflammation pathway after blunt trauma. Overall, treatment with ST266 was shown to improve functional and pathological outcomes in a mouse model of TON, warranting future exploration of ST266 as a cell-free therapeutic candidate for testing in all optic neuropathies.
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Affiliation(s)
- Robyn McCartan
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | | | | | - Scott Ferguson
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
| | - Alexander Morin
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
| | - Corbin Bachmeier
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
- Bay Pines Veterans’ Hospital, Saint Petersburg, FL 33708, USA
| | - Andrew Pearson
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
| | - Larry Brown
- Noveome Biotherapeutics, Inc., Pittsburgh, PA 15219, USA
| | - Michael Mullan
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
| | - Fiona Crawford
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
- James A. Haley Veterans’ Hospital, Tampa, FL 33612, USA
| | | | - Benoit Mouzon
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
- James A. Haley Veterans’ Hospital, Tampa, FL 33612, USA
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15
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Siyanaki MRH, Azab MA, Lucke-Wold B. Traumatic Optic Neuropathy: Update on Management. ENCYCLOPEDIA 2023; 3:88-101. [PMID: 36718432 PMCID: PMC9884099 DOI: 10.3390/encyclopedia3010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Traumatic optic neuropathy is one of the causes of visual loss caused by blunt or penetrating head trauma and is classified as both direct and indirect. Clinical history and examination findings usually allow for the diagnosis of traumatic optic neuropathy. There is still controversy surrounding the management of traumatic optic neuropathy; some physicians advocate observation alone, while others recommend steroid therapy, surgery, or both. In this entry, we tried to highlight traumatic optic neuropathy's main pathophysiologic mechanisms with the most available updated treatment. Recent research suggests future therapies that may be helpful in traumatic optic neuropathy cases.
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Affiliation(s)
| | - Mohammed A. Azab
- Department of Neurosurgery, University of Cairo University, Cairo 12613, Egypt
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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16
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Sommer F, Brand M, Scheithauer MO, Hoffmann TK, Theodoraki MN, Weber R. [Diagnosis and Treatment in frontobasal fractures]. HNO 2023; 71:35-47. [PMID: 36525033 DOI: 10.1007/s00106-022-01256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
Traumatic brain injury can result in frontobasal fractures (FBF). The goals of treatment for FBF are to eliminate primary morbidity and/or prevent secondary morbidity. Of particular importance in this regard is the proximity of important sensory organs for hearing, vision, smell, and taste, as well as their supplying nervous structures. Medical history, clinical findings, or CT scan are necessary and should lead to an individual evaluation. Depending on the severity of the fractures, the following disciplines may be involved in the treatment of FBF: neurosurgery, plastic surgery, oral and maxillofacial surgery, and/or otorhinolaryngology. Particularly less invasive endoscopic endonasal therapy is a specialty of otorhinolaryngologic surgeons and has not been widely established in other disciplines. The present work provides an overview of the current state of the art in terms of the following aspects, taking into account the current literature: anatomic principles, classification of fractures, diagnostics (in particular clinical examination, imaging, and laboratory chemistry tests), clinical symptoms, and treatment.
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Affiliation(s)
- F Sommer
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland.
| | - M Brand
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - M O Scheithauer
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - T K Hoffmann
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - M-N Theodoraki
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - R Weber
- Hals-Nasen-Ohrenklinik des Städtischen Klinikums Karlsruhe, Karlsruhe, Deutschland
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17
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Portela M, Lorga T, Portelinha J, Costa JM. Surgical approach for traumatic chiasmal syndrome and complete third nerve palsy following severe head trauma. BMJ Case Rep 2022; 15:e253798. [PMID: 36593631 PMCID: PMC9743279 DOI: 10.1136/bcr-2022-253798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Traumatic chiasmal syndrome and traumatic third nerve palsies are rare entities usually caused by severe, high-speed, closed-head road accidents that require a thorough diagnostic work-up and complex medical and surgical management. This report presents the case of a young adult who was involved in a motorcycle accident and sustained blunt frontal head trauma, resulting in optical chiasmal syndrome and complete unilateral third nerve palsy. Ophthalmological examination demonstrated a right complete ptosis, a downward and outward position of the right eye with a fixed and dilated pupil, and bitemporal hemianopsia. In addition, funduscopy revealed bilateral optical nerve atrophy. After stabilisation and during follow-up, strabismus surgery was performed with improvement of ocular alignment in the primary position. Subsequently, eyelid surgery was carried out with good amplification of the visual field, particularly on the left side. Although challenging, surgical intervention in these cases should be considered for both functional and cosmetic reasons.
