Sphenoethmoid approach to the optic nerve

Abstract

Five percent of all head injuries affect some portion of the visual system, and the most common locus of injury is the canalicular segment of the optic nerve. The classic surgical approach to this area is via the transfrontal craniotomy, although the Japanese have utilized an external ethmoidal technique to provide limited extracranial access to the optic canal. Harvey Cushing utilized the transsphenoidal hypophysectomy principally for pituitary tumors causing visual deficits. This paper presents a variation of the transsphenoidal hypophysectomy technique which will allow exposure of the optic nerve from the orbital apex to the optic chiasm through the use of microsurgical instrumentation. A detailed step-wise description of the surgical methodology is presented, along with drawings to define the approach fully. Four case reports and representative pre and postoperative radiographs illustrate the actual approach in the clinical setting.

Endoscopic optic nerve decompression for traumatic optic neuropathy in children

“…Possible reasons for that are: (1) there are not many reports available about pediatric optic nerve decompression in research literature (2) the sinuses, skull base, orbits, and optic canals in children have not fully developed. In particular, the sphenoid sinus in some children has not developed [8], which makes it more difficult for the surgery to be performed on children than adults -in terms of operative techniques.…”

Endoscopic Endonasal Trans-sphenoidal Optic Nerve Decompression for Traumatic Optic Neuropathy -Technical Note-

“…In the fields of otolaryngology and ophthalmology, the endonasal approach for optic nerve decompression has often been performed more laterally using the trans-ethmoid transsphenoidal route like the Messerklinger and Stammberger technique rather than the direct transsphenoidal route, which we have adopted. 4,12,18,19) The trans-ethmoid trans-sphenoidal approach is a shortest straightest route to the optic canal, but carries the risk of directly injuring the optic nerve in such cases as the posterior ethmoid cells called Onodi cells. 12) Posterior ethmoid cells are pneumatized laterally and the optic prominence is significant in the lateral wall.…”

Craniofacial Fracture Symptoms

“…The highest risk of damage exists in frontal (72%) and fronto-temporal (12%) traumas (Kline et al 1984;Sofferman 1988Sofferman , 1991.…”

“…The operation has to be performed within the first 6 h following trauma (Yoshinao 1972;Fukado 1981;Krausen et al 1981;Stoll et al 1987Stoll et al , 1994Sofferman 1988Sofferman , 1991Mann et al 1991;Niho 1991;Mathog 1992;Rochels and Behrendt 1996;Koch and Lehnhardt 2000). Decompression 8-10 h following trauma often results in a permanent reduction of vision or even an amaurosis (Kennerdell et al 1976;Lädrach et al 1999).…”