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Trans-ethmoidal optic nerve decompression

D A Tandon1, A Thakar, A K Mahapatra

  • 1Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi.

Clinical Otolaryngology and Allied Sciences
|April 1, 1994
PubMed
Summary
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Blunt head injuries can cause vision loss. While steroids help some patients, optic nerve decompression surgery significantly improves outcomes for those with unsatisfactory results, enhancing recovery rates.

Area of Science:

  • Ophthalmology
  • Neurosurgery
  • Trauma Care

Background:

  • Blunt head trauma frequently leads to visual impairment.
  • Optimal treatment strategies for indirect optic nerve injury remain debated.
  • Vision loss is often the sole neurological deficit following closed head trauma.

Purpose of the Study:

  • To evaluate the efficacy of steroid treatment and surgical optic nerve decompression for vision loss due to blunt head injury.
  • To compare outcomes between conservative steroid treatment and combined steroid-decompression therapy.
  • To identify prognostic factors for visual recovery in patients with traumatic optic neuropathy.

Main Methods:

  • A cohort of 111 patients with indirect optic nerve injury from closed head trauma was treated over five years (1987-1991).

Related Experiment Videos

  • Group A (66 patients) received initial high-dose prednisolone (80 mg/day for 3 weeks), with subsequent transethmoidal optic nerve decompression for non-responders.
  • Group B (45 patients) served as a control, receiving only prednisolone treatment.

    • Main Results:

    • Overall improvement in Group A (steroids + decompression) was 74.2% (48/66 patients improved).
    • Steroid treatment alone resulted in improvement for 27/66 patients in Group A (approx. 41%).
    • The control Group B (steroids only) showed an overall improvement rate of 51% (23/45 patients).

    Conclusions:

    • Optic nerve decompression significantly improves recovery rates in patients with indirect optic nerve injury unresponsive to initial steroid therapy (P < 0.05).
    • Approximately half of patients may improve with steroids alone, but surgical intervention enhances overall outcomes.
    • Poor prognostic indicators include complete vision loss unresponsive to steroids, absent visual evoked response waveforms, and optic canal fractures.