Extracranial optic canal decompression: indications and technique

Optic canal decompression may be beneficial in cases of indirect optic nerve trauma, with or without canal fracture. Although no definitive data exist to clarify its role, several clinical series have reported on optic canal decompression for the treatment of intracanalicular optic nerve trauma, providing only limited information of the details of the procedure. We describe extradural optic canal decompression using a transethmoidal/transorbital approach. Removal of > 180 degrees of the bony canal is possible with this method. The technique can be accomplished by orbital surgeons familiar with orbital apical anatomy and orbital microsurgery. Experience with cadaver dissection of the orbital apex and cadaver surgery may be useful in that it provides confidence for the surgeon operating in this critical region. Careful exposure, microscopic visualization, delicate technique, and thorough anatomic knowledge minimize the risk of complications such as carotid artery penetration or dural laceration.