Optic nerve decompression in trauma and tumor patients

Abstract

Optic nerve decompression is a procedure that is now receiving increasing clinical attention. However, there are currently no standardized treatment protocols in the therapy of traumatic or pressure insults to the nerve. The present retrospective study was designed to report our experience with microscopic endonasal transethmoid-sphenoid optic nerve decompression in 24 unilateral trauma cases and 11 unilateral skull base tumor patients. In general preoperative visual acuities in the trauma patients were worse than in the tumor patients. Following surgery, 9 of 11 tumor patients (82%) had at least some improvement of their vision, including 5 complete recoveries. In the group with traumatic visual impairment, 16 of the patients had no light perception preoperatively. Postoperatively, 13 patients (54%) had at least some improvement, with 4 patients regaining normal or near normal vision. Compared to other techniques and approaches, our technique is a minimally invasive procedure for optic nerve decompression, reducing unnecessary operative trauma to nasal structures, skin incisions or even craniotomy and frontal lobe retraction.

Anatomical aspects in the transsphenoidal–transethmoidal approach to the optic canal: An anatomic–cadaveric study

“…In skull base surgery practice, transcranial (Chen et al, 2004;Schick et al, 2004;Mathiesen and Kihlström, 2006;Yang et al, 2006;Tan et al, 2007) or extracranial (Knox et al, 1990;Goldberg and Steinsapir, 1996;Li et al, 1999aLi et al, , 1999bMaurer et al, 1999;Pletcher and Metson, 2007;Thaker et al, 2009) approaches have been preferred for lesions involving the optic canal. With the less invasive extended transsphenoidaletransethmoidal approach, which reaches the optic canal directly, the performance of biopsies, decompression of the optic nerve and even removing lesions affecting the optic nerve have become possible (Cook et al, 2004;Laws et al, 2005;Kitano et al, 2007;Cappabianca et al, 2008).…”

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. 2,3,5,12,15,17,[21][22][23][25][26][27]33,35,36,39,41,42,45,46,…”

Neuronavigation-Guided Endoscopic Decompression of Superior Orbital Fissure Fracture: Case Report and Literature Review

“…2 Endoscopic decompression in orbital trauma, especially when the optic nerve is involved, is receiving more attention, but there is a lack of management guidelines. 20 Transnasal endoscopic repair is already well documented and widely accepted as a safe method for treatment and repair of orbital blowout fracture, [21][22][23][24] however, the use of neuronavigationassisted transnasal endoscopic decompression in cases of partial or complete SOFS secondary to trauma has not been reported to our knowledge.…”