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[Bitemporal hemianopsia after skull base fracture]

T Hayashi1, H Wakamoto, Y Shimamoto

  • 1Department of Neurosurgery, Hiratsuka City Hospital.

No Shinkei Geka. Neurological Surgery
|December 5, 1997
PubMed
Summary

A skull base fracture caused bitemporal hemianopsia in a young male. Direct pressure on the optic chiasm from the tuberculum sellae, not stretching, was the cause, highlighting a rare traumatic chiasmal syndrome presentation.

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Trauma Surgery

Background:

  • Skull base fractures can lead to complex neurological and visual deficits.
  • Traumatic optic neuropathy is a known complication, often attributed to direct injury or ischemia of the optic nerve/chiasm.
  • Bitemporal hemianopsia typically suggests injury to the optic chiasm.

Observation:

  • An 18-year-old male sustained a frontal head injury in a traffic accident, presenting with altered consciousness, traumatic subarachnoid hemorrhage, and pneumocephalus.
  • Following initial conservative management, the patient developed bilateral frontal hemorrhage and complained of CSF rhinorrhea, anosmia, and double vision.
  • Preoperative visual field testing revealed bitemporal hemianopsia.

Findings:

  • Three-dimensional CT imaging identified two fracture lines extending from the ethmoid sinus roof to the planum sphenoidale.

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  • Intraoperative findings confirmed these fractures and revealed compression of the optic chiasm by the tuberculum sellae.
  • No obvious tearing or stretching of the optic chiasm was observed, differentiating this case from typical traumatic chiasmal syndrome presentations.

    • Implications:

    • This case demonstrates that bitemporal hemianopsia following skull base fracture can result from direct compression of the optic chiasm by bony structures, such as the tuberculum sellae.
    • It challenges the prevailing assumption that traumatic chiasmal syndrome exclusively involves mechanical stretching or tearing of the optic chiasm.
    • Understanding alternative mechanisms of optic chiasm compression is crucial for accurate diagnosis and surgical management of visual deficits after head trauma.