scholarly journals Strategies for Optic Pathways Decompression for Extra-Axial Tumors or Intracranial Aneurysms: A Technical Note

2021 ◽  
Author(s):  
Pier Paolo Mattogno ◽  
Carmelo Lucio Sturiale ◽  
Alessandro Rapisarda ◽  
Alessandro Olivi ◽  
Alessio Albanese
Keyword(s):  
Optic Nerve ◽  
Intracranial Aneurysms ◽  
Nerve Compression ◽  
Optic Canal ◽  
Falciform Ligament ◽  
Optic Strut ◽  
Paraclinoid Aneurysms ◽  
Optic Pathways ◽  
Optic Canal Unroofing ◽  
Optic Nerve Compression

Abstract Background Different types of skull base tumors and intracranial aneurysms may lead to compression of the optic pathways. Since most of them are biologically benign conditions, the first aim of surgery is preservation of optic nerves rather than the oncologic radicality. Materials and methods Based on the progressive technical refinements coming from our institutional experience of optic nerve compression from aneurysms and extra-axial tumors, we analyzed the surgical steps to release nerves and chiasm during tumor debulking and aneurysm clipping. Results We distinguished vascular and tumor lesions according to the main direction of optic nerve compression: lateral to medial, medial to lateral, inferior to superior, and anterior to posterior. We also identified four fundamental sequential maneuvers to release the optic nerve, which are (1) falciform ligament (FL) section, (2) optic canal unroofing, (3) anterior clinoid process drilling, and (4) optic strut removal. The FL section is always recommended when a gentle manipulation of the optic nerve is required. Optic canal unroofing is suggested in case of lateral-to-medial compression (i.e., clinoid meningiomas), medial-to-lateral compression (i.e., tuberculum sellae meningiomas), and inferior-to-superior compression (i.e., suprasellar lesions). Anterior clinoidectomy and optic strut removal may be necessary in case of lateral-to-medial compression from paraclinoid aneurysms or meningiomas. Conclusions Preservation of the visual function is the main goal of surgery for tumors and aneurysms causing optic nerve compression. This mandatory principle guides the approach, the timing, and the technical strategy to release the optic nerve, and is principally based on the direction of the compression vector.

Optic Nerve Compression from a Basal Encephalocele

1995 ◽  
Vol 15 (3) ◽  
pp. 161???165 ◽  
Author(s):  
Gerard L. Hershewe ◽  
James J. Corbett ◽  
Karl C. Ossoinig ◽  
H. Stanley Thompson
Keyword(s):  
Optic Nerve ◽  
Nerve Compression ◽  
Basal Encephalocele ◽  
Optic Nerve Compression

Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy

2006 ◽  
Vol 104 (4) ◽  
pp. 621-624 ◽  
Author(s):  
Han Soo Chang ◽  
Masahiro Joko ◽  
Joon Suk Song ◽  
Kiyoshi Ito ◽  
Tatsushi Inoue ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Visual Outcome ◽  
Optic Canal ◽  
Internal Auditory Meatus ◽  
Major Morbidity ◽  
Anterior Clinoidectomy ◽  
Optic Nerve Damage ◽  
Bone Removal ◽  
Visual Status ◽  
Optic Canal Unroofing

✓Extradural unroofing of the optic canal and subsequent mobilization of the optic nerve is a useful technique in the surgical treatment of parasellar tumors; however, the drilling procedure itself is associated with the risk of optic nerve damage. A safer technique would certainly be beneficial. The ultrasonic bone curette is a device developed in Japan for safer bone removal. Its use in intradural anterior clinoidectomy and opening of the internal auditory meatus has been reported before. In this article the authors describe their experience in using this device for extradural unroofing of the optic canal in patients with parasellar tumors. Between March 2002 and November 2004, the aforementioned technique was used in the treatment of eight patients with parasellar tumors. After undertaking a frontotemporal craniotomy and orbital osteotomy, an ultrasonic bone curette was used to unroof the optic canal via an epidural approach; in five cases anterior clinoidectomy was added subsequently. Using an ultrasonic bone curette, unroofing of the optic canal was completed safely and required much less expertise than that required for standard drilling. The mortality and major morbidity rates were 0%. The visual function outcome was satisfactory, with the overall visual status improving in all seven patients in whom this symptom was present preoperatively. The ultrasonic bone curette makes the unroofing of the optic canal safer and easier, possibly improving the visual outcome of patients undergoing surgery for parasellar tumors.

Pupil Cycle Time in Optic Nerve Compression

1980 ◽  
Vol 89 (2) ◽  
pp. 263-267 ◽  
Author(s):  
J.M. Weinstein ◽  
J.C. Van Gilder ◽  
H.S. Thompson
Keyword(s):  
Optic Nerve ◽  
Cycle Time ◽  
Nerve Compression ◽  
Pupil Cycle Time ◽  
Optic Nerve Compression

scholarly journals Optic nerve compression in allergic fungal sinusitis

2011 ◽  
Vol 125 (4) ◽  
pp. 381-385 ◽  
Author(s):  
A Thakar ◽  
P Lal ◽  
M Dhiwakar ◽  
S Bahadur
Keyword(s):  
Optic Nerve ◽  
Visual Loss ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Nerve Compression ◽  
Fungal Sinusitis ◽  
Tertiary Care Centre ◽  
Allergic Fungal Sinusitis ◽  
Urgent Surgery ◽  
Optic Nerve Compression

AbstractObjective:To describe the syndrome of optic nerve involvement in cases of allergic fungal sinusitis.Setting:Academic tertiary care centre.Methods:Analysis of prospectively accrued data for 10 consecutive cases (three bilateral, giving 13 eyes) with visual loss secondary to optic nerve compression, from a total of 70 cases of allergic fungal sinusitis undergoing surgical treatment between June 1997 and May 2007.Results:The mean duration of rhinological symptoms prior to the onset of visual loss was 22 months. At presentation, visual loss ranged from a visual acuity of 6/12 to complete loss of light perception. Bilateral involvement was noted in three of the 10 cases. Urgent surgical decompression with removal of all fungal debris and decompression of the optic nerve resulted in visual recovery in seven of the 13 eyes. On univariate analysis, recovery was less likely in cases with long standing visual loss, and in cases with complete visual loss.Conclusion:Long standing allergic fungal sinusitis may be complicated by visual loss due to compression of the optic nerve. Urgent surgery to clear the sinuses and decompress the optic nerve is successful in reversing visual loss in cases with partial visual loss.

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