Relationship of the Optic Nerve to the Medial Rectus Muscle During Endonasal Dissection of the Medial Intraconal Orbital Apex

2016 ◽  
Vol 13 (1) ◽  
pp. 131-137 ◽  
Author(s):  
Dmitriy Petrov ◽  
John Craig ◽  
Jayesh Thawani ◽  
Kalil Abdullah ◽  
James N. Palmer ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Rectus Muscle ◽  
Magnetic Resonance Images ◽  
Medial Rectus ◽  
Orbital Apex ◽  
Endoscopic Endonasal ◽  
Endoscopic Techniques ◽  
Superior Approach ◽  
Relationship Of ◽  
The Relationship

Abstract BACKGROUND: Few studies have established surgical landmarks for endoscopic endonasal dissection of the intraconal orbital apex (OA). OBJECTIVE: We describe the optic nerve (ON) anatomy and its relationships, as seen during a fully endoscopic, endonasal approach to the medial intraconal OA. METHODS: The study question was approached through a cadaver dissection and a radiographic study. Four formalin-fixed, latex-injected cadaver heads were dissected using transnasal endoscopic techniques. Dissection was performed using 0 degree and 30 degree nasal endoscopes and standard endoscopic sinus surgical instrumentation. A bi-nostril 4-handed technique was used. The anatomy of 8 medial OAs was evaluated and recorded. As the radiographic portion, 100 consecutively enrolled patient magnetic resonance images were evaluated, with particular attention given to the relationship of the ON to the medial rectus muscle (MRM) in 200 orbits. RESULTS: Intraconally, the ON consistently coursed along the superior half of the MRM. Interestingly, the nerve was more easily identified from a superior approach after retracting the MRM inferiorly. With the identification of the nerve at the OA, carrying the dissection of the medial OA was easily accomplished with the ON as the guiding landmark. The radiographic portion of this study revealed a consistent relationship between the superior edge of the ON and the MRM. This relationship was maintained in the orbital apex in 98.4%-100% of the orbits examined. CONCLUSION: The superior edge of the optic nerve is consistently found coursing along the superior half of the MRM, facilitating facile identification and further dissection navigation.

Significant Improvement of Visual Functions after Removal of an Intracranial Giant Optic Nerve Glioma Revealing Exophytic Growth: Case Report

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. E792-E792 ◽  
Author(s):  
Zhiyong Tong ◽  
Masahiko Wanibuchi ◽  
Teiji Uede ◽  
Sumiyoshi Tanabe ◽  
Kazuo Hashi
Keyword(s):  
Optic Nerve ◽  
Neurofibromatosis Type 1 ◽  
Residual Tumor ◽  
Neurofibromatosis Type ◽  
Magnetic Resonance Images ◽  
Optic Nerve Glioma ◽  
Visual Functions ◽  
Relationship Of ◽  
The Relationship

Abstract OBJECTIVE AND IMPORTANCE: Intracranial giant optic nerve gliomas, usually presumed as optic chiasmatic gliomas, are much less common. The architectural tumor form of optic nerve glioma without neurofibromatosis type 1 is usually the expansile-intraneural pattern. The exophytic optic nerve gliomas without neurofibromatosis type 1 are relatively uncommon. Surgical decompression for intracranial optic gliomas frequently leads to clinical improvement, but obvious improvement of vision is rare. We report a case that demonstrated significant recovery of visual function after removal of the intracranial giant optic nerve glioma, revealing exophytic growth. CLINICAL PRESENTATION: A 13-year-old boy presented with visual impairment in both eyes. Magnetic resonance images (MRI) disclosed a 6 cm diameter mass in the suprasellar area. On heavily T2-reversed MRIs, it was obvious that the intracranial portion of right optic nerve was enlarged, and optic tracts were shifted to the left by the tumor. The relationship of the tumor to the chiasma could not be affirmed on MRIs. INTERVENTION: A right frontotemporal craniotomy for decompression of the optic apparatus was performed. After the majority of the tumor was resected, it became clear that the tumor originated in the right optic nerve. The tumor exophytically grew and dislocated the optic chiasma and optic tracts. Significant improvement of visual functions began from the first week after surgery and continued gradually thereafter. The histological diagnosis was pilocytic astrocytoma. A follow-up MRI taken 4 years after surgery showed no regrowth of the residual tumor. CONCLUSION: Giant exophytic gliomas without neurofibromatosis type 1 may arise from the intracranial portion of an isolated optic nerve. Direct visualization of optic component by heavily T2-reversed MRI could more precisely delineate the relationship of the intracranial optic nerve glioma to the optic apparatus. Surgery may be indicated in giant exophytic intracranial optic nerve gliomas and preoperative postulated optic chiasmatic gliomas. Microsurgical resection can induce postoperative visual improvement without regrowth of the residual tumor.

scholarly journals Endoscopic endonasal approach to the lateral orbital apex: case report

2015 ◽  
Vol 16 (3) ◽  
pp. 305-308 ◽  
Author(s):  
Tomasz A. Dziedzic ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Optic Nerve ◽  
Rectus Muscle ◽  
Lateral Compartment ◽  
Endoscopic Approach ◽  
Minimal Access ◽  
Endoscopic Endonasal Approach ◽  
Orbital Apex ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Lateral Rectus Muscle

Although the medial and inferior orbital apex are considered safely accessible using the endonasal endoscopic approach, the lateral apex has been considered unsafe to access since the optic nerve lies between the surgeon and the pathology. The authors present the case of a 4-year-old girl with recurrent rhabdomyosarcoma attached to the lateral rectus muscle located lateral and inferior to the optic nerve in the orbital apex. The tumor was totally resected through an endoscopic endonasal transmaxillary transpterygoidal approach using a 45° endoscope. A gross-total resection was achieved, and the patient’s vision was unchanged. This procedure is a safe, minimal-access alternative to open procedures in selected cases and provides evidence that increases the applicability of the endonasal endoscopic approach to reach the lateral compartment of the orbital apex.

