Lee Joung H, Tobias Samuel, Kwon Jeong-Taik, Sade Burak, Kosmorsky Gregory
Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Surg Neurol. 2006 Jul;66(1):11-7; discussion 17. doi: 10.1016/j.surneu.2005.11.004.
In 1904, Hermann Wilbrand reported that nasal ON fibers form a loop into the contralateral ON, subsequently referred to as Wilbrand's knee. He had further theorized that a lesion affecting Wilbrand's knee would develop a distinct visual field defect characterized by an ipsilateral central scotoma with a contralateral superotemporal visual field defect. We present clinical evidence that disputes the existence of Wilbrand's knee.
A retrospective analysis of 3 patients whose ONs were divided at the ON-chiasm junction is presented. Two patients had an ONS meningioma and the other patient had sarcoidosis of the ON. Resection of the lesion and the ON up to the nerve-chiasm junction was done to prevent the disease from extending into the OC and the contralateral ON. The patients had detailed neuro-ophthalmologic evaluations preoperatively and postoperatively.
After the resection of the ON at the ON-chiasm junction in the 3 patients, junctional scotoma could not be detected by visual perimetry.
No clinical perimetric evidence was found to support the existence of Wilbrand's knee in the anterior visual pathway.
1904年，赫尔曼·威尔布兰德报告称，鼻侧视神经纤维形成一个环进入对侧视神经，随后被称为威尔布兰德膝部。他进一步推测，影响威尔布兰德膝部的病变会产生一种独特的视野缺损，其特征为同侧中心暗点伴对侧颞上象限视野缺损。我们提供了反驳威尔布兰德膝部存在的临床证据。
对3例视神经在视神经-视交叉交界处被切断的患者进行回顾性分析。2例患者患有视神经鞘脑膜瘤，另1例患者患有视神经结节病。为防止疾病蔓延至视交叉和对侧视神经，对病变及直至神经-视交叉交界处的视神经进行了切除。患者在术前和术后均接受了详细的神经眼科评估。
在3例患者的视神经在视神经-视交叉交界处被切除后，视野检查未发现交界性暗点。
未发现临床视野检查证据支持前视觉通路中存在威尔布兰德膝部。
