Endoscopic Optic Nerve Decompression: The Graz Experience

Abstract

Recommendations for management of traumatic injuries to the optic nerve in the literature include expectant management, medical therapy, surgical treatment, and medical therapy combined with surgical decompression. Traditional surgical approaches to optic nerve decompression (OND) are a neurosurgical or craniotomy approach, extranasal transethmoidal approach, transorbital approach, transantral approach, and intranasal microscopic approach. Recent advances in instrumentation and surgical techniques have made an endoscopic approach to OND possible. Since 1991 endonasal endoscopic decompression of the optic nerve has been the surgical approach of choice in patients requiring OND in the authors' hospital. The endoscopic method offers many advantages over the traditional approaches. Decreased morbidity, preservation of olfaction, rapid recovery time, more acceptable cosmetic results with no external scars, no risk of injury to the developing teeth in children, and less operative stress in a patient who may have multisystem trauma are only some of the benefits associated with the endoscopic OND. The authors' technique of endonasal endoscopic approach to OND, medical management, and indications for surgery and the results in 22 patients undergoing this procedure are discussed.

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

“…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.…”

Descompressão endoscópica orbitária na oftalmopatia de Graves

“…Among the disadvantages, we mention a higher incidence of diplopia, which may be surgically corrected later on, and the potential development of sinusitis or secondary mucocele [14][15][16][17][18] . The most frequently reported complications with this procedure are sinusitis or frontal or maxillary mucocele, CSF fistulas, lesion of the nasolacrimal duct, strabismus and diplopia, which may occur in 15 to 60% of the cases.…”

Traumatic Optic Neuropathy

“…53 The risk of damage to this artery may be minimized by incising the nerve sheath in its upper medial quadrant. 37,51 Concomitant damage to the base of the skull with a resultant CSF leak may occur as a result of the trauma or may occur iatrogenically, while decompressing the optic nerve. In any case, once detected, it should be managed simultaneously endoscopically by sealing the site of leak using a connective tissue either as a bath-plug or a carpet-graft in a multilayered closure (Figs 7 and 8).…”

“…Proponents of decompression of the nerve sheath note that the post-traumatic compartmental syndrome is best relieved by releasing the constricting sheath enveloping the nerve. 36,37 Detractors of nerve sheath slitting, however, doubt its efficacy and also note that this may cause an occasional cerebrospinal fluid (CSF) leak, may potentially disrupt the pial vessels contributing to nerve vascularity, may disrupt the nerve fascicles and may also risk injury to the ophthalmic artery coursing in the optic canal. 37,38 The layers of the optic nerve sheath as viewed from a medial transsphenoidal approach include the periosteal and dural layers of the duramater, arachnoid sheath, subarachnoid space and the pial sheath which is adherent to the nerve.…”