The therapeutic efficacy of endoscopic optic nerve decompression and its effects on the prognoses of 96 cases of traumatic optic neuropathy

Yang, Qintai; Zhang, Gehua; Lu, Xian; Ye, Jin; Li, Yuan

doi:10.1097/ta.0b013e3182493c70

Cited by 55 publications

(43 citation statements)

References 12 publications

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“…1,7,10,14,26,36,43,58 This technique definitely provides excellent exposure of the optic canal and orbital apex in a minimally invasive fashion. While decompression in traumatic optic neuropathy has been widely investigated, 11,13,[18][19][20]24,28,29,36,37,40,47,48,[52][53][54][55][56][57][58][59]61 indeed with debatable results, decompression for nontraumatic optic neuropathies (NONs) is still insufficiently studied.…”

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confidence: 99%

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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Object While several approaches have been described for optic nerve decompression, the endoscopic endonasal route is gaining favor because it provides excellent exposure of the optic canal and the orbital apex in a minimally invasive manner. Very few studies have detailed the experience with nontraumatic optic nerve decompressions, whereas traumatic cases have been widely documented. Herein, the authors describe their preliminary experience with endoscopic endonasal decompression for nontraumatic optic neuropathies (NONs) to determine the procedure’s efficacy and delineate its potential indications and limits. Methods The medical reports of patients who had undergone endoscopic endonasal optic nerve and orbital apex decompression for NONs at the Lyon University Neurosurgical Hospital in the period from January 2012 to March 2014 were reviewed. For all cases, clinical and imaging data on the underlying pathology and the patient, including demographics, preoperative and 6-month postoperative ophthalmological assessment results, symptom duration, operative details with video debriefing, as well as the immediate and delayed postoperative course, were collected from the medical records. Results Eleven patients underwent endoscopic endonasal decompression for NON in the multidisciplinary skull base surgery unit of the Lyon University Neurosurgical Hospital during the 27-month study period. The mean patient age was 53.4 years, and there was a clear female predominance (8 females and 3 males). Among the underlying pathologies were 4 sphenoorbital meningiomas (36%), 3 optic nerve meningiomas (27%), and 1 each of trigeminal neuroma (9%), orbital apex meningioma (9%), ossifying fibroma (9%), and inflammatory pseudotumor of the orbit (9%). Fifty-four percent of the patients had improved visual acuity at the 6-month follow-up. Only 1 patient whose sphenoorbital meningioma had been treated at the optic nerve atrophy stage continued to worsen despite surgical decompression. The 2 patients presenting with preoperative papilledema totally recovered. One case of postoperative epistaxis was successfully treated using balloon inflation, and 1 case of air swelling of the orbit spontaneously resolved. Conclusions Endoscopic endonasal optic nerve decompression is a safe, effective, and minimally invasive technique affording the restoration of visual function in patients with nontraumatic compressive processes of the orbital apex and optic nerve. The timing of decompression remains crucial, and patients should undergo such a procedure early in the disease course before optic atrophy.

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confidence: 99%

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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“…Causes of vision loss include bone fracture or tissue swelling within the optic canal that compresses the optic nerve or a bone fragment penetrating into the optic nerve [ 76 ]. Optic nerve decompression via the sphenoid sinus may result in vision improvement in patients with light perception [ 76 ]. On the other hand, this procedure may not be indicated for patients with no light perception who have a lateral wall fracture of the optic canal or a bone fragment penetrating the optic nerve [ 76 ].…”

Section: Clinical Tipsmentioning

confidence: 98%

“…(c) An injury to the head, especially to the brow, may result in an optic canal fracture [ 74 , 75 ]. Causes of vision loss include bone fracture or tissue swelling within the optic canal that compresses the optic nerve or a bone fragment penetrating into the optic nerve [ 76 ]. Optic nerve decompression via the sphenoid sinus may result in vision improvement in patients with light perception [ 76 ].…”

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confidence: 99%

The Sinonasal Anatomy: Endoscopic Lacrimal and Orbital Perspectives

Kakizaki

2014

Principles and Practice of Lacrimal Surgery

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“…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.…”

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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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The therapeutic efficacy of endoscopic optic nerve decompression and its effects on the prognoses of 96 cases of traumatic optic neuropathy

Abstract: III, epidemiological study.

Cited by 55 publications

References 12 publications

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

The Sinonasal Anatomy: Endoscopic Lacrimal and Orbital Perspectives

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

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