Salvage optic nerve decompression for traumatic blindness under nasal endoscopy: risk and benefit analysis

“…Table summarizes the available data obtained from the systematic review, with outcome data based on surgical delay and preoperative vision status being presented separately. In the group of patients receiving surgery within 3 days of the traumatic event, 57% (105/183) of patients were noted to have vision improvement.…”

Section: Resultsmentioning

confidence: 99%

Timing of endoscopic surgical decompression in traumatic optic neuropathy: a systematic review of the literature

Dhaliwal

Sowerby

Rotenberg

2016

Int Forum Allergy Rhinol

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“…However, the complete endoscopic ethmoidectomy includes removal of the uncinate process and anterior ethmoidal sinus, and the long-term effects of this trauma are unknown. Additionally, common postoperative sequelae such as nasal synechia and sinusitis[4] should not be ignored. To avoid iatrogenic trauma as much as possible, we developed a modified surgical procedure that leaves the uncinate process, ethmoidal bulla, and middle meatus intact.…”

Section: Discussionmentioning

confidence: 99%

“…[3] However, despite its safety, effectiveness, and minimal invasiveness, the long-term effects of the iatrogenic trauma (removal of uncinate process and anterior ethmoidal sinus) resulting from the complete ethmoidectomy procedure used to gain full access to the optic nerve canal is unknown, and sequelae such as nasal synechia and sinusitis should not be ignored. [4]…”

Section: Introductionmentioning

confidence: 99%

A modified surgical procedure for endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy

et al. 2014

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Background:Although the endoscopic anterior-to-posterior technique offers many advantages, the long-term effects of the iatrogenic trauma (removal of the uncinate process and anterior ethmoidal sinus) resulting from the complete ethmoidectomy procedure used to gain full access to the optic nerve canal is unknown, and sequelae such as nasal synechia and sinusitis should not be ignored.Aims:The aim of our study is to develop a less invasive procedure for endoscopic optic nerve decompression.Materials and Methods:We proposed a modified trans-sphenoidal surgical procedure for endoscopic optic nerve decompression in five patients with traumatic optic neuropathy (TON), all with high sphenoidal pneumatisation and without Onodi cellulae.Results:After performing a direct sphenoidotomy through the natural ostium of the sphenoid sinus rather than a complete ethmo-sphnoidectomy, we found that the modified approach provided adequate access to the optic nerve canal and the apex using a 45° angled endoscope. Successful decompression of the canal optic nerve was performed trans-sphenoidally in all five TON patients using an angled endoscope. No surgical complications occurred, and none of the patients suffered from anterior ethmoidal sinus or skull base damage.Conclusions:The modified trans-sphenoidal approach is a feasible, safe, effective, and minimally invasive approach for TON patients with high sphenoidal pneumatisation and without supersphenoid-ethmoid cellulae.

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“…On the other hand, there are some disadvantages which effect their popularity: 1) the narrow surgical corridor and anatomic variations could effect the process and outcome of the optic nerve decompression (9); 2) The complications, including cerebrospinal fluid leakage and intracranial infection, more likely occur in the procedure via nasal sinus; 3) Due to the intimate relationship between arteries and optic nerve on its inferior surface, one must be careful to avoid the injury of the internal carotid artery or ophthalmic artery, which would lead to a serious consequence if happened (13). So, these non-transcranial surgical approaches have been chosen, in selected cases, to treat the traumatic optic neuropathy (10).…”

Section: █ Discussionmentioning

confidence: 99%

Endoscopic optic nerve decompression through supraorbital keyhole extradural approach: a cadaveric study

Wang

Wu²,

Zhang³

et al. 2015

Turkish Neurosurgery

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ABSTRACTlarger trauma from the craniotomy procedure may hinder the patients to accept the approach. The endoscopic transnasal approach has an advantage of minimal invasion, but the narrow surgical corridor and potential severe bleeding reduce the popularity of the approach.For the supraorbital keyhole operation, a small incision located in the unilateral eyebrow is made and the sellar region can be reached through the intracranial natural space. Enlightened by the keyhole idea and with the aim to decrease the corresponding invasion of the conventional approaches, we tried to design a novel endoscopic approach to achieve an █ InTRODuCTIOn M any surgical approaches have been described for decompression of the optic nerve to treat traumatic optic neuropathy (14,18,21,22). The most commonly used approaches include the transcranial and the transnasal approaches (15), and each of them has specific advantages and disadvantages. The conventional transcranial approach can enable a direct access and sufficient exposure to the superior wall of the optic canal, which could help achieve an effective decompression of the optic nerve. However, the AIM: Many approaches for optic nerve decompression have their own advantages and disadvantages. The aim of this study was to perform endoscopic decompression of optic nerve through the supraorbital keyhole and evaluate its feasibility. MATERIAL and METhODS:Ten adult cadaveric heads were studied using 4-mm, 0-and 30-degree rigid endoscopes to perform the optic nerve decompression through the supraorbital keyhole extradural approach. Furthermore, the relevant measurements about the optic canal were recorded. RESuLTS:Through the supraorbital keyhole, the endoscope was introduced into the extradural space, and the following structures could be exposed and identified: the sphenoid ridge, the anterior clinoid process, the roof of the optic canal and the falciform ligament. The roof and lateral wall of the optic canal were removed using a drill under the endoscope, and more sufficient decompression could be achieved by further incising the falciform ligament and optic sheath. After measurement, the distance from the zygomatic process of the frontal bone to the optic canal was 59.32 ± 2.27 mm, the distance from the upper midpoint of the posterior foramen of the optic canal to the internal carotid artery was 3.80 ± 0.93 mm.COnCLuSIOn: According to the cadaveric study, it is feasible to perform the endoscopic decompression of optic nerve with a clear view through the supraorbital keyhole extradural approach. Our study may provide a minimally invasive and safe option for the optic nerve decompression.

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Salvage optic nerve decompression for traumatic blindness under nasal endoscopy: risk and benefit analysis

Cited by 28 publications

References 15 publications

Timing of endoscopic surgical decompression in traumatic optic neuropathy: a systematic review of the literature

Timing of endoscopic surgical decompression in traumatic optic neuropathy: a systematic review of the literature

A modified surgical procedure for endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy

Endoscopic optic nerve decompression through supraorbital keyhole extradural approach: a cadaveric study

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