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Optic Nerve Decompression through a Supraorbital Approach.

Luigi Rigante¹, Alexander I Evins², Luigi V Berra³

¹Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States ; Neurosurgery Institute, Catholic University School of Medicine, Rome, Italy.

Journal of Neurological Surgery. Part B, Skull Base

|July 31, 2015

Summary

This study introduces a supraorbital minicraniotomy for optic nerve decompression, offering a minimally invasive surgical option. This technique provides a favorable cosmetic outcome and a shorter learning curve for optic nerve decompression procedures.

Keywords:

decompression minimally invasive optic nerve optic neuropathy supraorbital approach

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Area of Science:

Neurosurgery
Ophthalmology
Surgical Anatomy

Background:

Optic nerve (ON) decompression is crucial for conditions like posttraumatic or compressive optic neuropathy.
Extended surgical approaches for ON decompression can involve longer operative times and less favorable cosmetic outcomes.

Purpose of the Study:

To present a stepwise supraorbital minicraniotomy technique for optic nerve (ON) decompression.
To describe the surgical anatomy of the ON through this approach.
To discuss the clinical applications and advantages of the supraorbital approach.

Main Methods:

Supraorbital approaches were performed on 10 cadaveric heads (20 sides).
A 3.5-cm skin incision was made along the supraciliary arch, followed by a 2x3 cm bone flap creation.
Extradural dissections achieved 180-degree unroofing of the optic nerve (ON) and optic canal (OC).

Main Results:

The supraorbital minicraniotomy provided clear visualization of surgical landmarks, including the anterior clinoid process.
Adequate drilling of the optic canal (OC) roof was achieved with a comfortable working angle.
A 25-degree contralateral head rotation enhanced visualization of the optic nerve (ON).

Conclusions:

The supraorbital approach is a minimally invasive and cosmetically favorable alternative for optic nerve (ON) decompression.
This technique is suitable for managing ON compression from skull base pathologies affecting the optic canal (OC).
The approach offers a relatively short learning curve for neurosurgeons.