Standardized Endoscopic Optic Nerve Decompression: A Comprehensive Radiological and Anatomical Study

Area of Science:

• Neurosurgery
• Ophthalmology
• Medical Imaging

Background:

• Endoscopic optic nerve decompression (EOND) indications are expanding, but a lack of standardized guidelines leads to variable nerve exposure and difficulty comparing outcomes.
• Current practices for EOND lack uniformity, impacting the reliability and comparability of treatment effectiveness.

Purpose of the Study:

• To propose a standardized methodology for planning and executing endoscopic optic nerve decompression (EOND).
• To leverage radiological and anatomical data for consistent EOND procedures.

Main Methods:

• Fifteen cadaver heads underwent EOND using non-standard oblique computed tomography (CT) reconstruction planes to map the optic canal.
• Decompression targeted the posterior cranial aspect of the optic canal, aiming for 180-degree bone coverage.
• Transcranial access verified decompression adequacy post-procedure.

Main Results:

• Mean distances from decompression endpoint: 8.2 mm to orbital apex, 3.0 mm to cranial optic canal end, 0.4 mm to lateral optico-carotid recess.
• All 30 procedures demonstrated adequate decompression coverage confirmed transcranially.
• The method allowed precise, individualized planning for EOND.

Conclusions:

• Non-standard oblique CT reconstruction planes facilitate accurate, patient-specific EOND planning.
• This technique reduces the likelihood of inadequate or excessive optic nerve decompression.
• The proposed method offers a pathway to standardize optic nerve decompression extent in endoscopic procedures.