Visual improvement and pain resolution in traumatic optic nerve sheath meningocele treated by optic nerve sheath fenestration

Article type: Research Article

Authors: Hui, Chen^{; ; ;} | Xiaoyun, Wu | Yi, Liang | Ningbo, Chen | Xizhong, Qiu | Shaowei, Yang | Wei, Lin | Maozhu, Zhao | Wubo, Ma | Xuefei, Pan | Li, Lai | Haibin, Tan | Daiwen, Zeng | Yong, Jiang

Affiliations: Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China | Laboratory Animal Institute, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China | Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China | Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China | Emergency Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China | Department of Ophthalmology (East Area), Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China | Neurosurgery Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China | School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China | School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China | Neurosurgery Department, Lu Zhou Medical College, Luzhou, Sichuan, China

Note: [] Chen Hui, Wu Xiaoyun, Liang Yi and Chen Ningbo contributed equally to this work. Corresponding author: Chen Hui, No. 32, 1st ring road, 2nd west section, Chengdu, Sichuan 610072, China. Tel.: +86 028 6708 7565; Fax: +86 028 6708 7557; E-mail: chenhuicq@gmail.com

Note: [] Chen Hui, Wu Xiaoyun, Liang Yi and Chen Ningbo contributed equally to this work.

Note: [] Chen Hui, Wu Xiaoyun, Liang Yi and Chen Ningbo contributed equally to this work.

Note: [] Chen Hui, Wu Xiaoyun, Liang Yi and Chen Ningbo contributed equally to this work.

Note: [] Corresponding author: Jiang Yong, Taiping Street 25th, Luzhou, Sichuan 646000, China. Tel.: +86 830 3165 461; Fax: +86 830 2392 753; E-mail: jiangy0122@gmail.com

Abstract: Purpose: There is no consensus as to the optimum treatment for traumatic optic neuropathy (TON). The decision to intervene medically or surgically, or simply observe was recommended to be on an individual basis. The purpose of this study is to test whether optic nerve sheath fenestration (ONSF) could improve vision in patients with traumatic optic nerve sheath meningocele, although it was reported to be effective in patients with traumatic optic nerve sheath hematoma. Methods: ONSF was performed on two traumatic patients with dilated optic nerve sheath from MRI. Results: Both patients initially suspected as traumatic optic nerve sheath hematoma were diagnosed as traumatic optic nerve sheath meningocele by intraoperative findings of the enlarged optic nerve sheath and clear fluid drained without evidence of blood in the subdural space. Moreover, significant orbit/head pain resolution and visual improvement within a week after ONSF was found. Conclusions: When TON presents with an enlarged optic nerve/sheath on CT or MRI with visual loss, an optic nerve sheath meningocele should be considered with the consideration that ONSF may benefit both visual acuity and post-traumatic pain, if present.

Keywords: Traumatic optic neuropathy, optic nerve sheath meningocele, optic nerve sheath fenestration (ONSF), head/orbital pain

DOI: 10.3233/RNN-140395

Journal: Restorative Neurology and Neuroscience, vol. 32, no. 5, pp. 655-661, 2014