Optic Canal Decompression with a Lateral Approach for Optic Nerve Injury Associated with Traumatic Optic Canal Fracture

Abstract

Summary:Optic canal fracture (OCF) is a traumatic injury that requires urgent intervention because it can induce optic nerve damage and visual impairment. Despite the severity of OCF, a standard treatment method has not been established. In this article, we report a case of OCF and traumatic optic nerve injury in which visual acuity was recovered by releasing the optic canal using an unconventional lateral approach. A 43-year-old man presented with right lateral ethmoid fracture, right orbit blowout fracture, and OCF. The visual acuity was “hand motion” before surgery. Decompression was performed 10 hours after injury by approaching the right optic canal laterally from a coronal incision in front of the right ear, cutting along the border of the sphenoid bone, and scraping away some of the sphenoid wing and zygomatic bone. Steroid pulse therapy was added. Eventually, the visual acuity improved to 0.2 and the intraocular pressure decreased to 16.0 mm Hg. Compared with conventional methods, this method associates with better safety because (1) it causes relatively little bleeding and cerebrospinal fluid leak; (2) once the sphenozygomatic suture is identified, the distance to the optic canal is relatively short; and (3) if the fracture point is on the outer optic canal, the fracture line can be observed directly. Steroid pulse therapy may also have contributed to the good visual outcome. This is the first report of a novel lateral approach to OCF that is safe, effective, and only requires plastic surgery skills.

Anatomical Study of Ethmoidal Foramina and Optic Canal in Endoscopic Trans-Nasal Approach to Anterior Skull Base

“…OC is another important structure that should be considered during endonasal surgery, injury of OC can induce optic nerve damage and visual impairment. 14,15 Besides ASB tumor resection, the optic nerve disease also needs to be treated with surgical procedures. So, knowing the accurate position of OC in ethmoid sinus is of great importance.…”

Affection of Surgical Decompressive Scale of Optic Canal to Traumatic Optic Neuropathy

“…However, there is a paucity of evidence-based medical evidence that is backed by a significant body of clinical data, choosing the best treatment method is controversy. In recent years, with the continuous advancement of clinical research and microsurgical technique, optic nerve canal decompression surgery has gradually drawn the attention of clinicians [ 8 ]. Optic canal decompression surgery alleviates the mechanical compression of the visual pathway by removing the bone around the optic canal, thus providing the enlarged optic nerve with more physical space, enhancing local blood circulation, and preventing nerve injury.…”