Trans-ethmoidal optic nerve decompression

Abstract

Blunt head injury frequently results in visual impairment, the optimal treatment of which is still debated. Over a 5-year-period (1987-1991) 111 patients with indirect optic nerve injury resulting from closed head trauma have been treated. In each case loss of vision was the only neurological deficit. In group A, 66 patients were initially treated with large doses of prednisolone (80 mg/day) for 3 weeks. Twenty-seven patients improved on steroids alone. In the remaining 39 patients in whom either unsatisfactory or no improvement occurred a transethmoidal optic nerve decompression was performed. Twenty-two patients in the latter group improved, thus yielding an overall improvement rate of 74.2% in group A. Group B (control), in which 45 patients were treated with prednisolone only (80 mg/day for 3 weeks), had an overall improvement rate of 51% (23 patients). The study reveals that while nearly half of such patients can improve on steroids alone, optic nerve decompression significantly improves recovery rates in patients where conservative treatment is unsatisfactory (P < 0.05). Total loss of vision not responding to steroids, absence of waveform on visual evoked response, and presence of an optic canal fracture indicate a poor prognosis.

Optic nerve decompression in trauma and tumor patients

“…The presence or absence of bone fragments around the optic nerve or of optic nerve sheath hematoma did not show an obvious influence on pre-and postoperative vision in our series. Thus, in agreement with Joseph [9], we cannot reproduce the results of Tandon et al [25] who found no light perception in all patients with optic canal fractures pre-and postoperatively.…”

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

“…For pathology specifically affecting the optic canal, optic canal decompression may be performed by removing the lamina papyracea and medial wall of the optic canal by a transethmoidal approach (Akdemir et al, 2004). While this approach enables access to the medial and inferior aspects to the optic canal, it does not allow lateral or superior access to the optic canal (Anand et al, 1991;Tandon et al, 1994). With lesions advancing toward the optic canal from inferior and medial directions, decompressing the optic canal and removing the lesion is possible with various methods of transsphenoidaletransethmoidal approaches.…”

Extended Applications of Endoscopic Sinus Surgery to the Orbit and Pituitary Fossa

“…Visual loss in Grave's disease is uncommon, occurring in only 2 to 7% of patients (Kountantakis et al, 2000;Kuppersmith et al, 1997). Exopthalmos in Grave's disease is thought to result from the deposition of immune complexes in the intraocular mucles and fat which in turn leads to edema and fibrosis (Tandon et al, 1994). The resultant increase in intraorbital pressure pushes the globe forward causing proptosis.…”

“…The most common indication for endoscopic optic canal decompression is traumatic optic nerve neuropathy(TON). Currently it is thought that 5% of severe head injuries will have concomitant injury to the optic nerve, optic tract or optic cortex (Tandon et al, 1994;Kountantakis et al, 2000;Kuppersmith et al, 1997). Since major brain injury takes precedence over traumatic optic neuropathy, it may result in the optic nerve injury being diagnosed somewhat later then the brain injury.…”