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  • Title: Wilbrand's knee: does it exist?
    Author: Lee JH, Tobias S, Kwon JT, Sade B, Kosmorsky G.
    Journal: Surg Neurol; 2006 Jul; 66(1):11-7; discussion 17. PubMed ID: 16793428.
    Abstract:
    OBJECTIVE: In 1904, Hermann Wilbrand reported that nasal ON fibers form a loop into the contralateral ON, subsequently referred to as Wilbrand's knee. He had further theorized that a lesion affecting Wilbrand's knee would develop a distinct visual field defect characterized by an ipsilateral central scotoma with a contralateral superotemporal visual field defect. We present clinical evidence that disputes the existence of Wilbrand's knee. METHODS: A retrospective analysis of 3 patients whose ONs were divided at the ON-chiasm junction is presented. Two patients had an ONS meningioma and the other patient had sarcoidosis of the ON. Resection of the lesion and the ON up to the nerve-chiasm junction was done to prevent the disease from extending into the OC and the contralateral ON. The patients had detailed neuro-ophthalmologic evaluations preoperatively and postoperatively. RESULTS: After the resection of the ON at the ON-chiasm junction in the 3 patients, junctional scotoma could not be detected by visual perimetry. CONCLUSION: No clinical perimetric evidence was found to support the existence of Wilbrand's knee in the anterior visual pathway.
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