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18
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Zwerling CS, Carter L, Lucke-Wold B. Current Review of Traumatic Optic Neuropathy and Traumatic Brain Injury among Military Service Members. RECENT TRENDS IN PHARMACEUTICAL SCIENCES AND RESEARCH 2022; 4:1-11. [PMID: 36848303 PMCID: PMC9956096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Traumatic optic neuropathy (TON) is a form of optic nerve damage that while rare in the general population, is commonly associated with traumatic brain injury (TBI). With increasingly high rates of TBI in the military community, our service members and veterans represent a population where traumatic optic neuropathy is prevalent. Parachute jumpers have been identified as a high-risk group for under-reported head injury and therefore many cases of TBI are easily overlooked. With recent insights into the limitations of the veteran's disability exam, we review the current understanding of TON and propose an updated protocol for TON evaluation. We also urge for development of safer helmet design to reduce and prevent further cases of TBI, mTBI, and TON in our military personnel.
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Affiliation(s)
- Charles S Zwerling
- Associate Professor of Surgery, School of Osteopathic Medicine, Campbell University, North Carolina, United States
| | - Lea Carter
- School of Osteopathic Medicine, Campbell University, North Carolina, United States
| | - Brandon Lucke-Wold
- Pgy4, Neurosurgery Resident, University of Florida, Department of Neurosurgery, United States
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Zwerling CS, Carter L, Lucke-Wold B. Electrophysiological Analysis of Traumatic Optic Neuropathy and Traumatic Brain Injury Among Active Military. MEDICAL REPORTS & CASE STUDIES 2022; 7:201. [PMID: 36032332 PMCID: PMC9410250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Traumatic Optic Neuropathy (TON) can cause persistent visual deficits and is a known sequala of Traumatic Brain Injury (TBI). Little is known regarding appropriate diagnosis, management, and treatment. Methods we performed a prospective cohort study with 356 active military personnel using electrophysiological Visual Evoked Potential (VEP) testing for TON in the context of known or suspected TBI. This was done with the intent to review and revise management protocol for patients who are susceptible to TON. This new VEP protocol was incorporated with kinetic and static visual field testing to uncover occult cases of TON previously missed in the current disability examination, as well as aid in evaluation of patients with borderline concussive cases that do not meet current diagnosis of mild, moderate, or severe TBI by the Veteran's Disability Exam. Results 80 patients were diagnosed with TON. Average age of TON patients was 37.4 years, with most patients being male. Of those patients with TON, 45% had reported TBI, whereas an additional 54% had suspected history of concussion. Patients presented with bilateral TON (65.8%, n=52), while unilateral TON cases occurred less frequently (35.4%, n=28). Visual field defects were apparent in both static and kinetic visual field testing in 54% of cases. VEP sensitivity in our study was 88%. Military parachute jumpers (paratroopers) represent the highest risk group for undiagnosed TBI and TON. Conclusions we recommend periodic static and kinetic visual field testing in high-risk individuals working in fields with high concussion rates. Focused collaboration for safer helmet design is imminent. By improving helmet design, we can reduce mTBI and related TON, as well as reduce costly medical care and disability payments after military discharge.
