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Case Reports
. 2018 Jun 19;10(6):e2835.
doi: 10.7759/cureus.2835.

Craniotomy Improves Traumatic Optic Neuropathy

Juni Ejyj  1 , Wen-Jeat Ang  1 , Wan-Hazabbah Wh  1 , Yew Chin Tan  2
Affiliations
Case Reports

Craniotomy Improves Traumatic Optic Neuropathy

Juni Ejyj et al. Cureus. .

Abstract

Traumatic optic neuropathy (TON) is a rare devastating complication of traumatic head injury and is an ophthalmic emergency. Herein, we report a rare case of a 46-year-old gentleman who experienced severe blurring of vision, binocular diplopia, and pain over his left eye following a fall from a tree about three meters in height. Examinations revealed the visual acuity was 6/60 with a marked relative afferent pupillary defect and generalized ophthalmoplegia over his left eye. Emergency computed tomography (CT) brain and orbit showed a left frontotemporoparietal extradural hemorrhage, comminuted frontotemporoparietal and greater wing of sphenoid fracture with a bony spur impinging the lateral rectus and indirectly on the optic nerve. A diagnosis of left frontotemporoparietal bone fracture with traumatic optic neuropathy was made. An emergency left craniotomy, elevation of depressed skull fracture, and evacuation of clot was done. Postoperatively, his visual acuity showed marked improvement with visual acuity of 6/6 and all optic nerve functions were normal.

Keywords: bony spur; emergency craniotomy; traumatic optic neuropathy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. (A,B) left greater wing of sphenoid bone fracture with a bony spur abutting and impinging the left lateral rectus and indirectly the optic nerve on the same side; (C) multiple comminuted fractures in the left frontotemporoparietal; (D) left frontotemporoparietal extradural haemorrhage
Figure 2
Figure 2. a left craniotomy was done 12 hours post trauma. (A) elevation of depressed left frontotemporoparietal skull fracture; (B) evacuation of clots; (C) bony impingement being relieved
See this image and copyright information in PMC

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