Transnasal Endoscopic Optic Nerve Decompression in Post Traumatic Optic Neuropathy

Abstract

To quantify the successful outcome in patients following optic nerve decompression in post traumatic unilateral optic neuropathy in form of improvement in visual acuity. A prospective study was carried out over a period of 5 years (January 2011 to June 2016) at civil hospital Ahmedabad. Total 20 patients were selected with optic neuropathy including patients with direct and indirect trauma to unilateral optic nerve, not responding to conservative management, leading to optic neuropathy and subsequent impairment in vision and blindness. Decompression was done via Transnasal-Ethmo-sphenoidal route and outcome was assessed in form of post-operative visual acuity improvement at 1 month, 6 months and 1 year follow up. After surgical decompression complete recovery of visual acuity was achieved in 16 (80%) patients and partial recovery in 4 (20%). Endoscopic transnasal approach is beneficial in traumatic optic neuropathy not responding to steroid therapy and can prevent permanent disability if earlier intervention is done prior to irreversible damage to the nerve. Endoscopic optic nerve surgery can decompress the traumatic and oedematous optic nerve with proper exposure of orbital apex and optic canal without any major intracranial, intraorbital and transnasal complications.

Outcome of Endoscopic Optic Nerve Decompression for Traumatic Optic Neuropathy

“…It is widely believed that the transcranial approach provides better surgical view and exposure, but in the meantime, it results in more complications in the form of brain retraction injuries. 17 The endoscopic surgery technique is also performed in the field of neurosurgery such as optic nerve decompression. The endoscopic technique offers many advantages, including decreased morbidity, preservation of olfaction, rapid recovery, and more acceptable cosmetic results without any external scars.…”

“…The main purpose of optic nerve decompression is to relieve the compression in the intracanalicular portion of the optic nerve. 10 Endoscopic optic nerve decompression (EOND) using a trans-ethmosphenoid approach is less invasive compared with the transcranial approach. Although EOND has been widely applied in the treatment of TON, its efficacy remains controversial, with no consensus about its appropriate indications and timing.…”

Surgical Treatment for Traumatic Optic Neuropathy

“…A number of advantages of approaching the base of the skull via endoscopic endonasal approach have been noted. 1 , 3 , 8 , 10 , 14 , 17) This technique is less invasive and shows excellent exposure to OC and orbital apex than classic transcranial approach.…”

“…Several authors who reported on optic nerve decompression surgery have presented the following indications for surgery: 1) History of traumatic face and head injury with and without OC injury; 23 33) 2) progressive loss of vision not associated with non-traumatic intraocular lesions; 14 23 33) 3) a lack of evidence of damage or avulsion to the intracranial portion of the optic nerve; 14 30) 4) Prolonged absolute latency or amplitude reduction in preoperative visual evoked potential (VEP) scan; 15 24) 5) failure to respond to steroid therapy; 6 14 16 23) and 6) the presence of bony fragments compressing the optic nerve or a hematoma near the optic nerve.…”

Role of delayed wider endoscopic optic decompression for traumatic optic neuropathy: a single-center surgical experience

“…Timely intervention could block the pathophysiological process and relieve nerve swelling and ischemia, possibly recovering the VA. Early intervention (within 3 days or even 7 days) with ETOCD or/and corticosteroid therapy has been proposed, and is regarded to yield a good prognosis (16,(35)(36)(37)(38). The efficiency rate in patients treated within 3 days was significantly higher than those in patients treated later than 7 days (63.6% vs. 35.7%) (36).…”