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

  • Knapp, Herman, 1832-1911.
Date:
1877
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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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    •^1 TUMORS OF THE OPTIC NERVE. 9 sarcoma, and secondary cancer) the tumors may have sprung from the tissue of the subvaginal space and the inner sheath. Two tumors ot a carcinomatous structure (Neumann and Knapp) originated in the outer sheath. • . . ^ , . Symptoinatology.—The age of the patients varied from one and a quarter to forty years. There is no decided preference for either eye. ihe prevalent symptom is exophthalmos, either directly forward, in the direction of the orbital axis, or showing besides a secondary deviation in accordance with a greater development of the tumor on one side. The niptions of the globe are preserved.,Jut inore or je^ssj^estnciecl. On palpation, directly behind the globe a softlsh fifmorls felt, the move- ments of which correspond more or less to those of the eyeball. A free space can be recognized between the.tumor and the orbital wall. ISTeu^ dtjsjjescendens is a constant symptom in the early 8tages,^and atrophy oflhenerve ilTtFe'Tater stages of tire aftectibn. The sight is more or less impaired, the field of vision being restricted when the pseudoplasra originates in the inner sheath and perineurium internum. Sight is less impaired, and the visual field remains complete, when the tumor springs from the outer sheath. Intense and persistent pain has been noticed in the cases of cancer (Neumann, Knapp, Krohn); in the other cases there Avas pain only when the eyeball was inflamed, with the exception of one case of myxoma (Gruening) in which intense pain was felt after the pro- trusion of the eye had existed for four years without pain. The course of the disease shows in all cases a slow but steady increase of the tumor. The longest duration observed was fifteen years (Key- mann and Rothmund). First, the posterior part of the eyeball is flat- tened, and the eye becomes hyperopic; then the eye protrudes, and neuro-retinitis sets in ; then opacity, ulceration, and perforation of the cornea occur; after which the coats of the eye are so much pressed together that the optic disk touches the cornea. The ultimate, sponta- neous issue cannot be known from the published cases, since the tumor in all was extirpated, and recovery took place, except in one case in which a relapse implicating the brain occurred, and in which the patient died from meningitis in consequence of a second operation. The observations on record are not sufficient to enable us to form a reliable ■prognosis as to the natural course of tumors of the optic nerve. All the cases in which the tumor was removed ended in recovery, which, with the one exception of a fatal recurrence, seems to have been perma- nent. Sight is, of course, destroyed in all cases. The treatment, until lately, consisted in the removal of the tumor, together with the eyeball, which operation offers no difliculty. Two years ago, I succeeded in removing such a tumor, and preserved the eye. About one year since, Dr. E. Gruening did the same in another case. Both of these cases have continued to do well. In one case (Graefe), the operation was followed by suppurative inflammation in the wound ; in another (Szokalski), the operation caused death by meningitis. In none of the other cases was the operation followed by any unpleasant symp- tom. In conclusion, I may say that tumors of the optic nerve form, at pre- sent, a sufficiently understood chapter of surgery, and that their diti:eren- tial diagnosis is quite possible. Extirpation relieves the patient from disfigurement and pain, and prolongs life. By improved modes of operative procedure, the tumor may be removed while the eye, which, though blind, is better than a glass eye, is preserved.