Endoscopic Optic Nerve Decompression

Abstract

Traditionally, optic nerve decompression was performed via craniotomy, extranasal transethmoidal, transorbital, transantral, and intranasal microscopic approaches. Nowadays, transnasal endoscopic approach has been preferred for optic nerve decompression because this surgical approach provides excellent visualization, decreased morbidity by avoidance of external surgeries, preservation of important structures like olfaction, or developing teeth in children. Although this surgery is performed most frequently for post-traumatic optic neuropathy, compression on optic nerve from skull base tumors or fibro-osseous lesions seem most favorable indications. Indications for optic nerve decompression include traumatic optic neuropathy (TON), fibro-osseous lesions, skull base tumors, Graves’ ophthalmopathy associated with optic neuropathy, and idiopathic intracranial hypertension. TON is the most frequent indication for optic nerve decompression. TON means acute injury to the optic nerve due to craniofacial trauma. Approximately, 5% of severe head injuries affect some part of visual tract. Up to 1.5% cases of them have TON. The most common cause of optic neuropathy in pediatric age group is falls, whereas it is motor vehicle accidents in adults [6]. Otolaryngol Clin North Am. 44:903–22, 2011. Although it is not a common issue, TON should be evaluated in all cases of head injuries due to its devastating morbidity for the patient. In this chapter, we aimed to focus on the indications, surgical technique, and complications of endoscopic optic nerve decompression. Also we aimed to discuss controversial subjects as decision-making or timing of the surgical intervention.