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Affiliation(s)
| | - Lea Carter
- Campbell University School of Osteopathic Medicine, Class of 2023, USA
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王 鹏, 罗 生, 申 晨, 喻 哲, 聂 祖, 李 志, 文 婕, 李 萌, 曹 霞. [Protective effect of Epothilone D against traumatic optic nerve injury in rats]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:575-583. [PMID: 35527494 PMCID: PMC9085595 DOI: 10.12122/j.issn.1673-4254.2022.04.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the therapeutic effect of Epothilone D on traumatic optic neuropathy (TON) in rats. METHODS Forty-two SD rats were randomized to receive intraperitoneal injection of 1.0 mg/kg Epothilone D or DMSO (control) every 3 days until day 28, and rat models of TON were established on the second day after the first administration. On days 3, 7, and 28, examination of flash visual evoked potentials (FVEP), immunofluorescence staining and Western blotting were performed to examine the visual pathway features, number of retinal ganglion cells (RGCs), GAP43 expression level in damaged axons, and changes of Tau and pTau-396/404 in the retina and optic nerve. RESULTS In Epothilone D treatment group, RGC loss rate was significantly decreased by 19.12% (P=0.032) on day 3 and by 22.67% (P=0.042) on day 28 as compared with the rats in the control group, but FVEP examination failed to show physiological improvement in the visual pathway on day 28 in terms of the relative latency of N2 wave (P=0.236) and relative amplitude attenuation of P2-N2 wave (P=0.441). The total Tau content in the retina of the treatment group was significantly increased compared with that in the control group on day 3 (P < 0.001), showing a consistent change with ptau-396/404 level. In the optic nerve axons, the total Tau level in the treatment group was significantly lower than that in the control group on day 7 (P=0.002), but the changes of the total Tau and pTau-396/404 level did not show an obvious correlation. Epothilone D induced persistent expression of GAP43 in the damaged axons, detectable even on day 28 of the experiment. CONCLUSION Epothilone D treatment can protect against TON in rats by promoting the survival of injured RGCs, enhancing Tau content in the surviving RGCs, reducing Tau accumulation in injured axons, and stimulating sustained regeneration of axons.
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Affiliation(s)
- 鹏飞 王
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 生平 罗
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 晨 申
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 哲昊 喻
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 祖庆 聂
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 志伟 李
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 婕 文
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 萌 李
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 霞 曹
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
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Leitner I, Andrianakis A, Gellner V, Kiss P, Andrianakis D, Tomazic PV. Optic nerve injury in preoperative imaging is associated with visual improvement outcome in endoscopic optic nerve decompression. Wien Klin Wochenschr 2021; 134:185-194. [PMID: 34342713 PMCID: PMC8921008 DOI: 10.1007/s00508-021-01915-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/28/2021] [Indexed: 01/21/2023]
Abstract
Objective To evaluate potential clinical parameters having an impact on visual outcome after endoscopic optic nerve decompression in acute optic neuropathy patients. Methods A retrospective chart review of patients with acute optic neuropathy, who underwent endoscopic optic nerve decompression between June 2001 and November 2018 at an academic center was performed. Patients were divided into groups according to visual improvement after surgical treatment (yes/no). Following clinical parameters were compared between groups: perioperative steroid use, evidence of optic nerve affection in preoperative neuroimaging, additional optic nerve sheath incision, surgery delay and preoperative C-reactive protein (CRP) levels. Further subgroups analyses were conducted based on etiology (trauma/tumor). Results Among 32 included cases, 16 patients (50%) reported visual improvement after endoscopic optic nerve decompression. There was no significant difference in visual improvement between etiology subgroups (trauma: n = 9/20 (45%) vs. tumor: n = 7/12 (58.3%), p = 0.465). Tumor subgroup patients with visual improvement had a significantly higher prevalence of optic nerve affection in preoperative neuroimaging than those without visual improvement (p = 0.018, φ = 0.683). Perioperative steroid administration was negatively associated with visual outcome (p = 0.034, φ = 0.375). Nerve sheath incision, surgery delay and preoperative CRP levels did not have a significant impact on visual outcome (p > 0.05). Conclusion Radiological findings can help as an indicator for surgical treatment since an affected optic nerve in preoperative neuroimaging resulted in better visual outcome after surgery. The use of steroids should be considered more carefully since it did not show any beneficial effect.
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Affiliation(s)
- Isabella Leitner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Alexandros Andrianakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria.
| | - Verena Gellner
- Department for Neurosurgery, Medical University of Graz, Graz, Austria
| | - Peter Kiss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Damianos Andrianakis
- Institute of Mathematics and Scientific Computing, University of Graz, Graz, Austria
| | - Peter Valentin Tomazic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
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