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Endoscopic endonasal intracanalicular optic nerve decompression: how I do it.

Ivan Cabrilo¹, Neil L Dorward²

¹Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK. iv.cabrilo@gmail.com.

Acta Neurochirurgica

|July 21, 2020

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Endoscopic endonasal approach offers a safe and effective method for optic nerve decompression in non-traumatic optic neuropathy. This minimally invasive technique provides excellent access and should be considered an alternative to traditional transcranial surgeries.

Area of Science:

Neurosurgery
Ophthalmology
Endoscopic Skull Base Surgery

Background:

The endoscopic endonasal approach (EEA) is suitable for managing non-traumatic optic neuropathy.
Its adoption is limited, with transcranial approaches often preferred.
This highlights a need for wider reporting and consideration of EEA.

Purpose of the Study:

To describe the endoscopic endonasal approach for optic nerve decompression.
To evaluate its feasibility and potential as an alternative to transcranial methods.

Main Methods:

The optic canal is accessed endoscopically via a transsphenoidal route through the contralateral nostril.
An irrigated diamond drill is used to open the inferomedial wall of the optic canal.
Neuronavigation ensures precise anatomical orientation during the procedure.

Keywords:

Skull base surgery;Endoscopic endonasal approach;Transsphenoidal approach;Tumours of optic nerve sheath;Neuronavigation;Minimally invasive

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Main Results:

The EEA provides rapid and straightforward access to the inferomedial optic canal and nerve.
This technique demonstrates low morbidity rates for optic nerve decompression.

Conclusions:

Endoscopic endonasal optic nerve decompression is a viable alternative to transcranial approaches.
The technique offers significant advantages in terms of access and safety for specific indications.