Microvascular Decompression of the Optic Nerve

Abstract

Symptomatic compression of the optic apparatus by a tortuous internal carotid artery (ICA) is rare. We report a patient with visual decline due to optic nerve compression by the ICA. The patient presented with a visual field deficit and standard work-up revealed no discernible cause. Magnetic resonance imaging (MRI) demonstrated distortion of the optic nerve by the ICA. The optic nerve was decompressed with resultant clinical improvement. Optic nerve compression by the ICA may be considered a diagnosis of exclusion. Here, microvascular decompression led to improvement in visual function.

Management of patients with a neurovascular conflict involving the optic nerve and a non-diseased intracranial artery: Three cases

“…Conversely, in a case-report by Andrew et al, a 36-year-old female patient presented with acute painless monocular visual field deficit, most probably caused by a tortuous course of the supraclinoid segment of the ICA compressing the right ON. The acute presentation of a chronic process could mirror a loss of compensatory mechanism whereby venous insufficiency ultimately leads to micro-infarction ( McDougall, 2016 ). In our cases, all three patients presented with sub-acute (within weeks to months) onset of symptoms that showed progression within months.…”

“…If operative treatment is considered, it usually consists of a pterional or lateral supraorbital craniotomy to explore the relationship between the ON and neighboring vasculature ( Strom et al, 2012 ; McLaughlin and Bojanowski, 2011 ; McDougall, 2016 ). Intradural maneuvers may vary depending on intraoperative findings from freeing the nerve in transition to the optic canal, to dissection of arachnoid adhesions to the ON, and insertion of a piece of Teflon® between the ON and the compressing artery.…”