Endoscopic anatomy of the sphenoid sinus

1999 ◽  
Vol 113 (2) ◽  
pp. 122-126 ◽  
Author(s):  
Samy Elwany ◽  
Ibraheim Elsaeid ◽  
Hossam Thabet
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Sphenoid Sinus ◽  
Sella Turcica ◽  
Clinical Importance ◽  
Sinus Surgery ◽  
Endoscopic Anatomy ◽  
Relationship Of ◽  
The Relationship ◽  
Sphenoid Sinuses

AbstractThe anatomy of the sphenoid sinus, as it relates to endoscopic sinus surgery, was studied in 93 cadaver heads (186 sphenoid sinuses) using endoscopic dissections as well as sagittal sections. The relationship of the sphenoid sinuses to the carotid artery, optic nerve, floor of sella turcica, as well as other important structures, were verified and discussed. The recesses of the sinus as well as its ostium and accessory septa and crests were described and their clinical importance was discussed. Pertinent measurements were included wherever appropriate.

The Adventures of the Optic Nerve

2004 ◽  
Author(s):  
John Elderfield
Keyword(s):  
Optic Nerve ◽  
Art History ◽  
Modern Art ◽  
Historical Study ◽  
Visual Medium ◽  
Relationship Of ◽  
The Relationship

This chapter presents the text of a lecture on the role of visual medium in art-historical study. It addresses the relationship of art history to the existential acts of painting and looking at painting and describes how the so-called story of modern art has been narrated in the history literature. It also considers how modern histories can accommodate the unfamiliar that is normally part of the story.

Optic neuritis and paranasal sinus diseases

Open Medicine ◽  
2011 ◽  
Vol 6 (1) ◽  
pp. 117-119 ◽  
Author(s):  
P. Čelakovský ◽  
J. Vokurka ◽  
L. Školoudík ◽  
J. Růžička
Keyword(s):  
Optic Nerve ◽  
Optic Neuritis ◽  
Paranasal Sinus ◽  
Imaging Techniques ◽  
Rare Complication ◽  
Complete Recovery ◽  
Paranasal Sinus Diseases ◽  
Immediate Surgery ◽  
Relationship Of ◽  
The Relationship

AbstractThe relationship of sinusitis and paranasal sinus mucoceles to optic neuritis (ON) remains a challenge for both the otolaryngologist and the ophthalmologist. Currently, ON is assumed to be a rare complication of paranasal sinus diseases. Three new cases of ON associated with paranasal sinus diseases are described. We postulate different pathophysiologic mechanisms of ON in our three patients: compression of optic nerve due to sphenoid mucocele in the first patient; extension of bacterial infection to the optic nerve in the second patient; and invasion of aspergillosis to the orbital apex in the third patient. We assume that the complete recovery of the patient’s vision in the second case resulted from surgery, which had been performed immediately. A timely operation could possibly have prevented permanent blindness in cases 1 and 3 as well. Optic neuritis can occasionally be a complication of bacterial and mycotic sinusitis or paranasal sinus mucoceles, especially if located in the sphenoid sinus and posterior ethmoids. The evaluation of paranasal sinuses using imaging techniques is necessary to diagnose the problem, and immediate surgery can prevent permanent sequelae in indicated cases.

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

2014 ◽  
Vol 37 (4) ◽  
pp. E19 ◽  
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.

How I do it: the endoscopic endonasal optic nerve and orbital apex decompression

2014 ◽  
Vol 156 (10) ◽  
pp. 1891-1896 ◽  
Author(s):  
Timothée Jacquesson ◽  
Lucie Abouaf ◽  
Moncef Berhouma ◽  
Emmanuel Jouanneau
Keyword(s):  
Optic Nerve ◽  
Orbital Apex ◽  
Endoscopic Endonasal

Response to: “Considerations about endoscopic endonasal optic nerve and orbital apex decompression”

2015 ◽  
Vol 157 (4) ◽  
pp. 631-632 ◽  
Author(s):  
Timothée Jacquesson ◽  
Moncef Berhouma ◽  
Emmanuel Jouanneau
Keyword(s):  
Optic Nerve ◽  
Orbital Apex ◽  
Endoscopic Endonasal

scholarly journals On the relationship of diseases of the eye and lacrimal ducts with the pathology of the nose and its accessory cavities

2021 ◽  
Vol 32 (2-3) ◽  
pp. 212-215
Author(s):  
I. Kryindel
Keyword(s):  
Optic Nerve ◽  
Nasal Cavity ◽  
Relationship Of ◽  
The Relationship

Since the nasal cavity with the paranasal cavities is anatomically and topographically closely connected with the cavity of the orbit, the optic nerve and the lacrimal ducts, it is quite clear that certain pathological processes, both in the nasal cavity and in its sinuses, very often cause diseases eyes, sometimes very serious.

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