On tumors of the optic nerve / by H. Knapp.

  • Knapp, Herman, 1832-1911.
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: On tumors of the optic nerve / by H. Knapp. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    310.) The patient, ret. 20, had snfferecl from boadaclic for six years, and liad noticed a protrusion of her eye for tiiree years. The mobility of the eye was preserved, and was only a little restricted in an upward direction. The vision was almost normal. On palpation a hard immovable tumor was felt sur- rounding the posterior part of the globe on all sides. Dr. Jacobsou, of Konigs- berg, remoA'^ed the eye together with the tumor. The tumor was three-quarters of an inch in length, the size of a walnut, and immediately behind the eye surrounded the optic nerve, which passed quite loosely across it. The neoplasm was connected with the outer sheath, which on section showed itself as a distinct, white border-line. The inner sheath was smooth and shining. Between the two sheaths, delicate cords were stretched when the nerve was drawn away from the tumor. The microscopic examina- tion discovered that the structure of the tumor was partly compact, partly alveolar. Tiie alveolar part had a stroma which resembled that of a cancer, inclosing accumulations of fusiform cells in concentric layers. The centres of many cells were incrusted. Teased preparations showed that these fusiform , elements were flat endothelioid cells. The compact part of the tumor consisted of coarse fibrils, here and there inclosing numerous accumulations of sarcoma- tous cells. The periphery of the tumor consisted of adipose tissue. The tumor is styled by Neumann apsammoma,on accountof tiie prevalenceof the incrusted, arenoid bodies in the alveolar part of the tumor. Case V.—(Described by H. Knapp,in Archives of Ophthalmology and Oto- logy, vol. iv. pp. 323-354, 18^5, with four plates.) Mrs. J. K., set. 40, was first examined in August, 1871. Her left eye was normal in function and struc- ture; the right protruded about 5' in a forward and slightly downward direc- tion. The protrusion had begun six months previously, and the sight of that eye had gi-adually become impaired. She suffered from occasional headaches, which always increased the protrusion of the eye. The movements of the globe were somewhat restricted, chiefly in an upward direction. There was no pul- sation, nor bruit. S. with +10 Sn. y^^ ; F. complete. The optic disk showed a steep elevation, arteries small, veins dilated and tortuous. The ophthalmo- scopic condition did not materially change for three years. In June, 1874, a hardish tumor was felt, on palpation, on the inner and upper side of the poste- rior part of the globe. It moved with the eye. A free space was felt between the tumor and the orbital wall. The globe was dislocated slightly outward, and considerably downward (4'-5')5 but mostly forward (6')- Inversion was perfect, whereas the strongest eversion brought the corneal margin no nearer than 2' from the outer commissure; downward rotation was free, but upward rotation moved the eye no higher than the horizontal median plane; S. ^Vt)- F. complete. Media clear, pupil responsive. Papilla raised, with abrupt borders, like a jockey-cap. Venous hyperaemia marked. General health good. For the last years, great pain in eye and head. The diagnosis of orbit.nl tumor could now be more specifically revised into that of a tumor of the optic nerve, and acting upon this supposition I attempted, on June 10,1874, to enu- cleate the tumor while preserving the eyeball. I succeeded in the following manner:— 1 opened the conjunctiva by a circular section between the inner and supe- rior recti muscles, and laid the anterior portion of the tumor bare. Tlien I introduced my left forefinger into the wound, and under its guidance freed the hardish tumor from the soft, surrounding orbital tissue. After that, I dis- sected the mass from tlie posterior part of the globe, with which it was con- nected ))y a thin layer of connective tissue. Fui-ther, I severed the optic nerve, and then introduced my finger as deeply into the orbit as possible. Not being able to reach the apex of the tumor, which was close to the optic foramen, I cut the tumor across as near the summit of tlie orbit as I could reach. Now I rotated the growth on its antero-posterior axis, and severed such connections with its surroundings as had before escaped. All this was done with a pair of strabismus scissors. Then I introduced the closed blades of a stronger pair of