Emergency Optic Canal Decompression for Vision Salvage in Fibrous Dysplasia

Elwy, Reem; Gökden, Murat; Cai, Rongsheng

doi:10.1016/j.wneu.2017.09.119

Cited by 8 publications

(4 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Besides, the central visual eld area enlarged at one month after surgery. Other than emergent decompression to salvage one's vision [11] , our case indicated that even when the compression has damaged the optic nerve for a prolonged disease course, relieving the compression can still improve visual function partially. Possible explanation was that the central visual eld might be recently affected, which was therefore reversible.…”

Section: Discussionmentioning

confidence: 88%

Visual Field Improvement Achieved by Decompression Surgery for Craniomaxillofacial Fibrous Dysplasia: A Case Report

Li¹,

Chen²,

Tian³

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundCraniomaxillofacial fibrous dysplasia (CFD) is a type of congenital benign bone disorder that progressively replaces the healthy bone marrow with fibrous tissue. When the optic nerve is influenced, the efficacy of therapeutic decompression is doubtful, as vision loss is irreversible with the thinning nerve fiber layer. Case presentationA 22-year-old female presented to our institution with left painless, slowly-progressing orbito-fronto-temporal swelling. She had undergone several plastic surgeries before. Enlargement in her left frontal area involving the orbital region was seen, with increased frontal contour and vertical dystopia and minimal inferior displacement of the globe. We observed significant visual field defects in her left eye, and her retinal fiber layer was thin on examination. She was therefore diagnosed as FD. Decompression operation was performed, and her visual acuity and central visual field improved in the 1-month follow-up.Conclusions Our case indicated that visual defect caused by prolonged time course of optic nerve compression by craniomaxillofacial fibrous dysplasia can be relieved partially by decompression surgery.

show abstract

Section: Discussionmentioning

confidence: 88%

Visual Field Improvement Achieved by Decompression Surgery for Craniomaxillofacial Fibrous Dysplasia: A Case Report

Li¹,

Chen²,

Tian³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Previous reports advocated for prophylactic decompression before development of clinical symptoms. 7,11 Recent studies demonstrate low rates of optic neuropathy and improved visual outcomes with therapeutic decompression, 12,13 even in the context of complete optic nerve encasement, 9 and overall worse visual outcomes with prophylactic orbital intervention. 4 Our study revealed favorable visual outcomes with therapeutic optic nerve decompression.…”

Section: Discussionmentioning

confidence: 99%

“…4 Our study revealed favorable visual outcomes with therapeutic optic nerve decompression. 4,[12][13][14] Although we strive for no visual deterioration, a meta-analysis by Amit et al that included 241 patients with craniofacial FD found that performing surgery in asymptomatic patients is significantly associated with visual deterioration. 15 This highlights the importance of frequent visual assessment to optimize visual outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Natural History of Fibrous Dysplasia of the Orbit

Blum

Cho

Villavisanis

et al. 2023

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

Fibrous dysplasia (FD) is a benign fibroosseous tumor of growing bone whereby fibrous tissue replaces normal medullary bone. 1,2 FD likely arises from somatic activating mutations in the Gsα gene, leading to abnormal proliferation of skeletal progenitor cells. 3 FD exists along a spectrum of severity, affecting one (monostotic) or many (polyostotic) bones of the axial and appendicular skeleton, 4 with symptoms varying depending on location and disease burden. FD may exist in isolation or within the characteristic triad of symptoms associated with McCune-Albright syndrome (MAS), including polyostotic fibrous dysplasia, café-au-lait spots, and precocious puberty. 5 FD usually presents in childhood and may progress throughout puberty and adolescence, ultimately "burning out" around skeletal maturity with apoptosis of mutation-bearing mesenchymal cells. 6 Devastating sequelae of FD include optic neuropathy secondary to ischemic Background: Orbital fibrous dysplasia (FD) is a disease of disordered fibroosseous proliferation secondary to altered osteogenesis, with potential sequelae including compressive neuropathy and irreversible vision loss. The purpose of this study was to evaluate the natural history and longitudinal outcomes of 37 patients with orbital FD who underwent stratified surgical management. Methods: All patients treated for FD from 2015 to 2021 were identified, yielding 185 patients, 39 with orbital involvement. Impressions from head computed tomographic scans were analyzed by a craniofacial radiologist to evaluate location and timing of tumor growth. Operative records were reviewed to determine surgical approach (partial excision/contouring, complete excision, or partial excision with optic nerve decompression). Results: The average patient age at diagnosis was 10.7 ± 4.5 years, and the average follow-up was 5.2 ± 4.7 years. Of the 37 patients with orbital involvement, 28 (75.7%) had optic canal involvement. Of those with optic canal involvement, 13 (46.4%) required partial excision with optic nerve decompression, whereas 15 (53.6%) did not. Of those without optic canal involvement, two patients (22.2%) underwent partial excision/contouring of the anterior orbit to correct dystopia and/or proptosis, and four patients (44.4%) underwent complete excision of the orbital component and reconstruction with bone graft or mesh. Younger age at diagnosis was associated with an increased number of surgical interventions (P = 0.011), younger age at first optic canal decompression (P = 0.003), and worse visual outcomes (P = 0.009). Conclusion:In the authors' cohort, patients diagnosed at a younger age required more operations, underwent decompression earlier, and had worse visual outcomes.

show abstract

“…Despite the abundance of literature available over endoscopic endonasal decompression of the optic nerve in traumatic optic neuropathy, the studies for this approach in optic nerve compression in FD and other non-traumatic optic neuropathies are scarce with a few patients 7. Until now prophylactic optic nerve decompression is not indicated in FD, therapeutic decompression has shown to have favourable results 8. Yang Liu et al performed endoscopic endonasal optic nerve decompression in 21 eyes (20 cases) of non-traumatic optic neuropathy due to various space occupying lesions of which majority (eight cases) were due to fibro-osseous lesions.…”

Section: Discussionmentioning

confidence: 99%

Navigation-assisted endonasal endoscopic optic nerve decompression in fibrous dysplasia

Thota

Kumar

et al. 2019

BMJ Case Rep

View full text Add to dashboard Cite

A 12-year-old girl presented with left-sided decreased vision of 2-month duration. Clinical evaluation and imaging revealed fibrous dysplasia compressing the left optic nerve with no underlying endocrinological abnormalities. Best-corrected visual acuity showed progressive deterioration of vision over 2-month follow-up. She underwent navigation-assisted endonasal endoscopic optic nerve decompression. Post-surgery there was improvement in vision and it became normal (6/6). Six-month follow-up showed stable vision with no further complications.

show abstract

Emergency Optic Canal Decompression for Vision Salvage in Fibrous Dysplasia

Cited by 8 publications

References 16 publications

Visual Field Improvement Achieved by Decompression Surgery for Craniomaxillofacial Fibrous Dysplasia: A Case Report

Visual Field Improvement Achieved by Decompression Surgery for Craniomaxillofacial Fibrous Dysplasia: A Case Report

The Natural History of Fibrous Dysplasia of the Orbit

Navigation-assisted endonasal endoscopic optic nerve decompression in fibrous dysplasia

Contact Info

Product

Resources

About