Endoscopic Optic Nerve Decompression for Traumatic Blindness

Kountakis, Stilianos E.; Maillard, Alberto A. J.; El-Harazi, Shérif M.; Longhini, Luca; Urso, Richard G.

doi:10.1067/mhn.2000.106007

Cited by 71 publications

(68 citation statements)

References 10 publications

(22 reference statements)

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“…The authors observed that (1) For patients with injuries to I, III, IV, V and VI cranial nerves and brain contusion, not only their III, IV, V and VI cranial nerves function recovered well, but their eyesight also recovered relatively well, which may be related to the following mechanism: when acted upon by an external force, the brain was injured, which prolonged the action time of the force upon the optic nerve and lessened the indirect damage to the nerve. The therapeutic effect achieved is similar to that reported in relevant literature on the treatment of brain contusion with optic nerve injury [10,[13][14][15][16][17]. (2) For the patient who was with OAS and underwent decompression of the optic nerve and orbital apex over 2 weeks after injuries to multi-cranial nerves, although her eyesight did not improve, her eyeball movement and cornea esthesia recovered, probably because the optic nerve had degenerated or the ganglionic cells of retina had died, while the injured III, IV, V and VI cranial nerves could repair themselves as the motor nerves recovered better from damage than the sensory nerves.…”

Section: Discussionsupporting

confidence: 84%

“…There is literature available on treatment of patients with optic nerve injuries using a high dose of hormones and certain satisfactory results achieved in it, but according to the statistics, the effectiveness of this single medication treatment was much lower than that of comprehensive treatment with the surgery as the main therapy [10,[13][14][15][16][17][18][19][20][21][22]. In addition to that, patients with OAS were severely injured and the orbital apexes and the optic canals were obviously compressed by the fractures; therefore, surgical procedures are very necessary to treat OAS [23][24][25].…”

Section: Discussionmentioning

confidence: 93%

“…The authors chose the surgical opportunity by mainly relying on results of preoperative ophthalmologic examinations, high-resolution HRCT and the Glasgow Coma Scale. When the scale was C13 points [10][11][12], the surgery should be carried out as soon as possible. The authors observed that (1) For patients with injuries to I, III, IV, V and VI cranial nerves and brain contusion, not only their III, IV, V and VI cranial nerves function recovered well, but their eyesight also recovered relatively well, which may be related to the following mechanism: when acted upon by an external force, the brain was injured, which prolonged the action time of the force upon the optic nerve and lessened the indirect damage to the nerve.…”

Section: Discussionmentioning

confidence: 99%

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Study on the treatment of traumatic orbital apex syndrome by nasal endoscopic surgery

Xiao

et al. 2010

Eur Arch Otorhinolaryngol

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Orbital apex syndrome (OAS) is a complex disease caused by a variety of pathological factors, and trauma is one of the main factors/causes. Clinical data of 17 cases of traumatic OAS treated by nasal endoscopic surgery in our department from January 2002 to April 2009 were gathered and reviewed. Among them, the six patients presented with OAS after injury to the lateral wall of orbital apex. Seven other patients exhibited OAS after injury to the medial wall of orbital apex, two displayed OAS after zygomatic trauma, while OAS manifested in the other two patients with craniocerebral trauma 3 days after they had decompressive craniotomy--of them, one was blind in both eyes. In the 17 cases, 6 patients were without light sensation, 1 was blind in both eyes; the sight-chart index of eight patients was 0.1, that of three other patients was 0.1-0.2. Fifteen patients displayed eyeball movement disturbance (disorder) and cornea sensory disturbance (disorder), two were with the eyeball abducent disturbance. After the nasal endoscopic surgeries for OAS performed on the 17, the sight of the most patients was restored in varying degrees. The sight of nine patients was between 0.2 and 0.3, that of two patients was between 0.1 and 0.2, that of the other two patients was 0.1, and that of four patients remained unchanged. The eyeball movement and the cornea esthesia in 15 patients recovered from the surgeries, one patient recovered with good eyeball adducent movement and the cornea esthesia but with eyeball abducent disturbance, the other patient did not make a recovery from the eyeball immobility, cornea anesthesia and ptosis. A follow-up lasting 2 months to 2 years suggested that the 16 patients had stable recovery from the surgeries. Satisfactory results could be achieved in the treatment of traumatic OAS by nasal endoscopic surgery. From objective assessment of the therapeutic effects of traumatic OAS, it can be concluded that if a patient is diagnosed with fractures of the optic canal and the superior and medial walls of orbital apex, nasal endoscopic decompression of superior and medial walls of orbital apex and optic canal via the approach to the sphenoid and ethmoid sinuses is the most ideal operative therapy.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Study on the treatment of traumatic orbital apex syndrome by nasal endoscopic surgery

