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[Microsurgical endonasal decompression in traumatic and neoplastic optic nerve compression]
W E Lieb1, J Maurer, W Müller-Forell
1Augenklinik, Johannes-Gutenberg-Universität, Mainz.
Summary
Surgical decompression for traumatic optic neuropathy yielded poor visual results, especially for patients with no light perception preoperatively. However, this minimally invasive approach may offer palliative benefits for vision preservation in incurable tumor cases.
Area of Science:
- Ophthalmology
- Neurosurgery
- Trauma Surgery
Context:
- Traumatic optic neuropathy (TON) treatment remains debated, with options including observation, corticosteroids, and surgical decompression.
- Transethmoidal decompression has been reported to improve vision in some TON cases.
- The transnasal microscopic approach provides effective access to the optic canal.
Purpose:
- To evaluate the effectiveness of transnasal microscopic decompression of the optic canal in patients with traumatic optic neuropathy.
- To assess visual outcomes and complications associated with this surgical intervention.
Summary:
- A retrospective analysis of 15 patients (13 men, 2 women) who underwent transnasal optic canal decompression between 1989 and 1994.
- Thirteen patients had traumatic visual loss; two had tumors.
- Postoperative monitoring included visual acuity, pupillary reaction, visual field, and optic nerve morphology.
Impact:
- Overall visual results were poor, with no improvement in patients presenting with no light perception (NLP).
- Minor visual improvements were observed in patients with initial vision of 20/200 or less.
- Dramatic improvements were noted in patients with neoplastic optic nerve compression, suggesting a palliative role for decompression in such cases.