The Endoscopic Endonasal Transethmoido-Sphenoidal Optic Nerve Decompression: Surgical Technique, Case Series, and Potential Indications

ABSTRACT Objective To assess the visual outcome after endoscopic, endonasal trans-ethmo-sphenoidal optic nerve decompression in patients with traumatic optic neuropathy. Materials and methods Prospective study, at tertiary referral center. Study included 12 patients with post-traumatic indirect unilateral optic nerve injury, not responding to medical management with methylprednisolone. These patients underwent optic nerve decompression via trans-ethmo-sphenoidal route using nasal endoscope. Main outcome measure was postoperative visual acuity. Results Out of the 12 cases of traumatic optic neuropathy (TON) operated upon, nine had good visual outcome. Conclusion The endoscopic endonasal trans-sphenoidal approach can decompress the traumatized and swollen optic nerve with excellent visualization of the orbital apex and optic canal, without the morbidity associated with brain retraction as in the conventional transcranial decompression. How to cite this article Gupta M, Bindra GS, Vohra R. Endoscopic Trans-ethmo-sphenoidal Optic Nerve Decompression for Traumatic Optic Neuropathy: Case Series and Review. Clin Rhinol An Int J 2015;8(3):99-103.

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Endoscopic endonasal medial-to-lateral and transorbital lateral-to-medial optic nerve decompression: an anatomical study with surgical implications

Journal of Neurosurgery ◽

10.3171/2016.8.jns16566 ◽

2017 ◽

Vol 127 (1) ◽

pp. 199-208 ◽

Cited By ~ 15

Author(s):

Alberto Di Somma ◽

Luigi Maria Cavallo ◽

Matteo de Notaris ◽

Domenico Solari ◽

Thomaz E. Topczewski ◽

...

Keyword(s):

Optic Nerve ◽

Morphometric Analysis ◽

Case Series ◽

Good Control ◽

Anatomical Study ◽

Optic Canal ◽

Endoscopic Endonasal ◽

Nerve Decompression ◽

Bone Removal ◽

Optic Nerve Decompression

OBJECTIVEDifferent surgical routes have been used over the years to achieve adequate decompression of the optic nerve in its canal including, more recently, endoscopic approaches performed either through the endonasal corridor or the transorbital one. The present study aimed to detail and quantify the amount of bone removal around the optic canal, achievable via medial-to-lateral endonasal and lateral-to-medial transorbital endoscopic trajectories.METHODSFive human cadaveric heads (10 sides) were dissected at the Laboratory of Surgical Neuroanatomy of the University of Barcelona (Spain). The laboratory rehearsals were run as follows: 1) preliminary preoperative CT scans of each specimen, 2) anatomical endoscopic endonasal and transorbital dissections and Dextroscope-based morphometric analysis, and 3) quantitative analysis of optic canal bone removal for both endonasal and transorbital endoscopic approaches.RESULTSThe endoscopic endonasal route permitted exposure and removal of the most inferomedial portion of the optic canal (an average of 168°), whereas the transorbital pathway allowed good control of its superolateral part (an average of 192°). Considering the total circumference of the optic canal (360°), the transorbital route enabled removal of a mean of 53.3% of bone, mainly the superolateral portion. The endonasal approach provided bone removal of a mean of 46.7% of the inferomedial aspect. This result was found to be statistically significant (p < 0.05). The morphometric analysis performed with the aid of the Dextroscope (a virtual reality environment) showed that the simulation of the transorbital trajectory may provide a shorter surgical corridor with a wider angle of approach (39.6 mm; 46.8°) compared with the simulation of the endonasal pathway (52.9 mm; 23.8°).CONCLUSIONSUsed together, these 2 endoscopic surgical paths (endonasal and transorbital) may allow a 360° decompression of the optic nerve. To the best of the authors' knowledge, this is the first anatomical study on transorbital optic nerve decompression to show its feasibility. Further studies and, eventually, surgical case series are mandatory to confirm the effectiveness of these approaches, thereby refining the proper indications for each of them.

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P.093 Visual outcomes after expanded endoscopic endonasal resection of suprasellar meningiomas and optic nerve decompression

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.188 ◽

2019 ◽

Vol 46 (s1) ◽

pp. S38

Author(s):

K Yang ◽

Y Ellenbogen ◽

J Kim ◽

A Rodriguez ◽

D Sommer ◽

...

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Visual Outcome ◽

Symptom Duration ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Visual Symptoms ◽

Nerve Decompression ◽

Optic Nerve Decompression

Background: The Endoscopic endonasal approach (EEA) has become increasingly popular in the treatment of suprasellar meningiomas, which often cause visual symptoms due to compression of the anterior optic apparatus. Methods: We performed a retrospective chart review on patients who underwent EEA optic nerve decompression and resection of suprasellar meningiomas between January 1st 2005 and December 1st 2018 at McMaster University. Results: The mean age of our patients was 59.8 years. We treated 9 male and 23 female patients, with a mean follow up of 6.29 years. 23 patients (71.9%) presented with visual symptoms, with a mean duration of 8.65 months. In our patient cohort, 95.5% had stable or improved visual acuity postoperatively. Less than six months of visual decline was more likely to be associated with postoperative improvement of visual acuity, with an odds ratio (OR) of 0.0222 (95% CI: 0.0017–0.289, p<0.05); as well as visual field (OR:0.0625; 95% CI, 0.0042–0.915, p<0.05). Additionally, the absence of RAPD was associated with improved postoperative visual acuity (OR: 0.0675; 95% CI, 0.0354–0.706, p<0.05). Conclusions: Endoscopic endonasal approach can achieve good visual outcome in patients harboring suprasellar meningiomas. Symptom duration of less than six months and absence of RAPD were positive predictor of postoperative visual outcome.

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

Neurosurgical FOCUS ◽

10.3171/2014.7.focus14303 ◽

2014 ◽

Vol 37 (4) ◽

pp. E19 ◽

Cited By ~ 45

Author(s):

Moncef Berhouma ◽

Timothee Jacquesson ◽

Lucie Abouaf ◽

Alain Vighetto ◽

Emmanuel Jouanneau ◽

...

Keyword(s):

Optic Nerve ◽

Minimally Invasive ◽

Invasive Technique ◽

Ossifying Fibroma ◽

Symptom Duration ◽

Imaging Data ◽

Orbital Apex ◽

Endoscopic Endonasal ◽

Nerve Decompression ◽

Optic Nerve Decompression

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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