The role of endoscopic versus microsurgical techniques in optic canal decompression: a meta-analysis of randomized...

The ideal surgical technique for optic canal decompression (OCD) in cases of compressive optic neuropathy continues to be the subject of contention. Endoscopic and microsurgical OCD procedures have demonstrated encouraging outcomes; however, their comparative efficacy in enhancing visual acuity and post-op complications remains unclear. This meta-analysis thus evaluated the safety and efficacy of these methods across different circumstances.

A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. Relevant randomized controlled trials (RCTs) were identified through PubMed, Embase, Cochrane Library, Scopus, and Web of Science. Studies assessed endoscopic and microsurgical decompression techniques for compressive ocular neuropathies. Statistical analyses were conducted using RevMan 5.4. A fixed-effects model was applied due to minimal heterogeneity (I ² = 0%), and statistical significance was defined as a p-value of <0.05.

A total of seven studies (n = 194 participants) were incorporated. Endoscopic techniques demonstrated considerable enhancements in visual acuity, especially for medial canal disorders (RR = 2.01; p < 0.00001). Microsurgical techniques gave superior circumferential decompression, up to 252.8° with pterional craniotomy, in contrast to 124.6° attained with endoscopic methods. Both procedures demonstrated minimal complication rates, with no substantial variations in postoperative cerebrospinal fluid (CSF) leakage or necessity for reoperation. Funnel plots suggested negligible publication bias, and sensitivity analysis validated the strength of findings.

Both endoscopic and microsurgical techniques were effective for OCD, with endoscopic methods providing the least invasive advantages and microsurgical approaches excelling in complex diseases necessitating considerable decompression.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251078576.