Refining Operative Strategies for Optic Nerve Decompression: A Morphometric Analysis of Transcranial and Endoscopic Endonasal Techniques Using Clinical Parameters

Gogela, Steven L.; Zimmer, Lee A.; Keller, Jeffrey T.; Andaluz, Norberto

doi:10.1093/ons/opx093

Cited by 25 publications

(19 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ACP is generally composed of compact bone and is involved by clinoidal ligaments and dural elements, however, pneumatized ACPs are observed in up to 28% of the patients [ 4 , 7 ]. Intense pneumatization of the sphenoid bone can limit AC due to the high risk of sphenoid sinus opening and, ultimately, cerebrospinal fluid leak [ 22 ]. In such situations, bone removal should be minimized to a sufficient extent, not adequate for the desired anatomical exposure of target structures [ 5 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…An intradural AC is indicated for small and soft intradural lesions around the ACP, such as type III anterior clinoidal meningioma or carotid-ophthalmic aneurysms, or when optic nerve mobilization is mandatory for greater exposure of the opticocarotid and carotid-oculomotor triangles to access lesions that extend to the upper clivus and interpeduncular fossa [ 5 , 7 , 11 - 12 ]. The incision of the optic nerve sheath and the distal dural ring facilitates the mobilization of the optic nerve and promotes wide exposure and access around the ICA to remove parasellar and suprasellar tumors [ 22 ]. Intradural removal of the ACP with fracture of the optic strut requires minimal drilling, resulting in a decreased risk of injury to the optic nerve and a shortened time for clinoidectomy, known as the “en bloc” technique [ 12 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts

Pacheco

Melo

Acioly

et al. 2021

Cureus

View full text Add to dashboard Cite

Anterior clinoidectomy (AC) is a key microsurgical step for the safe and successful management of parasellar pathologies that involve the anterior clinoid process (ACP) and the optic canal. Traditionally, extra and intradural ACs are performed separately according to the surgeon's experience or preference. The objective is to present and discuss the tailored AC concept through illustrative cases. We conducted a retrospective record review of three patients who underwent AC as a surgical step for the treatment of parasellar pathologies that involve the ACP and optic canal. A review of the relevant literature on AC was performed in the PubMed, LILACS, and SciELO databases. In all three cases, the pterional craniotomy was the preferred approach for AC. Case 1, a 47-year-old female patient with type III anterior clinoidal meningioma, underwent a tailored intradural technique (optic canal unroofing) with total tumor resection and complete visual recovery. Case 2, a 63-year-old female patient with a complex type II anterior clinoidal meningioma with extensive hyperostosis of the ACP, underwent a hybrid AC technique with complete removal of the tumor and visual improvement. Case 3, a 62-year-old female, underwent a tailored intradural AC for clipping an incidental carotid-ophthalmic aneurysm. Tailored AC aims to provide adequate exposure with less risk of neurovascular injury, allowing enough space to safely treat parasellar lesions. The type, size, and location of the lesion, as well as the surgeon’s experience, should always be considered for surgical planning.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts

Pacheco

Melo

Acioly

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…Transcranial approach provides a wide surgical corridor while showing a familiar view to the neurosurgeons. 5 13 35) In the morphometric analysis, the range of OC decompression via transcranial route was 245.2 degrees, which enabled wider decompression than endonasal route. 13) However, the transcranial approach is more invasive and associated with more cosmetic problems than the endonasal approach and brain retraction may cause serious complications.…”

Section: Surgical Techniquementioning

confidence: 99%

Surgical Treatment for Traumatic Optic Neuropathy

Yeo

Hwang

2018

Korean J Neurotrauma

View full text Add to dashboard Cite

Traumatic optic neuropathy (TON) is an important cause of severe visual loss after blunt or penetrating head and facial trauma. High-dose steroids and surgical interventions have been applied in the indirect TON. However, there is no convincing evidence that results of the treatment have any strong benefits in terms of improvement of visual acuity. Nevertheless, surgical decompression should be considered in the case of a direct bony compression to the optic nerve and a progressive visual loss in indirect TON. Neurosurgeon should be aware the surgical indication, optimal timing and relevant technique for the optic canal (OC) decompression. In this review article, we will focus on the surgical approaches to the OC and how to decompress it.

show abstract

“…7). ON decompression could be performed by EEA or TC depending on the tumor and ON compression side: medial compression of the ON will tend to result in proposal of EEA; conversely, lateral compression will tend to result in proposal of TC with clinoidectomy [67][68][69]. A case-by-case analysis is usually required.…”

Section: Surgical Approaches Cs Lateral Wall Of the Cs And Clinoid mentioning

confidence: 99%

Parasellar Meningiomas

Graillon¹,

Régis²,

Barlier³

et al. 2020

Neuroendocrinology

View full text Add to dashboard Cite

Parasellar spaces remain particularly singular, comprising the most important neurovascular structures such as the internal carotid artery and optic, oculomotor, and trigeminal nerves. Meningiomas are one of the most frequent tumors arising from parasellar spaces. In this location, meningiomas remain mostly benign tumors with WHO grade I and a meningothelial subtype. Progestin intake should be investigated and leads mostly to conservative strategies. In the case of benign nonsymptomatic tumors, observation should be proposed. Tumor growth will lead to the proposition of surgery or radiosurgery. In the case of an uncertain diagnosis and an aggressive pattern, a precise diagnosis is required. For cavernous sinus and Meckel's cave lesions, complete removal is rarely considered, leading to the proposition of an endoscopic endonasal or transcranial biopsy. Optic nerve decompression could also be proposed via these approaches. A case-by-case discussion about the best approach is recommended. A transcranial approach remains necessary for tumor removal in most cases. Vascular injury could lead to severe complications. Cerebrospinal fluid leakage, meningitis, venous sacrifice, visual impairment, and cranial nerve palsies are more frequent complications. Pituitary dysfunctions are rare in preoperative assessment and in postoperative follow-up but should be assessed in the case of meningiomas located close to the pituitary axis. Long-term follow-up is required given the frequent incomplete tumor removal and the risk of delayed recurrence. Radiosurgery is relevant for small and well-limited meningiomas or intra-cavernous sinus postoperative residue, whereas radiation therapy and proton beam therapy are indicated for large, extended, nonoperable meningiomas. The place of the peptide receptor radionuclide therapy needs to be defined. Targeted therapy should be considered in rare, recurrent, and aggressive parasellar meningiomas.

show abstract

Refining Operative Strategies for Optic Nerve Decompression: A Morphometric Analysis of Transcranial and Endoscopic Endonasal Techniques Using Clinical Parameters

Cited by 25 publications

References 40 publications

Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts

Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts

Surgical Treatment for Traumatic Optic Neuropathy

Parasellar Meningiomas

Contact Info

Product

Resources

About