Otsu Yusuke, Komaki Satoru, Takeshige Nobuyuki, Sakata Kiyohiko, Morioka Motohiro
Department of Neurosurgery, Kurume University School of Medicine, Kurume City, Japan.
Surg Neurol Int. 2023 Jul 14;14:245. doi: 10.25259/SNI_450_2023. eCollection 2023.
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.
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.
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.
外伤性视神经病变（TON）行手术视神经管减压术（OCD）的指征仍存在争议，因为尚无可靠的预后良好预测指标。我们报告1例TON致盲患者，其残余视觉诱发电位（VEP）提示OCD术后受损视神经有恢复潜力。
一名48岁男性从7米高处坠落，头部着地。他当即诉说右眼失明。右眼无光感，右瞳孔直接对光反射消失，尽管计算机断层扫描和磁共振成像未显示骨折或外伤性病变。由于刺激右眼时VEP波幅未变，我们实施了右侧OCD。手术OCD过程中，VEP波幅和潜伏期开始改善。最终，几乎所有方向的视野均有改善，视力提高到0.2。
TON中保留的VEP活动可能提示受损视神经的恢复潜力，即使在失明病例中也是如此。VEP有可能是TON积极治疗（如OCD）的一个指标。
