Endoscopic Optic Nerve Decompression for Patients with Traumatic Optic Neuropathy: Is Nerve Sheath Incision Necessary?

Xu, Rui; Chen, Fenghong; Zuo, Kejun; Ye, Xingling; Yang, Qintai; Shi, Jianbo; Chen, Hexin; Li, Hua-Bin

doi:10.1159/000358305

Cited by 31 publications

(23 citation statements)

References 27 publications

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“…5,50,57 Our positive visual results in the short term in the present study, despite the study's retrospective nature, limited number of patients, and heterogeneous series, reflect an obvious benefit from a minimally invasive technique with very low morbidity. The technique can be proposed for diverse pathologies (Table 3) threatening the optic nerve(s) in their intracanalicular portion (Fig.…”

Section: Indications For and Timing Of Surgerymentioning

confidence: 54%

“…23,29,50,57 Nontraumatic optic neuropathy is a rare condition that can be caused by a variety of disorders, including tumors, endocrine orbitopathy, idiopathic intracranial hypertension, bone dysplasia, or infectious processes (Table 2). Therefore, surgical decompression of the optic nerve may be either part of the treatment for the primary compressive process (for example, an orbital apex tumor) or a preliminary step before treating the underlying cause via an intracranial route (for example, sphenoorbital meningioma).…”

Section: Discussionmentioning

confidence: 99%

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

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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Object While several approaches have been described for optic nerve decompression, the endoscopic endonasal route is gaining favor because it provides excellent exposure of the optic canal and the orbital apex in a minimally invasive manner. Very few studies have detailed the experience with nontraumatic optic nerve decompressions, whereas traumatic cases have been widely documented. Herein, the authors describe their preliminary experience with endoscopic endonasal decompression for nontraumatic optic neuropathies (NONs) to determine the procedure’s efficacy and delineate its potential indications and limits. Methods The medical reports of patients who had undergone endoscopic endonasal optic nerve and orbital apex decompression for NONs at the Lyon University Neurosurgical Hospital in the period from January 2012 to March 2014 were reviewed. For all cases, clinical and imaging data on the underlying pathology and the patient, including demographics, preoperative and 6-month postoperative ophthalmological assessment results, symptom duration, operative details with video debriefing, as well as the immediate and delayed postoperative course, were collected from the medical records. Results Eleven patients underwent endoscopic endonasal decompression for NON in the multidisciplinary skull base surgery unit of the Lyon University Neurosurgical Hospital during the 27-month study period. The mean patient age was 53.4 years, and there was a clear female predominance (8 females and 3 males). Among the underlying pathologies were 4 sphenoorbital meningiomas (36%), 3 optic nerve meningiomas (27%), and 1 each of trigeminal neuroma (9%), orbital apex meningioma (9%), ossifying fibroma (9%), and inflammatory pseudotumor of the orbit (9%). Fifty-four percent of the patients had improved visual acuity at the 6-month follow-up. Only 1 patient whose sphenoorbital meningioma had been treated at the optic nerve atrophy stage continued to worsen despite surgical decompression. The 2 patients presenting with preoperative papilledema totally recovered. One case of postoperative epistaxis was successfully treated using balloon inflation, and 1 case of air swelling of the orbit spontaneously resolved. Conclusions Endoscopic endonasal optic nerve decompression is a safe, effective, and minimally invasive technique affording the restoration of visual function in patients with nontraumatic compressive processes of the orbital apex and optic nerve. The timing of decompression remains crucial, and patients should undergo such a procedure early in the disease course before optic atrophy.

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Section: Indications For and Timing Of Surgerymentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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“…According to previous studies, the VA improvement rate of high-dose steroid treatment and high-dose steroid combined with OCD was 4.3–44% and 60.9–71.1% [13–17]. OCD with combination of steroid is generally thought to be more effective in visual improvement than steroid treatment only.…”

Section: Discussionmentioning

confidence: 99%

“…An improvement of 60.9–71.1% after ETOCD has been reported [13, 14, 17]. When it comes to patients with NLP, the effective rate dropped from 10% to 30% [19–21].…”

Section: Discussionmentioning

confidence: 99%

The Outcome of Endoscopic Transethmosphenoid Optic Canal Decompression for Indirect Traumatic Optic Neuropathy with No-Light-Perception

et al. 2016

Journal of Ophthalmology

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Purpose. To present the safety and effect of endoscopic transethmosphenoid optic canal decompression (ETOCD) for indirect traumatic optic neuropathy (ITON) patients with no-light-perception (NLP). Methods. A retrospective study performed on 96 patients (96 eyes) with NLP after ITON between June 1, 2010, and June 1, 2015, who underwent ETOCD, was reviewed. Visual outcome before and after treatment was taken into comparison. Results. The overall visual acuity improvement rate after surgery was 46.9%. The improvement rates of visual acuity of patients who received treatment within 3 days of injury, 3–7 days after injury, and later than 7 days were 63.6%, 42.9%, and 35.7%, respectively. Statistically significant difference was detected between the effective rates of within-3-day group and later-than-7-day group (χ 2 = 5.772, P = 0.016). The effective rate of atrophy group and nonatrophy group was 25.0% and 51.3%, respectively. The effective rate was significantly higher in nonatrophy group (χ 2 = 4.417, P = 0.036). Conclusion. For patients suffering from ITON with NLP, time to medical treatment within 3 days is an influential factor for visual prognosis. Optic nerve atrophy is an important predictor for visual prognosis. Treatment should still be recommended even for cases of delayed presentation to hospital.

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“…In patients undergoing EOND for nontraumatic ON, visual acuity improved in 28% to 89% of patients . In those with traumatic ON, improvement was seen 35% to 82% of the time . Although there was no data assessing differences in outcomes in patients who present with clinical blindness (no light perception [NLP]) compared to those with partial visual loss in the setting of nontraumatic ON, in cases of traumatic ON evidence suggests that patients with partial vision (light perception or better) have better visual outcomes postoperatively.…”

Section: Optic Nerve and Orbitmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

160

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Endoscopic Optic Nerve Decompression for Patients with Traumatic Optic Neuropathy: Is Nerve Sheath Incision Necessary?

Cited by 31 publications

References 27 publications

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

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

The Outcome of Endoscopic Transethmosphenoid Optic Canal Decompression for Indirect Traumatic Optic Neuropathy with No-Light-Perception

ICAR: endoscopic skull‐base surgery

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