Outcome of endoscopic trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy in children

Abstract

BackgroundTo evaluate the safety and outcomes of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) for children with indirect traumatic optic neuropathy (ITON).MethodsFrom July 1st, 2008 to July 1st, 2015, 62 children diagnosed with ITON who underwent ETOCD were reviewed. Main outcome measure was improvement in visual acuity after treatment.ResultsAltogether 62 children (62 eyes) with a mean age of 11.26 ± 4.14 years were included. Thirty-three (53.2%) of them had residual vision before surgery while 29 (46.8%) had no light perception (NLP). The overall visual acuity improvement rate after surgery was 54.84%. The improvement rate of patients with residual vision (69.70%) was significant higher than that of patients with no light perception (NLP) (37.9%) (P = 0.012). However, no significant difference was shown among patients with different residual vision (P = 0.630). Presence of orbital and/ or optic canal fracture and hemorrhage within the post-ethmoid and/or sphenoid sinus resulted in poor postoperative visual acuity, duration of presenting complaints did not affect final visual acuity or did not effect outcomes. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome. Three patients developed cerebrospinal fluid rhinorrhea and one encountered cavernous sinus hemorrhage during surgery. No other severe complications were observed.ConclusionChildren with residual vision had better postoperative visual prognosis and benefited more from ETOCD than children with NLP. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome, however, this needs to be reassessed in children presenting long after the injury.Treatment should still be recommended even for cases of delayed presentation to hospital.

Nursing Research of Optic Canal Decompression Operation under Nasal Endoscopic Medical Treatment Based on Intelligent Internet of Things for Traumatic Vision Disorders

“…A specific injury factor, such as a head injury and stroke, causes damage to the brain tissue, often causing cognitive dysfunction in the patient, resulting in difficulty in perceiving the patient and adapting to the external environment. Life and society can live independently, work hard, and even constitute obstacles [ 1 , 2 ]. Various cognitive dysfunctions appear in the human head after trauma, such as emotional disturbance, memory loss, and decreased concentration.…”

Exosome-Mediated Delivery of the Neuroprotective Peptide PACAP38 Promotes Retinal Ganglion Cell Survival and Axon Regeneration in Rats With Traumatic Optic Neuropathy

“…Currently, no effective treatment is available for TON ( Chaon and Lee, 2015 ; Singman et al, 2016 ; Yan et al, 2016 ). The clinical treatment options for TON include observation (conservative management), high-dose corticosteroid treatment, or surgery (optic canal decompression), which are based on studies on small patient cohorts ( Goldberg and Steinsapir, 1996 ; Yu-Wai-Man and Griffiths, 2013 ; Yan et al, 2016 ; Yu et al, 2016 ; Kashkouli et al, 2017 ). In comparative nonrandomized studies on the treatment outcomes in patients with TON, the results showed no clear effect of either hormonal therapy or surgical treatment ( Levin et al, 1999 ; Carta et al, 2003 ).…”

Outcome of Endoscopic Optic Nerve Decompression for Traumatic Optic Neuropathy

“…Increased intracanalicular pressure after an injury is considered to be one of the main pathophysiological manifestations. 2…”

“…11 Previous studies showed that independent factors for VA prognosis were time interval between injury and treatment, degree of visual loss, optic canal fracture, orbital fracture, and hemorrhage in the post-ethmoid or sphenoid sinus. 2,12,13…”