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Optic Nerve and Optic Nerve Sheath Biopsy Indications and Outcomes
Reilly A Coombs1, John J Chen, Diva R Salomão
1Departments of Ophthalmology (RAC, SAM), Mayo Clinic Health Systems, Eau Claire, Wisconsin; Departments of Opthalmology (JJC, DS, DAT, JL, JG, SAM) and Neurology (JJC, DAT), Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology (DS), Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology and Neurology (EE, MP), Mayo Clinic, Jacksonville, Florida; and Department of Ophthalmology and Neurosurgery (MD), Mayo Clinic, Scottsdale, Arizona.
Optic nerve and sheath biopsies yielded a 67% diagnostic rate for unexplained optic neuropathies. However, these procedures carry risks of permanent vision loss and other complications.
Area of Science:
- Ophthalmology
- Neurology
- Pathology
Background:
- Optic nerve and nerve sheath biopsies are performed for diagnosing various optic neuropathies.
- Understanding the diagnostic yield and potential complications is crucial for patient management.
Purpose of the Study:
- To evaluate the clinical presentation, diagnostic yield, and outcomes of optic nerve and nerve sheath biopsies.
- To determine the effectiveness and risks associated with these biopsy procedures.
Main Methods:
- Retrospective review of 72 patients who underwent optic nerve or optic nerve sheath biopsy between 2000 and 2023.
- Analysis of patient data including clinical presentation, biopsy site, surgical approach, diagnoses, and post-biopsy outcomes.
Main Results:
- A diagnostic yield of 67% was achieved, with optic nerve biopsies (81%) performing better than nerve sheath biopsies (55%).
- Common diagnoses included meningioma (32%), glioma (13%), and sarcoidosis (8%).
- Post-biopsy complications occurred in 18% of patients, including vision loss and strabismus.
Conclusions:
- Optic nerve and nerve sheath biopsies offer a 67% diagnostic yield for unexplained optic neuropathies.
- The diagnostic benefits must be weighed against the risk of permanent postsurgical complications, including vision loss.
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