Skip to main content
SpringerLink
Log in

How I do it: the endoscopic endonasal optic nerve and orbital apex decompression

  • How I Do it - Neurosurgical Techniques
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

ABSTRACT

Background

With the refinement of the technique, endoscopic endonasal surgery increases its field of indications. The orbital compartment is among the locations easily reached through the nostril. This anteromedial approach has been described primarily for inflammatory or traumatic diseases, with few data for tumoral diseases.

Method

Since 2010, this route has been used at our institution either for decompression or for biopsy of orbital tumoral diseases.

Findings/Conclusions

Even if further studies are warranted, this strategy proved to be beneficial for patients, with improvements in visual outcome. In this article, the authors summarize their technique and their experience with endonasal endoscopic orbital decompression.

Key points

• Nasal and sphenoidal anatomies determine the feasibility and risks for doing an efficient medial optic or orbit decompression.

• Techniques and tools used are those developed for pituitary surgery.

• A middle turbinectomy and posterior ethmoidectomy are mandatory to expose the medial wall of the orbit.

• The Onodi cell is a key marker for the optic canal and must be opened up with caution.

• The lamina papyracea is opened first with a spatula and the optic canal opened up by a gentle drilling under continuous irrigation from distal to proximal.

• Drilling might always be used under continuous irrigation to avoid overheating of the optic nerve. An ultrasonic device can be used as well.

• The nasal corridor is narrow and instruments may hide the infrared neuronavigation probe. To overcome this issue, a magnetic device could be useful.

• Doppler control could be useful to locate the ICA.

• The optic canal must be opened up from the tuberculum of the sella to the orbital apex and from the planum (anterior cranial fossa) to the lateral OCR or ICA canal

• At the end of the procedure, the optic nerve becomes frequently pulsatile, which is a good marker of decompression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Berhouma M, Messerer M, Jouanneau E (2012) Shifting paradigm in skull base surgery: Roots, current state of the art and future trends of endonasal endoscopic approaches. Rev Neurol (Paris) 168(2):121–134

    Article  CAS  Google Scholar 

  2. Berhouma M, Messerer M, Jouanneau E (2012) Occam’s razor in minimally invasive pituitary surgery: tailoring the endoscopic endonasal uninostril trans-sphenoidal approach to sella turcica. Acta Neurochir (Wien). doi:10.1007/s00701-012-1510-2

    Google Scholar 

  3. Cebula H, Lahlou A, De Battista JC, Debry C, Froelich S (2010) Endoscopic approaches to the orbit. Neurochirurgie 56(2–3):230–235

    Article  PubMed  CAS  Google Scholar 

  4. Hart CK, Theodosopoulos PV, Zimmer LA (2009) Anatomy of the optic canal: a computed tomography study of endoscopic nerve decompression. Ann Otol Rhinol Laryngol 118(12):839–844

    PubMed  Google Scholar 

  5. Jiang RS, Hsu CY, Shen BH (2001) Endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy. Rhinology 39(2):71–74

    PubMed  CAS  Google Scholar 

  6. Locatelli M, Caroli M, Pluderi M, Motta F, Gaini SM, Tschabitscher M, Scarone P (2011) Endoscopic transsphenoidal optic nerve decompression: an anatomical study. Surg Radiol Anat 33(3):257–262

    Article  PubMed  Google Scholar 

  7. Mariniello G, Bonavolontà G, Tranfa F, Maiuri F (2013) Management of the optic canal invasion and visual outcome in spheno-orbital meningiomas. Clin Neurol Neurosurg 115(9):1615–1620

    Article  PubMed  Google Scholar 

  8. Michel O, Oberländer N, Neugebauer P, Neugebauer A, Rüssmann W (2001) Follow-up of transnasal orbital decompression in severe Graves’ ophthalmopathy. Ophthalmology 108(2):400–404

    Article  PubMed  CAS  Google Scholar 

  9. Netuka D, Masopust V, Belšán T, Profantová N, Beneš V (2013) Endoscopic endonasal resection of medial orbital lesions with intraoperative MRI. Acta Neurochir (Wien) 155(3):455–461

    Article  Google Scholar 

  10. Sia DIT, Chan WO, Wormald PJ, Davis G, Selva D (2012) Decompression of benign orbital apex lesion via medial endoscopic approach. Orbit 31(5):344–346

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Skull Base Surgery Unit – Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical Hospital – Hospices Civils de Lyon, Lyon, France

    Timothée Jacquesson, Moncef Berhouma & Emmanuel Jouanneau

  2. Research and Education Unit of Medicine, Claude Bernard University Lyon 1, Lyon, France

    Timothée Jacquesson & Emmanuel Jouanneau

  3. Department of Neuro-ophthalmology (Pr A Vighetto), Pierre Wertheimer Neurological and Neurosurgical Hospital – Hospices Civils de Lyon, Lyon, France

    Lucie Abouaf

  4. INSERM U1028, CNRS UMR5292, Neurosciences Research Center of Lyon, Neuro-oncology and Neuro-inflammation team, Lyon, France

    Emmanuel Jouanneau

  5. Skull Base Surgery Unit – Department of Neurosurgery A, Pierre Wertheimer Neurological and Neurosurgical Hospital – Hospices Civils de Lyon, 59 Boulevard Pinel, 69394, Lyon, Cedex 03, France

    Timothée Jacquesson

Authors
  1. Timothée Jacquesson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucie Abouaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moncef Berhouma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emmanuel Jouanneau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothée Jacquesson.

Electronic supplementary material

Below is the link to the electronic supplementary material.

(MP4 240623 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jacquesson, T., Abouaf, L., Berhouma, M. et al. How I do it: the endoscopic endonasal optic nerve and orbital apex decompression. Acta Neurochir 156, 1891–1896 (2014). https://doi.org/10.1007/s00701-014-2199-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-014-2199-1

Keywords

Search

Navigation