The Intracranial and Intracanalicular Optic Nerve as Seen Through Different Surgical Windows: Endoscopic Versus Transcranial

Caporlingua, Alessandro; Prior, Alessandro; Cavagnaro, María José; Winston, Graham; Oliveira, Dayvid L C; Sadwhani, Shaan D; Arias, Glenn Alvarez; Schwalb, Jesse N; Akhbari, Melika; Evins, Alexander I.; Bernardo, Antônio

doi:10.1016/j.wneu.2019.01.122

Cited by 20 publications

(9 citation statements)

References 43 publications

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“…2 Depending on the location of the pathology and its relationship with the optic nerve, the OC may be decompressed through an open transcranial approach or an endoscopic endonasal approach. 1,3 OC drilling can be tailored based on the location of the pathology and its extension. Anterior clinoid process and optic strut drilling can be added based on these factors as well.…”

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confidence: 99%

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Optic Canal Decompression: Concepts and Techniques: 2-Dimensional Operative Video

Patra¹,

Turcotte²,

Bendok³

2021

Operative Surg.

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The optic canal (OC) is a bony channel that transmits the optic nerve (ON) and ophthalmic artery (OphA) as they course through the lesser wing of the sphenoid bone to the orbital apex. The OC is involved in a variety of intracranial and extracranial pathologies,1 and opening of the canal may be necessary in order to achieve adequate exposure, better disease control, and vision preservation.2 Depending on the location of the pathology and its relationship with the optic nerve, the OC may be decompressed through an open transcranial approach or an endoscopic endonasal approach.1,3 OC drilling can be tailored based on the location of the pathology and its extension. Anterior clinoid process and optic strut drilling can be added based on these factors as well.4,5 In this video, we demonstrate the steps of OC drilling in both transcranial microscopic and endoscopic endonasal approaches through a combination of animated illustrations and operative videos. We present 4 cases, including 2 transcranial microscopic and 2 endoscopic endonasal approaches,6 demonstrating OC decompression and its technical nuances. Each case was selected to represent the range of pathologies relevant to OC drilling to allow for a complete understanding of the techniques and concepts required for optimal treatment. An informed written consent has been obtained from each of the patients in this publication. Video © Mayo Foundation for Medical Education and Research. All rights reserved. Copyright information: Bendok BR, Abi-Aad KR, Sattur MG, Welz ME, Hoxworth JM, Lal D. Endoscopic resection of a paraclinoid meningioma extending into the optic canal: 2-dimensional operative video. Operative Neurosurgery. 2018 September 1;15(3):356 by permission of Oxford University Press. Cadaveric images provided by courtesy of: The Rhoton Collection. http://rhoton.ineurodb.org/.

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Optic Canal Decompression: Concepts and Techniques: 2-Dimensional Operative Video

Patra¹,

Turcotte²,

Bendok³

2021

Operative Surg.

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“…The transcranial routes represent the first choice, allowing a circumferential decompression. 7,8 On the other hand, minimally invasive techniques, such as endonasal and transorbital approaches, have been increasingly used in the last decades. [9][10][11][12][13][14] The goals of surgical management of the parasellar tumors should be optic nerve decompression to limit visual loss and gross total resection of the tumor for a better oncologic outcome.…”

Section: Discussionmentioning

confidence: 99%

Strategies for Optic Pathways Decompression for Extra-Axial Tumors or Intracranial Aneurysms: A Technical Note

Mattogno

Sturiale

Rapisarda

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Different types of skull base tumors and intracranial aneurysms may lead to compression of the optic pathways. Since most of them are biologically benign conditions, the first aim of surgery is preservation of optic nerves rather than the oncologic radicality. Materials and methods Based on the progressive technical refinements coming from our institutional experience of optic nerve compression from aneurysms and extra-axial tumors, we analyzed the surgical steps to release nerves and chiasm during tumor debulking and aneurysm clipping. Results We distinguished vascular and tumor lesions according to the main direction of optic nerve compression: lateral to medial, medial to lateral, inferior to superior, and anterior to posterior. We also identified four fundamental sequential maneuvers to release the optic nerve, which are (1) falciform ligament (FL) section, (2) optic canal unroofing, (3) anterior clinoid process drilling, and (4) optic strut removal. The FL section is always recommended when a gentle manipulation of the optic nerve is required. Optic canal unroofing is suggested in case of lateral-to-medial compression (i.e., clinoid meningiomas), medial-to-lateral compression (i.e., tuberculum sellae meningiomas), and inferior-to-superior compression (i.e., suprasellar lesions). Anterior clinoidectomy and optic strut removal may be necessary in case of lateral-to-medial compression from paraclinoid aneurysms or meningiomas. Conclusions Preservation of the visual function is the main goal of surgery for tumors and aneurysms causing optic nerve compression. This mandatory principle guides the approach, the timing, and the technical strategy to release the optic nerve, and is principally based on the direction of the compression vector.

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“…7). ON decompression could be performed by EEA or TC depending on the tumor and ON compression side: medial compression of the ON will tend to result in proposal of EEA; conversely, lateral compression will tend to result in proposal of TC with clinoidectomy [67][68][69]. A case-by-case analysis is usually required.…”

Section: Surgical Approaches Cs Lateral Wall Of the Cs And Clinoid mentioning

confidence: 99%

Parasellar Meningiomas

Graillon¹,

Régis²,

Barlier³

et al. 2020

Neuroendocrinology

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Parasellar spaces remain particularly singular, comprising the most important neurovascular structures such as the internal carotid artery and optic, oculomotor, and trigeminal nerves. Meningiomas are one of the most frequent tumors arising from parasellar spaces. In this location, meningiomas remain mostly benign tumors with WHO grade I and a meningothelial subtype. Progestin intake should be investigated and leads mostly to conservative strategies. In the case of benign nonsymptomatic tumors, observation should be proposed. Tumor growth will lead to the proposition of surgery or radiosurgery. In the case of an uncertain diagnosis and an aggressive pattern, a precise diagnosis is required. For cavernous sinus and Meckel's cave lesions, complete removal is rarely considered, leading to the proposition of an endoscopic endonasal or transcranial biopsy. Optic nerve decompression could also be proposed via these approaches. A case-by-case discussion about the best approach is recommended. A transcranial approach remains necessary for tumor removal in most cases. Vascular injury could lead to severe complications. Cerebrospinal fluid leakage, meningitis, venous sacrifice, visual impairment, and cranial nerve palsies are more frequent complications. Pituitary dysfunctions are rare in preoperative assessment and in postoperative follow-up but should be assessed in the case of meningiomas located close to the pituitary axis. Long-term follow-up is required given the frequent incomplete tumor removal and the risk of delayed recurrence. Radiosurgery is relevant for small and well-limited meningiomas or intra-cavernous sinus postoperative residue, whereas radiation therapy and proton beam therapy are indicated for large, extended, nonoperable meningiomas. The place of the peptide receptor radionuclide therapy needs to be defined. Targeted therapy should be considered in rare, recurrent, and aggressive parasellar meningiomas.

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The Intracranial and Intracanalicular Optic Nerve as Seen Through Different Surgical Windows: Endoscopic Versus Transcranial

Cited by 20 publications

References 43 publications

Optic Canal Decompression: Concepts and Techniques: 2-Dimensional Operative Video

Optic Canal Decompression: Concepts and Techniques: 2-Dimensional Operative Video

Strategies for Optic Pathways Decompression for Extra-Axial Tumors or Intracranial Aneurysms: A Technical Note

Parasellar Meningiomas

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