Endoscopic optic nerve decompression for traumatic optic neuropathy in children

Peng, Anquan; Li, Youzhong; Hu, Peng; Wang, Qin

doi:10.1016/j.ijporl.2011.05.004

Cited by 28 publications

(27 citation statements)

References 13 publications

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“…1,7,10,14,26,36,43,58 This technique definitely provides excellent exposure of the optic canal and orbital apex in a minimally invasive fashion. While decompression in traumatic optic neuropathy has been widely investigated, 11,13,[18][19][20]24,28,29,36,37,40,47,48,[52][53][54][55][56][57][58][59]61 indeed with debatable results, decompression for nontraumatic optic neuropathies (NONs) is still insufficiently studied. 2,3,5,12,15,17,[21][22][23][25][26][27]33,35,36,39,41,42,45,46,…”

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Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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Object While several approaches have been described for optic nerve decompression, the endoscopic endonasal route is gaining favor because it provides excellent exposure of the optic canal and the orbital apex in a minimally invasive manner. Very few studies have detailed the experience with nontraumatic optic nerve decompressions, whereas traumatic cases have been widely documented. Herein, the authors describe their preliminary experience with endoscopic endonasal decompression for nontraumatic optic neuropathies (NONs) to determine the procedure’s efficacy and delineate its potential indications and limits. Methods The medical reports of patients who had undergone endoscopic endonasal optic nerve and orbital apex decompression for NONs at the Lyon University Neurosurgical Hospital in the period from January 2012 to March 2014 were reviewed. For all cases, clinical and imaging data on the underlying pathology and the patient, including demographics, preoperative and 6-month postoperative ophthalmological assessment results, symptom duration, operative details with video debriefing, as well as the immediate and delayed postoperative course, were collected from the medical records. Results Eleven patients underwent endoscopic endonasal decompression for NON in the multidisciplinary skull base surgery unit of the Lyon University Neurosurgical Hospital during the 27-month study period. The mean patient age was 53.4 years, and there was a clear female predominance (8 females and 3 males). Among the underlying pathologies were 4 sphenoorbital meningiomas (36%), 3 optic nerve meningiomas (27%), and 1 each of trigeminal neuroma (9%), orbital apex meningioma (9%), ossifying fibroma (9%), and inflammatory pseudotumor of the orbit (9%). Fifty-four percent of the patients had improved visual acuity at the 6-month follow-up. Only 1 patient whose sphenoorbital meningioma had been treated at the optic nerve atrophy stage continued to worsen despite surgical decompression. The 2 patients presenting with preoperative papilledema totally recovered. One case of postoperative epistaxis was successfully treated using balloon inflation, and 1 case of air swelling of the orbit spontaneously resolved. Conclusions Endoscopic endonasal optic nerve decompression is a safe, effective, and minimally invasive technique affording the restoration of visual function in patients with nontraumatic compressive processes of the orbital apex and optic nerve. The timing of decompression remains crucial, and patients should undergo such a procedure early in the disease course before optic atrophy.

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confidence: 99%

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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“…A prolonged absolute latency on VEP often suggests visual block physiologically 5 . It is generally believed that optic nerve demyelination is induced by edema, ischemia, or hypoxia after trauma.…”

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confidence: 99%

Endoscopic decompression of the optic canal for traumatic optic neuropathy

Lan

Xiong

et al. 2016

Chinese Journal of Traumatology

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PurposeTraumatic optic neuropathy (TON) is a serious complication of head trauma with the incidence rate of 0.5%–5%. The aim of this study was to investigate the therapeutic efficacy of endoscopic decompression of the optic canal for optic nerve injuries.MethodsIn this study, 11 patients treated in our hospital from January 2009 to January 2015 with the visual loss resulting from TON were retrospectively reviewed for preoperative vision, visual evoked potential (VEP) scan, surgical approach, postoperative visual acuity, complications, and follow-up results.ResultsAll these patients received endoscopic decompression of the optic canal. At the 3-month follow-up, the visual acuity improvement rate of the 11 patients was 45.5%. The vision acuity of 2 cases improved from hand movement to 0.08 and 0.3 after operation. Another patient's vision acuity returned to 0.05 compared to light sensation preoperatively. Two cases had finger counting before surgery but they had a vision acuity of 0.4 and light sensation respectively after surgery. However, the other 6 cases' vision did not improve after surgery.ConclusionEndoscopic decompression of the optic canal is an effective way to cure TON. VEP could be used as an important reference for preoperative and prognosis evaluation. Operative time after trauma is only a relative condition that may affect the therapeutic effect of optic canal decompression. Poor results of this procedure may be related to the severity of the optic nerve injury.

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“…The VEP scan was performed before surgery for the confirmed TON patients, which was also adopted by Peng [10]. We only performed procedures with a detected VEP P100 wave because we believed otherwise that the retinofugal pathway would not be intact and the therapeutic effect would be poor.…”

Section: Discussionmentioning

confidence: 99%