Surgical reversal of prolonged blindness from a metastatic neuroblastoma.
BACKGROUND
Reports of tumor-related anterior visual pathway blindness that have resolved after surgical decompression are rare. The longest reported duration of tumor-related blindness completely reversed by optic nerve decompression is 3 days. We describe a pediatric patient with 7 days of no light perception who experienced reversal of blindness following tumor resection and optic nerve decompression.


METHODS
A 33-month-old boy presented with a 4-day history of no light perception. Magnetic resonance imaging revealed a mass involving the sphenoid sinus, sella turcica, and clivus with significant optic nerve involvement. Loss of light perception and complete absence of a pupillary light reflex were documented for the next 72 h. A sluggish pupillary light reflex was regained 24 h after instituting intravenous steroids. An urgent bi-frontal craniotomy and optic nerve decompression were performed 7 days after the onset of blindness. Surgical pathology revealed metastatic neuroblastoma. Eleven days after optic nerve decompression, the child was able to count fingers and recognize faces and printed book characters.


CONCLUSIONS
Prolonged blindness secondary to tumor-related optic nerve compression may be reversible up to 1 week from onset in children presenting with no light perception.
McGirt
Matthew J
MJ
Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, MD, USA.
Cowan
John A
JA
Gala
Vishal
V
Garton
Hugh J
HJ
Muraszko
Karin M
KM
Thompson
B Gregory
BG
D001766:Blindness / Q000209:etiology / Q000601:surgery*; D002675:Child, Preschool; D019299:Decompression, Surgical; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009447:Neuroblastoma / Q000150:complications / Q000556:secondary* / Q000601:surgery*; D009901:Optic Nerve Diseases / Q000601:surgery*; D016896:Treatment Outcome; D014796:Visual Perception / Q000502:physiology