Xiao

et al. 2010

Eur Arch Otorhinolaryngol

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“…7,8 Rarely, orbital decompression has also been used to relieve optic neuropathy, secondary to disorders of cranial bone such as fibrous dysplasia, 9,10 osteopetrosis, 11 or renal osteodystrophy. 12 While transnasal and/or transorbital approaches have been described for optic canal decompression in patients with post-traumatic optic neuropathy, [13][14][15][16][17] the efficacy of this procedure remains very doubtful. 18 We present a series of patients with optic neuropathy, secondary to orbital encroachment by the sphenoidal wing meningioma, treated by transnasal endoscopic medial orbital decompression.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic transnasal orbital decompression for visual failure due to sphenoid wing meningioma

Lund

Rose

2006

Eye

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“…Systemically administered steroids have a similar effect, resulting in a 'medical decompression'. On the basis of the demonstrated efficacy of steroids in the treatment of spinal cord injury [9] , it has been proposed that TON can be similarly treated [10] . In 1982, high-dose steroids were first used in the treatment of TON.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Optic Nerve Decompression for the Treatment of Traumatic Optic Nerve Neuropathy

Wang¹,

Zheng²,

Jiao

et al. 2008

ORL

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Objective: We aimed to investigate the efficacy of endoscopic optic nerve decompression in patients with traumatic optic neuropathy. Methods: We performed a retrospective analysis of 46 patients with traumatic optic neuropathy in the Shanghai Eye, Ear, Nose and Throat Hospital between March 2002 and September 2005. All patients were first treated with methylprednisolone for 6 days. Forty-four patients (46 eyes) that did not improve with methylprednisolone treatment were offered endoscopic optic nerve decompression. Results: In 38 eyes with no light perception vision preoperatively, 21 eyes (45.6%) had improvement in visual acuity. These patients had postoperative light perception in 17 eyes, hand movement in 3 eyes and 60/200 in 1 eye. Four of 5 eyes with light perception preoperatively had postoperative vision for hand movement in 2 eyes, finger counting in 1 eye and 20/200 in 1 eye. For 3 eyes with preoperative visual acuity of hand movement, the postoperative visual acuities were 60/200, 60/200 and 120/200. Neither worsening of vision nor major complications was encountered in our series. Conclusions: We conclude that endoscopic optic nerve decompression in experienced surgeons’ hands can improve visual acuity in traumatic optic nerve neuropathy with minimal morbidity. Our results also demonstrate that even patients initially without light perception may benefit from optic nerve decompression.

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Endoscopic Optic Nerve Decompression for Traumatic Blindness

Abstract: EOND is an appropriate treatment technique for patients with TON in whom high-dose steroid treatment has failed.

Cited by 71 publications

References 10 publications

Study on the treatment of traumatic orbital apex syndrome by nasal endoscopic surgery

Study on the treatment of traumatic orbital apex syndrome by nasal endoscopic surgery

Endoscopic transnasal orbital decompression for visual failure due to sphenoid wing meningioma

Endoscopic Optic Nerve Decompression for the Treatment of Traumatic Optic Nerve Neuropathy

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